The Health Technology Assessment (HTA) in action is the first journal dedicated to health technology assessment in developing countries. IR's National Institute for Health Research publishes this journal under the supervision of Tehran University of Medical Sciences (TUMS).

Journal of HTA in action is a peer-reviewed journal that aims to publish topics related to health technology assessment; it is noteworthy that HTA in action offers a fast route for publishing high-quality peer-reviewed research. The journal covers studies evaluating medical equipment, medicines, vaccines, procedures and systems developed to solve a health problem in the form of original studies, review articles, case reports, brief communications, and letters. HTA plays an important role in the process of macro and micro policy and decision making, therefore it is expected to witness an improvement in the pace, efficiency and validity of policy making via publishing HTA studies.

Current Issue

Vol 5, No 2 (2021)

Articles

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    Introduction and Aim: Lung cancer is recognized as one of the most prevalent cancers and the most important cause of cancer mortality worldwide. Given the incidence and mortality of this disease, implementing preventive interventions is necessary. In this regard, the present study has investigated the effectiveness of one of the most important interventions of lung cancer screening (using low-dose computed tomography (CT) scan (LDCT)) in high-risk individuals.

    Method: The present study is an applied study performed as a comprehensive review. To assess safety, studies on the technical specifications of CT scans and issues related to the safety of applying this device for lung cancer screening were searched and surveyed using keywords in medical databases such as PubMed, Google Scholar, etc. To evaluate the clinical effectiveness, a comprehensive review of all studies regarding health technology assessment, systematic review and meta-analysis studies, and screening guidelines around the world was performed in this regard.

    Results: After searching and reviewing the safety issue, 1982 articles were extracted and finally the results of 15 studies were used. The diagnosis of harmless tumors, false positives and performing invasive complementary interventions for them, and the possible negative effects of radiation exposure are safety discussable issues. To measure clinical effectiveness, a total of 17827 studies were found through the surveyed medical databases, and finally 16 studies entered into the final phase of analysis. Based on the synthesis of studies, the effectiveness of lung cancer screening intervention using LDCT has been found to reduce lung cancer mortality by 15% to 20% and mortality from other causes by 0% to 6%. Also, as a result of this screening, the incidence of lung cancer and its diagnosis in the early stages of the disease increase and the incidence of this disease in its upper stages decreases significantly. The findings of the clinical effectiveness survey show that performing this intervention does not create any psychological consequences in individuals’ quality of life.

    Conclusion: Lung cancer screening using LDCT in older people with a high smoking history is safer than not performing the intervention, and does not threat the health of individuals undergoing screening. The disadvantages of this screening are negligible compared to its advantages. Compared to non-intervention, this screening is more clinically effective and will lead to a statistically significant reduction in lung cancer mortality and the increase of timely diagnosis of this disease.

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    Abstract

    Introduction: Medical equipment plays a key role in diagnosis, treatment, and medical education. Outsourcing is delegating a part or all activities of an organization to a party (individuals or organizations) outside the organization, which has an important role in the organization's productivity. The current study aimed to investigate the effect of outsourcing the department of medical equipment of a university hospital in the city of Tehran by emphasizing cost and profit as well as performance.

    Method: This is a descriptive-analytical and cross-sectional study. We investigated documents and financial records of the financial office in order to obtain costs and revenue. Also, a researcher-developed questionnaire was used to evaluate the effect of outsourcing on employees' performance. A total of 36 subjects were randomly selected, following the sampling formula (the response rate was 72%). The Kolmogorov-Smirnov test was applied to test for a normal distribution. As data were not normally distributed, the Wilcoxon test was used. Also, t-test and ANOVA were used to study the difference in the effect of outsourcing and age, gender, and educational level. Data were analyzed using SPSS.

    Results: According to the findings, there was a significant difference before and after outsourcing concerning the cost and revenue of the medical equipment department. Concerning the effect of outsourcing on the performance, "human resources factor" obtained the highest mean (3.37), which indicates the poor perspective of the staff in this aspect. Also, the lowest score was related to the "cost-effectiveness" (2.96), which is an average score. We found weak scores concerning dimensions of management (3.28) and quality of services (3.36).

    Conclusion: Considering the importance of staff in the hospital, it is necessary to pay serious attention to the impact of different types of reforms intended to increase the revenue and reducing the costs of hospitals on the staff of the organization by emphasizing managerial and human resources dimensions, which not only will increase the efficiency of the organization and satisfaction of the staff, but also translates into better quality.

    Keywords: Outsourcing, Medical Equipment Department, Cost and Profit, Performance.

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    Background: The aim of this study was to investigate the satisfaction of professors with the short-term course (fellowship) of medical education in Birjand University of Medical Sciences in the Covid 19 pandemic. The results of this study can be used to plan training courses in person and virtually in post-Corona era.

    Methods: Initially, needs assessment was conducted for the content of the course, after determining the content, the course was held online through Adobe Connect system and offline through Navid system. Following completing the course, evaluation was done and finally satisfaction with the course assessed based on the questionnaire of 34 items confirmed validity and reliability. The data were analyzed by SPSS software version 18 , using t-test and correlation coefficient.

    Results: The mean age of participants was 36.34 with a standard deviation of 5.64 years, 56.8% (25 people) were female and 43.2% (19 people) were male. In terms of academic rank, 75% were assistant professors. The average score of satisfaction is equal to 140.48, which indicates a high score of satisfaction with the course. Also, in general, the score of satisfaction is higher than average, in all fields. The average score of satisfaction in men is significantly lower than women. There was no significant relationship between degree, academic rank, age and work experience with satisfaction.

    Conclusion: Totally, professors' satisfaction with the online and offline medical education fellowship course in the relevant systems is at a high level, so it is suggested that in the post-corona era, combined empowerment courses in person and online should be held.

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    Introduction: Fire is one of the potential dangers that threaten human activities more and more. Given that, this study will seek to introduce the factors preventing the spread of fire in hospitals to policymakers through prioritization based on applied mathematics modeling.

    Methods: This study consisted of two stages. In the first stage, first through a comprehensive review of studies, factors preventing the spread of fire were identified, and then in the second stage, based on experts' opinions, the attributes affecting selection prioritization, their weights were determined and finally, based on the simple additive weighting (SAW) model the final prioritization was done for 5 types of hospital buildings.

    Results: On the base of literature review and expert opinions, 7 factors and 4 attributes were identified. The most important factors were following as; "use of safety architecture and equipping appropriate emergency exit accesses according to the standard" in high-rise hospitals; "continuous training of firefighters" in wide hospitals; "use of fire extinguishing systems (automatic and manual)" in subsurface hospitals; "the use of fire extinguishing systems (automatic and manual)" in combined hospitals, and "continuous training of personnel firefighters" in portable hospitals.

    Conclusion: Fire safety is not limited to the installation of a manual fire extinguisher, but for fire safety, especially in hospitals, all aspects should be considered, including the architectural form of the building, how the materials and equipment in the building caught fire, fire behavior in terms of heat transfer methods, the amount of firefighting training of the personnel, recognition and application of modern and ready-made equipment for smoke ventilation systems and fire products, automatic and manual fire alarm and extinguishing systems to prevent the spread of fire.

    Keywords: Hospital, Inhibitors, Fire, Safety

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    Background and Aim: Performance evaluation in facilitating organizational effectiveness is considered as an important task of human resources management which depends on the employment status of employees. The present study aimed to investigate the relationship of organizational performance to employment status and shift work of nurses in Shahid Rahnemoun Hospital.

    Method: This descriptive-analytical study was conducted in 2018. The study population included nurses of Shahid Rahnemoun Hospital, and the study sample consisted of 151 nurses who were entered into the study by census. The instrument used in this study was a standard questionnaire whose content validity was confirmed by 3 experts, and its reliability was approved by Cronbach's alpha coefficient. Data analysis was performed using SPSS.19 software through independent t-test, one-way analysis of variance (ANOVA), and one-sample t-test.

    Results: Among the 4 components surveyed in this study, the highest mean and standard deviation were related to the dimension of participation and cooperation (4.35±0.48) and the lowest mean and standard deviation were related to infection control and prevention (4.21±0.60). The total performance and the two dimensions of care and treatment practices and participation and cooperation were significantly associated with employment status (P <0.05).

    Conclusion: According to the results, it can be concluded that nurses’ employment type, of any type, will definitely affect organizational performance and in an organization where employees are more likely to survive, consider their organization as a safe place, and feel job security, they will also feel themselves committed to that organization and will perform their duties better and with more motivation and satisfaction.

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    Abstract

    Subject: The needs and wants of patients as one of the pillars of marketing in the health field required the right tools to identify the consumer's requests. This research was conducted in order to design an appropriate tool based on the 7 Ps model to evaluate the factors affecting the behavior of using services in the customers referring to diabetes units.

    Methods: The study conducted in three steps. The first steps included definition of the concept, determination of the items, and characteristics of the instrument. In the step of concept definition, through literature review, the items were identified and arranged in the form of a questionnaire. Then, using the opinions of professionals and diabetics, the identified items were reviewed. In the third step, the validity and reliability of the instrument were confirmed using CVI, CVR, ICC and Cronbach's alpha.

    Results: according to the results of the first and second phase of the study, the initial 46-itmes questionnaire was provided. After determining the formal and content validity quantitatively and qualitatively, statements of the questionnaire decreased to 38.The calculated Cronbach's alpha coefficients (0.89) represents the high internal consistency of the questionnaire. The results of the reliability of the questionnaire were obtained by re-test method (0.92).

    Conclusion: Using this questionnaire helps researchers to analyze the diabetic patients' behavior and specifies the reasons for acceptance or rejection of the services of the diabetes unit by the patient. It can also be used in all centers providing care services to its diabetic patients

Review Article

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    Epilepsy is one of the problems and diseases that accompany a person for the rest of his life after diagnosis. This disease, in addition to severely affecting a person's physical condition, can also lead to psychological problems. Many patients with epilepsy suffer from psychological problems and are under the supervision of a psychiatrist and take medications to control their mental state; However, many of these people are reluctant to take other medications, including psychiatric medications, due to long-term use of the drug; Therefore, in this study, we have examined non-pharmacological treatments in psychological problems caused by epilepsy. In addition to developing epilepsy and receiving medications for the disease, these patients develop mental illnesses such as stress, depression, anxiety, and cognitive processes that require treatment; This article describes the methods of self-care in patients with epilepsy who have mental illness.

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     Context: skin and wound health a serious public health problem with high morbidity and mortality rates worldwide. Although there are different treatment options presented, there is no agreement on the best treatment for severe burns and wound problems as of yet. Stem cell therapy has a bright prospect in many preclinical studies of burn wounds. The rapid review was performed to assess the efficacy and possible mechanisms of stem cells in wound healing.

    Methods: This is a rapid review of the evidence for the potential effects of stem cell on wound healing, which intended to create a policy guide. To do so, health technology assessment studies indexed in PubMed, Scopus and Scholar on March 13, 2021 were searched using the keywords, including stem cell effects and wound healing. In addition, references of recovered studies were checked to ensure through the capture of the literature. Studies on the safety and efficacy of stem cell on wound healing, both in Persian or English, were included.

    Results: In total 92 titles were identified, which after eliminating duplicates and applying inclusion criteria, 22 were included. The overall review showed that stem cell therapy improved wound but more study is needed though it is promising. Also, studies showed using stem cell technology as a non-invasive way can be a good alternative to older treatments. Finally, Restrictions of this technology may include the need to improve cell delivery methods, cell viability, heterogeneity in the preparation of mesenchymal stem cells, and wound substrate. Further studies may be needed to determine its safety and efficiency.

    Conclusions: Evidence on the safety and efficacy of stem cell on wound were very limited to make a decision but Studies showed that stem cell technology is a good alternative to traditional therapies. These findings also demonstrate the need for considering variations in future clinical studies using stem cells to treat a burn wound in order to maximize the effectiveness.

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