Alireza Jeddian | University of Birmingham (original) (raw)

Papers by Alireza Jeddian

Human psychopharmacology, Jul 18, 2017

To evaluate the efficacy and safety of cilostazol, a selective inhibitor of phosphodiesterase III... more To evaluate the efficacy and safety of cilostazol, a selective inhibitor of phosphodiesterase III, as an adjunctive to risperidone in alleviating the negative symptoms of schizophrenia. Eighty-four in-patients with diagnosis of chronic schizophrenia participated in a randomized, placebo-controlled trial and underwent 8 weeks of treatment with either cilostazol (50 mg twice a day) or placebo as an adjuvant to risperidone. Participants were assessed using the positive and negative syndrome scale (PANSS) at baseline and at weeks 2, 4, 6, and 8. The primary outcome measure of the trial was to evaluate the efficacy of cilostazol compared to placebo in improving the PANSS negative subscale score. General linear model repeated measures demonstrated significant effect for time × treatment interaction on negative subscale scores (p < .001) and PANSS total (p = .006) but did not demonstrate significant effect on the PANSS positive (p = .37) and general (p = .06) subscales. Frequency of adv...

DOAJ (DOAJ: Directory of Open Access Journals), 2013

Background: Today, hematopoietic stem cells transplantation (HSCT) has been accepted as a therape... more Background: Today, hematopoietic stem cells transplantation (HSCT) has been accepted as a therapeutic approach and is widely applied in many patients with disorders of hematopoietic systems or patients with malignancies. Concomitant use of this therapeutic approach with long term chemotherapeutic procedures and hospitalization requires special care. This study was conducted to examine basic needs of patients after HSCT. Methods: In this study, 171 hospitalized patients were selected after transplantation, using convenience sampling method. They completed a questionnaire formulated on the basis of Yura and Walsh Theory of Basic Needs. Results: Most of the needs reported in the areas of vital functions, functional health status, and reaction to functional health status were chills (76.8%), insomnia (68.5%), and dissatisfaction with changes of lifestyle/habits (53.6%), respectively. Furthermore, 94.1% of the patients were aware of their disease. Conclusion: This study identified a broad spectrum of the needs in HSCT patients. Given the importance of determining needs to reach thorough nursing care, paying attention to the provided list can facilitate the achievement of the goals of the care program for these patients.

Figure S2. The map depicting Iran provincial divisions in 1995 (The two-letter codes in the figur... more Figure S2. The map depicting Iran provincial divisions in 1995 (The two-letter codes in the figure are Hierarchical Administrative Subdivision Codes (HASC) of Iranian provinces from which â IR.â has been eliminated in order to avoid repetition. The full names of provinces are presented in the following table). (JPG 4615 kb)

Table S1. Mean values of mortality rates and covariates for 25 provinces of Iran, 1995â 2004 and ... more Table S1. Mean values of mortality rates and covariates for 25 provinces of Iran, 1995â 2004 and 2005â 2011. Values are shown in number of deaths per 1,000 live births and are presented as number (standard error). Years of schooling takes values between 0 and 30. Sex ratio is the number of males in the population divided by the number of females. Data from 2007 were excluded from the study due to inaccuracy. Data are extracted from the vital horoscopes study. (DOCX 20 kb)

Figure S1. Behvarz density at the national level, reflecting the inconsistency in the data for 20... more Figure S1. Behvarz density at the national level, reflecting the inconsistency in the data for 2007. (TIF 279 kb)

Background: This study explored the state of hematopoietic stem cell transplantation (HSCT) recip... more Background: This study explored the state of hematopoietic stem cell transplantation (HSCT) recipient patients and problems experienced by them and nurse about these state and problems, in Iran. Methods: Qualitative content analysis was used for analyzing semi-structured interviews with 12 HSCT recipient patients and 18 nurses. Results: Three main categories described the HSCT state and problems: shadow of death, living with uncertainty, and immersion in problems. Patients treated with risk variety in continuity with probability of death. The patients lived with uncertainty. Consequently these resulted immersion in problems with four sub-categories including: (a) Physical problems, (b) money worries, (c) life disturbances, and (d) emotional strain. Conclusion: HSCT patients live in a state of limbo between life and death with multidimensional problems. Establish centers for supporting and educating of patients and their families, education of health care

Archives of Iranian medicine, 2016

INTRODUCTION The number of acutely ill patients has risen in general wards due to the aging popul... more INTRODUCTION The number of acutely ill patients has risen in general wards due to the aging population, more advanced and complicated therapeutic methods, economic changes in the health system, therapeutic choices and shortage of intensive care unit beds. This may lead to adverse events and outcomes with catastrophic results. The purpose of this study was to describe the conditions of acutely ill patients, from the perspective of caregivers. METHODS The study was conducted in Tehran University of Medical Sciences and its two affiliated general teaching hospitals. Ten nurses and physicians participated in interviews, which were analyzed using qualitative content analysis methods. RESULTS Four main categories of difficulties in caring for acutely ill patients in general wards were described: problems in identifying acutely ill patients, problems in clinical management of acutely ill patients, inappropriate use of Intensive Care Unit (ICU) beds, and poor structure for mortality control...

Population Health Metrics, 2017

Background: The rural family physician program and social protection scheme were started in Iran ... more Background: The rural family physician program and social protection scheme were started in Iran about 10 years ago, and no comprehensive study has been carried out to investigate the effects of this program on mortalityrelated health indicators yet. The present study aims to examine the impacts of implementation of the family physician program and rural insurance program, which was launched in June 2005, on neonatal (NMR), infant (IMR), and under-5-year (U5MR) mortality rates in rural areas of Iran between 1995 and 2011, using a time-series analysis. Methods: Three segmented regression models were built to evaluate the effects of the program on NMR, IMR, and U5MR, and several independent variables were entered into the models, including annual incremental effect of the program (variable of interest), time effect, behvarz density, effect of the family physician and rural insurance programs, as well as socioeconomic variables including years of schooling, wealth index, sex ratio, and logarithmic scales of rural population size in each area. Data were gathered from secondary sources and other studies. Data pertaining to the year 2007 were excluded from the final analysis due to their inaccuracy. Results: Our results show that the incremental effect of implementing the rural family physician program is associated with significant reductions in NMR (β = − 0.341. p − value = 0.003) and IMR (β = − 0.016. p − value = 0.009). Although the association between this effect and reductions in U5MR were evident, they were not statistically significant (β = − 0.003. p − value = 0.542). Moreover, wealth status of inhabitants was associated with reductions in NMR (β = − 0.889. p − value = 0.001), IMR (β = − 0.052. p − value < 0.001), and U5MR (β = − 0.055. p − value < 0.001) in the time period of the study. Conclusions: In this nationally representative study, we showed that implementation of the second health system reform in Iran, known as the family physician program and social protection scheme for rural inhabitants, is associated with significant reductions in NMR and IMR. However, reported reductions in U5MR were not found to be statistically associated with the launch of the program. The advantage of this study was the ability to depict a more precise picture of the outcomes of a national-level intervention.

Public Health, May 1, 2017

Objectives: Improving trauma systems in various forms has always been an important aspect of heal... more Objectives: Improving trauma systems in various forms has always been an important aspect of health policy. While several papers have reported the implementation of a structured trauma system of care, research evidence on the effectiveness of such regionalization for improvement in trauma outcome is limited. Study design: Systematic review. Method: Medline, EMbase, EconLit and Health Management Information Consortium were searched, using sensitive search terms, for interventional studies that reported a trauma regionalization system as their intervention, and compared important outcomes such as mortality and preventable deaths. At least two authors assessed eligibility for inclusion and risk of bias, and extracted data from the included studies. As meta-analysis was not possible for all studies, two controlled beforeeafter studies were included in the metaanalysis, and a narrative analysis was conducted for the other studies. Results: After title and abstract sifting, 66 papers were retrieved. After reading the full texts, a total of 24 studies from the USA, UK, Canada, Australia, and the Netherlands were included in this review. In spite of variation in study specifications, most were beforeeafter studies with a high risk of bias. Although a reduction in mortality was shown in most studies, only two studies were eligible for meta-analysis, and the results showed a significant reduction in mortality after implementation of an organized trauma system (odds ratio 0.840, 95% confidence interval 0.756e0.924; P ¼ 0.00). Conclusion: Correlation was found between a regionalized network of trauma care and a reduction in trauma-related mortality, based on studies that did not exclude the effects of other concurrent changes on observed reductions. It is recommended that more studies with robust research designs should be conducted in a more diverse range of countries to assess the effectiveness of regionalization. Despite this limitation, the present findings support the regionalization of trauma care services.

Archives of Iranian medicine, 2017

BACKGROUND Appropriate admissions and patients' length of stay are two of the most important ... more BACKGROUND Appropriate admissions and patients' length of stay are two of the most important indicators of efficient health care delivery in hospitals. Paying due attention to these indicators may lead to optimal use of hospital resources as well as provision of ambulatory services to a larger population of patients. The purpose of the current study is to quantify the rate of inappropriate hospital admissions and days of hospital stay to identify factors affecting them. METHODS Data were collected regarding admissions and length of stay of 1815 patients admitted to an educational hospital in Tehran, Iran, with a total 12,629 days of hospitalization using the Appropriateness Evaluation Protocol. A qualitative study was conducted using content analysis method by analyzing data from interviews with the hospital personnel about the factors affecting patients' length of stay. RESULTS The results indicated that the average length of stay in medical and surgical wards was 9.4 to 6....

The numbers of acutely ill patients (AIP) are admitted in general hospital wards increased. The f... more The numbers of acutely ill patients (AIP) are admitted in general hospital wards increased. The failing to identify, manage and deliver timely and optimal care to AIPs may lead to catastrophic outcomes. A qualitative study aimed to define the current state of AIPs in Iranian hospitals showed the flaws and shortcomings in the current services for identifying and managing AIPs. An evaluation study was designed to explore the potential impact of Critical Care Service (CCS) in an Iranian University Hospital. The study design was a Stepped-Wedge Cluster Randomized Controlled Trial. The study included, for each ward, an unexposed to the intervention, training, and an exposed to the intervention phase. The data was analyzed using three methods: all patients, matched randomized and before-after. The null-hypothesis was tested using the mixed effect logistic regression, linear mixed and the mixed effects models. The results showed that there are no significant differences in mortality, CPR, ...

Journal of Iranian Medical Council, 2021

Background: Patients under mechanical ventilation are at risk of ventilator-associated complicati... more Background: Patients under mechanical ventilation are at risk of ventilator-associated complications. One of these complications is lung injury due to high tidal volume. Nurses’ competence in mechanical ventilation is critical for preventing ventilator-associated complications. This study assessed the effects of feedback and education on nurses’ clinical competence in mechanical ventilation and accurate tidal volume setting. Methods: This single arm pretest-post-test interventional study was conducted in 2019 at Shariati hospital affiliated to Tehran University of Medical Sciences. Participants were 75 conveniently selected nurses. Initially, nurses’ clinical competence in mechanical ventilation and ventilator parameters of 250 patients were assessed. A mechanical ventilation -based feedback and education intervention was implemented for nurses. Finally, mechanical ventilation clinical competence of nurses and ventilator parameters of 250 new patients were assessed. Moreover, patien...

Objetivo: El objetivo de este estudio fue analizar las percepciones del personal hospitalario de ... more Objetivo: El objetivo de este estudio fue analizar las percepciones del personal hospitalario de los desafios y resultados percibidos de la implementacion de un servicio de extension de cuidados criticos. Antecedentes: Se diseno e implemento un servicio de extension de cuidados criticos dirigido por enfermeras para identificar y tratar a pacientes agudos en un gran hospital terciario de Iran. Metodos: Se realizo un analisis cualitativo de los datos de dos focus groups y siete entrevistas, utilizando tecnicas convencionales de analisis de contenido. Participo un total de 24 miembros del personal hospitalario, incluyendo los miembros del equipo de extension de cuidados criticos, medicos, enfermeras jefe de unidad y personal de unidad. Resultados: Dos categorias principales describieron los desafios percibidos para la implementacion del servicio de extension de cuidados criticos: 1) El contexto hospitalario, con cuatro subcategorias relacionadas con la escasez de personal, la inestabil...

International Journal of Hematology-Oncology and Stem Cell Research, 2013

Background This study explored the state of hematopoietic stem cell transplantation (HSCT) recipi... more Background This study explored the state of hematopoietic stem cell transplantation (HSCT) recipient patients and problems experienced by them and nurse about these state and problems, in Iran. Methods Qualitative content analysis was used for analyzing semi-structured interviews with 12 HSCT recipient patients and 18 nurses. Results Three main categories described the HSCT state and problems: shadow of death, living with uncertainty, and immersion in problems. Patients treated with risk variety in continuity with probability of death. The patients lived with uncertainty. Consequently these resulted immersion in problems with four sub-categories including: (a) Physical problems, (b) money worries, (c) life disturbances, and (d) emotional strain. Conclusion HSCT patients live in a state of limbo between life and death with multidimensional problems. Establish centers for supporting and educating of patients and their families, education of health care providers, enhancement of public...

This trial evaluates implementation of critical care outreach in a middle-income country. Materia... more This trial evaluates implementation of critical care outreach in a middle-income country. Materials and Methods Critical care outreach delivered by a team of intensive care nurses was implemented across general hospital wards in an Iranian university hospital. The order of implementation was randomised with wards stratified by predicted mortality rates. Effectiveness was evaluated using a stepped wedge cluster randomised controlled trial design, comparing outcomes between patients admitted before and after implementation. The primary outcomes were inhospital mortality and cardiopulmonary resuscitation. A nested qualitative study explored challenges to implementation and contextualised the trial outcomes. Results Between July 2010 and December 2011, 13 wards were sequentially randomised to implement the critical care outreach: 7,802 patients were admitted before implementation and 10,880 after implementation. There were 370 deaths (4.74%) among patients admitted before implementation and 384 deaths (3.53%) after implementation. Adjusting for clustering and temporal trends, the odds ratio for mortality was 1.03 (95% CI: 0.68-1.53). Results for other outcomes were broadly similar. Focus groups revealed a lack of endorsement of the intervention by management and ward nurses. Conclusions This pragmatic evaluation of critical care outreach in a middle income country did not show a reduction in mortality or other outcomes. Trial registration number IRCT201107187053N1

Background Today, hematopoietic stem cells transplantation (HSCT) has been accepted as a therapeu... more Background Today, hematopoietic stem cells transplantation (HSCT) has been accepted as a therapeutic approach and is widely applied in many patients with disorders of hematopoietic systems or patients with malignancies. Concomitant use of this therapeutic approach with long term chemotherapeutic procedures and hospitalization requires special care. This study was conducted to examine basic needs of patients after HSCT. Methods In this study, 171 hospitalized patients were selected after transplantation, using convenience sampling method. They completed a questionnaire formulated on the basis of Yura and Walsh Theory of Basic Needs. Results Most of the needs reported in the areas of vital functions, functional health status, and reaction to functional health status were chills (76.8%), insomnia (68.5%), and dissatisfaction with changes of lifestyle/habits (53.6%), respectively. Furthermore, 94.1% of the patients were aware of their disease. Conclusion This study identified a broad sp...

Background: The implementation of Family Physician Program (FPP) in Iran during the past decade, ... more Background: The implementation of Family Physician Program (FPP) in Iran during the past decade, despite of its numerous achievements, has faced many challenges. We aimed to compare the implementation and the performance of FPP in Iran with selected countries, in order to analyze those challenges and suggest potential solutions. Methods: This current descriptive-comparative study was conducted in 2015. The implementation and the performance of the FPP in Iran and six countries (Canada, Australia, United Kingdom, Denmark, United States and the Netherlands) were described and compared. The criteria for selection of these countries were the existence of well-established FFPs and ease of access to data required to conduct the research. A documentation checklist of the implementation status and FPP practice was prepared. The checklist's content validity was established by an independent 10 member expert panel, specializing in the field of Family Medicine. The conclusive checklist was...

Origins of Critical Care Outreach Services1 Currently, an ever-increasing number of acutely ill p... more Origins of Critical Care Outreach Services1 Currently, an ever-increasing number of acutely ill patients, whose critical and unstable conditions are life-threatening, are being admitted to medical and surgical wards in hospitals (1). This is the result of the aging of populations worldwide (2), invention and development of more sophisticated therapy modalities, novel technologies, and emerging diseases (3). On the other hand, since intensive care beds are not available in sufficient numbers, healthcare staffs encounter patients with unstable clinical conditions that require varying levels of critical care on a daily basis in general wards (4). Admission of acutely ill patients to general wards is associated with higher rates of morbidity and suboptimal care. Suboptimal care leading to patient mortality is recognized in hospitals worldwide as a major problem requiring particular attention. Some studies suggest that many cases of intensive care unit (ICU) admission are the result of i...

International Journal of Preventive Medicine

The present study describes the burden of occupational diseases in Iran based on the results of t... more The present study describes the burden of occupational diseases in Iran based on the results of the Global Burden of Disease study conducted in 2010 (GBD 2010). This study aimed to determine the burden of occupational diseases in Iran based on the results of GBD 2010. It is a cross-sectional study. Disability-adjusted life years (DALYs) of occupational diseases were calculated based on the prevalence rates obtained through model estimation, as well as GBD 2010 disability weights and mortality rates obtained from different data registry systems of Iran. Causal association criteria application to select risk outcome pairs, estimation of exposure to each risk factor in the population, estimation of etiological effect size, selection of a counterfactual exposure distribution, risk assessment, and identification of burden attributable to each risk factor were the main conducted statistical steps. There was an increasing trend of DALYs (710.08/100,000 people in 1990 and 833.00/100,000 people in 2005) followed by a slight decrease (833.00/100,000 in 2005-784.55/100,000 people in 2010). A total of 50.4% and 36% of total DALYs per 100,000 people were due to the adverse effects of musculoskeletal disorders and work-related injuries, respectively. Musculoskeletal disorders and work-related injuries are the most important adverse consequences of work-related risks that require urgent interventions to be controlled. Male workers (15-25 years and over 60) with the highest DALYs and mortality rates need more training programs, safety regulations, and higher level of protection support. In spite the decreasing trend of occupational disease related DALYs and death rates in Iran in recent years, a long-term effort is required to maintain the currently decreasing trend.