Health Technology Assessment in Action

An Observational Study on The Role of Magnetic Resonance Imaging in The Evaluation of Soft Tissue Tumors with Histopathological Correlation at Tertiary Care Centre

Mon, 28 Oct 2024 08:46:20 +0330

Background: The primary aim of this study is to evaluate the role of magnetic resonance imaging (MRI) in the assessment of soft tissue tumors with histopathological correlation at a tertiary care center.
Methods: An observational study was conducted on 75 patients (n = 75) in the Department of Radiodiagnosis over 18 months. The targeted population comprised patients who presented to the Radiodiagnosis Department for radiological imaging of soft tissue tumors.
Results: Out of 75 cases, 20% were found to have benign tumors, while 80% were found to have malignant tumors. The most frequent benign tumor was fibromatosis, with n = 10 cases (13.33%), and the most common malignant tumor was synovial sarcoma, with n = 14 cases (18.66%). The benign age group ranged from 11 to 20 years. T2-weighted heterogeneous hyperintensity was noted more frequently in malignant lesions, demonstrating a high positive predictive value; that is, 83% of malignant tumors exhibited changes on diffusion-weighted imaging/ apparent diffusion co efficient (DWI/ADC). Low-grade malignant lesions showed no restrictions. Most benign lesions displayed restrictions, with a high positive predictive value of 98.14%, specificity of 93.33%, and sensitivity of 88.33%.
Conclusions: Soft tissue tumors can be detected and locally staged using MRI; thus, this technique has proven its value. Intralesional hemorrhage and calcification are two parameters that have been shown to have no substantial association with cancer. Due to its high sensitivity, MRI is a viable option for evaluating soft tissue tumors.

The Effects of High-Intensity Interval Training with Different Duration on Fibrinogen and Plasma Viscosity in Sedentary Male College Students

Mon, 28 Oct 2024 07:40:31 +0330

Background: There have been few investigations into the impact of high-intensity interval training on blood rheology.
Objectives: This study aimed to evaluate how high-intensity interval training conducted with different duration affects fibrinogen and plasma viscosity in sedentary young college men.
Methods: For this study, 36 healthy male participants were selected and grouped based on their individual characteristics. The groups included a control group (n = 9), a 45-second training group (tr-45; n = 9), a 30-second training group (tr-30; n = 9), and a 15-second training group (tr-15; n = 9). The training regimen comprised six sessions over two weeks, with varying sets (4, 5, 6, 6, 7, 4 respectively) and durations
of 15, 30, and 45 seconds for different groups. There was a fixed 4-minute rest interval between each set, with a consistent load of 0.6 on the Wingate cycle ergometer. Blood samples were collected 48 hours before and after the final session to analyze fibrinogen and plasma viscosity levels.
Results: There were no significant differences between groups in plasma fibrinogen levels (F3, 32 = 2.303, P = 0.96). However, post-test analysis revealed a significant decrease in plasma fibrinogen in the tr-45 group (P = 0.027) compared to pre-test levels. Plasma viscosity did not significantly change between groups (F3, 32 = 0.651, P = 0.058), but there was a significant interaction between time and group (F3, 40= 4.43, P = 0.009). Post-test analysis showed a significant decrease in plasma viscosity in the tr-45 (P = 0.010), tr-30 (P = 0.002), and tr-15 (P =
0.003) groups, while it significantly increased in the control group (P = 0.004) compared to pre-test levels.
Conclusions: The findings suggest that high-intensity interval training can effectively decrease blood rheology and factors such as fibrinogen and plasma viscosity, with the 45-second HIIT being more efficient. Therefore, incorporating this training into Physical Activity Programs could be beneficial for inactive men.

Investigating the Comparative Effectiveness of Yoga and Relaxation Therapy on Restlessness, Fatigue and Difficulty Concentrating in Multiple Sclerosis Patients

Abdullah Azhdari, Neda Mardani, Marym Javanbakht, Tahereh Mombeni, Melika Ahmadi — Mon, 28 Oct 2024 07:33:49 +0330

Background: Multiple sclerosis (MS) is a long-term autoimmune disorder affecting the central nervous system, leading to reduced quality of life and impaired physical and psychological functions.
Objectives: This study aims to examine the relative efficacy of yoga and relaxation therapy in improving sleep disturbances, fatigue, and cognitive impairment among individuals diagnosed with MS.
Methods: This study employed a semi-experimental research design, including a pre-test, post-test, and follow-up over three months. The target population comprised all MS patients referred to the Iranian MS Association in Tehran between July and November 2023. Sixty participants were selected using purposive sampling and randomly assigned to research groups: Two yoga therapy groups with 17 participants each, a relaxation therapy group with 16 participants, and a control group with 18 participants. The yoga therapy group participated in twelve 90-minute sessions twice a week, while the control group received no intervention and was placed on a waiting list. Various tools, including the Multidimensional Fatigue Inventory (MFI), Cohen-Mansfield Agitation Inventory (CMAI-O), and a concentration skills questionnaire, were used to collect data. The data were analyzed using ANOVA, Bonferroni post hoc test, MANCOVA, and Kruskal-Wallis H tests with a significance level of 0.05, utilizing SPSS 27 software.
Results: The study found a significant difference (P < 0.001) in the restlessness factor in both the post-test and follow-up phases. Additionally, there was a significant difference (P < 0.001) in the levels of physical fatigue, mental fatigue, decreased activity, and decreased motivation in both the post-test and follow-up phases, indicating significant changes in the fatigue factor among the research groups. However, there was no significant difference in the general fatigue component between the research groups. A significant difference (P < 0.001) was also found in the concentration factor, particularly in the components of voluntary and involuntary concentration, during both the post-test and follow-up stages.
Conclusions: The results of this study indicate that both yoga and relaxation therapy techniques significantly reduce restlessness, physical tiredness, mental fatigue, decreased activity, and decreased motivation. Furthermore, the findings validate that both yoga and relaxation therapy techniques effectively enhance voluntary and involuntary concentration.

Laparotomy versus laparoscopy cholecystectomy for surgical treatment in patients with gallstone disease: a comparative cost-effectiveness analysis

Mon, 28 Oct 2024 00:00:00 +0330

Background: Due to the increasing costs of the health system and limited financial resources, healthcare policymakers should apply more cost-effective strategies. This study aimed to compare the cost-effectiveness of laparotomy cholecystectomy with laparoscopy.

Methods: This economic evaluation was performed on patients with cholecystitis who were candidate for surgery in a private hospital in Ahvaz, in 2021. Data collection tools consisted of 4 parts: 1) demographic information checklist; 2) clinical information checklist; 3) cost checklist and 4) effectiveness assessment tool. We used SPSS₂₂ and STATA_14.2 for data analysis. One-way sensitivity analysis and Tornado diagrams were performed using Tree Age software.

Results: The mean total effectiveness score in patients treated with laparoscopy 83.44 (SD = 11.34) was higher than those treated with laparotomy 68.39 (SD = 13.61). This difference was statistically significant in all effectiveness criteria except for postoperative infection dimensions and length of operation (P-value <0.001). The mean cost in patients undergoing laparoscopy was significantly higher than those undergoing laparotomy (481.43 $ VS 459.49 $), but overall laparoscopic treatment (5.77) was more cost-effective than laparotomy (6.71). The cost-effectiveness of the laparoscopic procedure was approximately 1.47 $ per effectiveness unit cheaper than laparotomy, according to the ICER. According to one-way sensitivity analysis, the laparotomy method was still more effective by changing the cost and effectiveness components.

Conclusion: Although laparoscopic cholecystectomy was more expensive than laparotomy cholecystectomy, it was generally more cost-effective. The results of this research may help Iran’s health system policymakers and managers in order to extend laparoscopic cholecystectomy in hospitals.

A Narrative Review on the Conceptual and Methodological Advancements in Digital Disruption: A Way to Improved Quality of Services in Health Care

Devika Kanade, Shailendrakumar Kale, Mamatha GS Reddy, Ankita Mathur — Tue, 22 Oct 2024 05:24:31 +0330

Background: The adoption and successful implementation of digital health solutions heavily depend on digital health literacy, which is particularly critical in the current COVID-19 era. Low levels of digital health literacy are associated with poor preventative practices, the spread of inaccurate information, vaccine hesitancy, and reduced subjective well-being. Thus, the aim of this review was to highlight areas of current scholarly interest and identify any gaps in the literature regarding conceptual and methodological advancements in digital disruption.
Methods: The authors conducted a literature search using the databases Scopus, Embase, Web of Science, PubMed, and Google Scholar, focusing on papers released between 2003 and October 2023. The following keywords were used to conduct a thorough literature search: ((digital health OR digital disruption OR digital dental health)) AND (medical health OR telemedicine)), ((online doctor OR online consultation OR online health app)) AND (COVID-19 OR pandemic)). A total of 1,244 studies were screened, including duplicates and nonEnglish research. After applying inclusion and exclusion criteria, 72 articles were selected for the review.
Results: A total of 72 articles were included in this review. The studies discussed the potential reasons for disrupted access to healthcare, which is linked to avoidable hospital admissions. Delayed care due to disruptions can lead to disease progression, the exacerbation of existing conditions, and chronic ambulatory care-sensitive conditions. Digital health innovations were presented as solutions to enhance care, reduce clinical workload, and promote independent living.
Conclusions: In conclusion, this narrative review provides a comprehensive overview of the conceptual and methodological advancements in digital technology related to healthcare. It demonstrates the potential of digital technology to revolutionize both medical and dental education.

The Strategies to Improve Primary Health Care Services: A Scoping Review

Mon, 28 Oct 2024 08:10:58 +0330

Context: Evaluation of health policies and identification of their challenges are vital for improving and implementing reforms in the healthcare system. The present study was conducted to identify interventions aimed at improving primary healthcare (PHC) services in Iran.
Evidence Acquisition: This research utilizes a scoping review to examine reform interventions in PHC services across 10 selected countries: Qatar, Oman, Turkey, Georgia, Armenia, United Arab Emirates, Saudi Arabia, Bahrain, Kazakhstan, and Kuwait. The study covers areas such as the PHC delivery system, human resource management, financial mechanisms, and the framework of community participation and intersectoral collaboration from 2010 to 2022.
Results: The main reform strategies for PHC systems in the reviewed countries included the establishment of family medical centers with nurse support as a comprehensive strategy for service provision in public health centers; providing comprehensive and quality healthcare service packages including maternal and child health, infectious disease immunization, chronic disease monitoring, and dental care services; health education; access to essential medications; improvement of electronic health services; implementation of health promotion and continuous prevention programs; capacity enhancement; and a greater focus on health screening programs and grading of healthcare centers.
Conclusions: The major findings from the reviewed countries indicate that healthcare policymakers focus on providing preventive care services, reducing maternal and child mortality, and increasing life expectancy. Programs such as referral systems, service grading, and the adoption of electronic health services are part of their reform agenda.

Principle Concepts in Futures Studies: A Narrative Review

Zahra Heydari Fard, Mohammad Reza Maleki, Hamid Pourasghari — Mon, 28 Oct 2024 08:51:27 +0330

Context: Our world is characterized by a dynamic landscape of variations, complexities, uncertainties, and ambiguities (VUCA). These elements manifest in various domains, including politics, economics, communication, information, science, and research, all of which significantly impact our lives. It is crucial for policymakers and managers to adopt a forward-thinking approach to comprehend these VUCA elements and their implications for the future. The future will undoubtedly differ from the present and the past. However, humans possess an inherent desire to understand and anticipate the future, particularly in the face of uncertainty. Therefore, exploring and understanding the future is not just a curiosity, but a necessity. Futures Studies can serve as a valuable tool in this context, enabling us to efficiently leverage opportunities and resources to navigate the chaotic environment. Review studies play a pivotal role in this process by reviewing existing work and synthesizing knowledge in a specific field. This study aims to collate findings related to the key concepts of Futures Research, thereby contributing to our collective understanding and preparation for the future.

Erratum

Sat, 09 Nov 2024 00:00:00 +0330

Erratum

Sat, 09 Nov 2024 08:20:24 +0330