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Background Acute coronary syndrome is the topmost cause of death worldwide; therefore, it is necessary to predict major adverse cardiovascular events and cardiovascular deaths in patients with acute coronary syndrome to make correct and timely clinical decisions. Objective The current review aimed to highlight algorithms and important predictor variables through examining those studies which used machine learning algorithms for predicting major adverse cardiovascular events in patients with acute coronary syndrome. Methods To predict major adverse cardiovascular events in patients with acute coronary syndrome, the preferred reporting items for scoping reviews guidelines were used. In doing so, PubMed, Embase, Web of Science, Scopus, Springer, and IEEE Xplore databases were searched for articles published between 2005 and 2021. The checklist “Quality assessment of machine learning studies” was used to assess the quality of eligible studies. The findings of the studies are presented in the form of a narrative synthesis of evidence. Results In total, among 2,558 retrieved articles, 22 studies were qualified for analysis. Major adverse cardiovascular events and mortality were predicted in 5 and 17 studies, respectively. According to the results, 14 (63.64%) studies did not perform external validation and only used registry data. The algorithms used in this study comprised, inter alia, Regression Logistic, Random Forest, Boosting Ensemble, Non-Boosting Ensemble, Decision Trees, and Naive Bayes. Multiple studies (N = 20) achieved a high area under the ROC curve between 0.8 and 0.99 in predicting mortality and major adverse cardiovascular events. The predictor variables used in these studies were divided into demographic, clinical, and therapeutic features. However, no study reported the integration of machine learning model into clinical practice. Conclusion Machine learning algorithms rendered acceptable results to predict major adverse cardiovascular events and mortality outcomes in patients with acute coronary syndrome. However, these approaches have never been integrated into clinical practice. Further research is required to develop feasible and effective machine learning prediction models to measure their potentially important implications for optimizing the quality of care in patients with acute coronary syndrome.

Background: Acute myeloid leukemia (AML) is the second common leukemia (5.18%) and the third deadliest leukemia in Iran. Moreover, it is the fifth prevalent cancer in the world, which involves 8% of all cancers. Objectives: The aim of this study was to calculate direct medical and non-medical costs of AML in 2019. Methods: The present retrospective-descriptive analysis was conducted on 192 patients with AML aged 19 to 70 years from 2016 to 2018. The data were collected from hospital records and interviews with experts. The bottom-up micro-costing approach and payer perspective was considered for cost analysis status. The relationship of affective variables was investigated, using nonparametric tests, including Mann–Whitney and Kruskal–Wallis tests. Costs were divided into costs of diagnosis, hospitalization, medication, nursing, visit and consultation, operating room, and medical supplies. The data were described by mean ± standard deviation and reported by percentage and also analyzed by SPSS 11 software. Results: According to the findings, the average age of all patients was 43.91 years and 55.7% of the patients were male. The highest and the lowest diagnostic costs were associated with laboratory tests at $1656459.48 and ultrasound charges $4229.46, respectively. The total direct medical costs per patient were $1056624.78 with an average of $4846.90 and the cost of medication included 36% of the total costs. The direct medical and non-medical costs were $10485488.48 and $487522.87, respectively Conclusions: Costs of AML treatment were estimated to be $1056624.78. Finally, it can be concluded that the cost of AML in Iran is much cheaper than that compared to other countries and also due to hidden subsidies from the public sector, the payment from the patient's pocket is very small.

Background Measuring patients’ perception from health service quality as an important element in the assessment of service quality has attracted much attention in recent years. Therefore, this study was conducted to find out how the patients evaluated service quality of clinics at teaching hospitals affiliated with Tehran University of Medical Sciences in Iran. Methods This cross-sectional study was conducted in Tehran in 2017 and 400 patients were randomly selected from four hospitals. Data were collected using a questionnaire, the validity and reliability of which were confirmed in previous study. In order to analyze the data, T-test, ANOVA, and Pearson correlation coefficient were calculated using SPSS 23. Results The results indicated that among eight dimensions of health service quality, the patients were more satisfied with physician consultation, services costs and admission process. The highest and lowest mean scores were related to physician consultation (Mean = 4.17), and waiting time (Mean = 2.64), in that order. The total mean score of service quality was 3.73 (± 0.51) out of 5. Outpatient services were assessed as good, moderate and weak by 57.5, 40 and 2.5% of the patients, respectively. There was a significant relationship between the positive perception of service quality and reason for admission, source of recommendation, gender, education level, health status, and waiting time in the clinics (p

Background: OVID-19 is a major cause of morbidity and mortality worldwide. The closure of governmental and nongovernmental centers as well as social, cultural, and economic activities are other major negative impacts of the virus. The present paper aimed to develop a model of economic and health-related factors which affect the reopening of businesses and the proper management of the effect of virus on different aspects, particularly on people’s health and economy. Methods: In order to facilitate decision-making and model risk analysis of guilds and occupations, an expert panel, including eight 8 experts, was convened by the Ministry of Health in Iran to prepare a strategic framework for the national taskforce of COVID-19 management. The panel spent many hours to prepare a simple model of reopening businesses and prioritize them from low to high risks. Results: The experts identified and weighed seven health and three economic-related factors. The businesses and jobs were classified into 69 categories based on their similarities; they were also graded according to a predefined five- point Likert scale and categorized into three levels of low, medium, and high risk. The policymakers recommended to reopen businesses stratified by risk levels at least two weeks’ intervals. Conclusion: The relaunch strategy in Iran put health and safety first while gradually reopening businesses, resuming activities, and getting people back to work. At the same time, attempts were made to slow the spread of the virus through following public health measures, social distancing, good hygiene, and continued acting responsibly. As many countries may have to deal with the same issue, this model can help them adopt appropriate policies and strategies for disease containment.

Background: In the coming years and near future, Iran will experience a main demographic transition resulting in an aging phenomenon and increased number of people over 65 years. Aging leads to increased medical expenditures associated with chronic diseases such as osteoporosis. This study aimed to investigate the patient-specific hospitalization costs of osteoporosis treatment in elderly patients. Methods: A retrospective cost analysis of hospitalization arising from osteoporosis conducted on all the elderly patients (adults aged 65 years and above) in a teaching hospital in Tehran through examining hospital admissions during 2017. The elderly patients consisted of 295 with a length of stay ≥ 24 hours. Cost analysis was performed using a bottom-up micro-costing approach and payer perspective (patient and insurer); and the result was statistically significant (p≤0.05). Nonparametric tests, including Mann–Whitney and Kruskal–Wallis tests, were used to investigate the relationship between affecting variables. Hospital training was considered as a control variable. The data were analyzed using SPSS 11 software Results: The mean age of the patients was 71.3 years; of the patients, 79% were female and 21% male. The overall crude prevalence of osteoporosis was 80% among people ≥ 65 years and 85% among patients who experienced relevant surgeries. The average cost of hospitalization was $3794.13. Also, 3 main areas of hospital costs were identified: consumables (57.70%), hoteling (17.24%), and surgical services (15.76%). The prevalence of osteoporosis was 4 times higher in women compared with men. Moreover, there were significant differences between the variables affecting hospital costs, such as gender, length of stay, diagnosis, intensive care unit services, and surgery (p

Background: The healthcare industry is increasingly growing in a competitive atmosphere. One of the essential key issues for the survival of healthcare organizations is patient satisfaction. This study aimed to investigate the impact of health service quality and demographic characteristics on patient satisfaction with outpatient departments at teaching hospitals affiliated with Tehran University of Medical Sciences in Iran.Method: This cross-sectional study was conducted in 2018. A sample of 400 patientsreferring to outpatient departments at teaching hospitalswasrandomly selected. A valid and reliable questionnaire was used to collect data which were then analyzed by using SPSS 23. Results: The mean scores of service quality and patient satisfaction were 3.73 ± 0.51 and 3.61 ± 0.97 out of 5, respectively. Moreover, patients’ demographic characteristics; age, marital status, residence area, and service quality dimensions; admission process, physician consultation, service costs, accessibility, and appointment were identified as the most effectivefactors on patient satisfaction. Conclusion: In order to increase patient satisfaction, physicians and reception staff are advised to provide patients with useful information and cost-effective services. Nonetheless,it seems necessary for teaching hospitalsto establish plans which facilitate payment, appointment, and examination process.

Background:The rising incidence of breast cancer places a financial burden on national health services and economies. The cost of breast cancer studies is constantly increasing; however, this cost is calculated based on the currency of the country in which the study takes place, therefore limiting national and international comparisons. On the other hand, there is no common method used to conduct such studies. The objective of this review is to contribute to this knowledge pool by examining the indirect costs of breast cancer in order to provide comparable estimates.Methods and analysis:This review will consider all relevant cost of illness studies dated from the year 2000 until the year 2018. Relevant papers will be identified through a systematic search in all major medical research databases. Two independent researchers will screen selected articles. Methodological quality of the studies will be assessed using a checklist designed by Stunhldreher et al. Discussion:The results will be presented in line with the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) checklist. While the costs of breast cancer studies are helpful in planning health interventions in terms of the severity of the problem and budget priorities, the results could also be of great help to policymakers and decision makers in health systems.Study registration number: PROSPERO CRD42018108392

Scaffolding is one of the key dimensions of the sociocultural theory that has been proposed in a substantial body of work as a potential metaphor for promoting second language (L2) learning. However, there is plenty of evidence that the term is misinterpreted and presents a number of epistemological problems. The first and foremost concerns the phenomenological nature of scaffolding in the sense that the original conception of the notion does not support its implication in mainstream second language acquisition (SLA) contexts. To substantiate the claim, we have proposed four underlying factors, including predictability, variability, mediation, and restructuring. The second has to do with the range of variation in the conceptual meaning of scaffolding, which normally leads to a state of confusion in the operational definition of the term in the SLA practice and research. Reviewing the texts, we have then found three fundamental points in the definitions of scaffolding, each with specific logical and methodological problems. From the above evidence, it can be argued that scaffolding is not a construct that meets the pedagogical goals of L2 learning and development. The paper then concludes that as long as the nature of scaffolding and its underpinnings in SLA are at stake, future research on the notion will most likely suffer a severe loss of pedagogical and intellectual validity.

Background Detection of small breast lesions is a challenging task for radiologists. Computer aided detection (CAD) systems are implemented to aid radiologists in detecting masses and microcalcifications. This has the potential to raise the level of sensitivity in breast cancer detection. Objectives To evaluate a new system to detect suggestions of suspicious small lesions. Methods Small samples were extracted from different tissue types. Texture features were calculated, and the best features were selected using Waikato Environment for Knowledge Analysis (WEKA) software. Subsequently, 7 selected features were used to form a decision tree. To reduce false negative cases, fuzzy logic was used. In the implementation phase, input images were divided into 8 pixel ´ 8 pixel tiles. For each tile, all selected features were computed as fuzzy inputs. Results To evaluate the technique, the suggested system was applied to 326 images obtained from the National Cancer Society of Malaysia. Based on this application, results showed that the suggested system has an acceptable sensitivity of 85.6% and specificity of 90.7%. Conclusions The fuzzy system is a promising technique for early detection of breast cancer.

Background Prolonged use of computers can lead to complications such as eye strain, eye and head aches, double and blurred vision, tired eyes, irritation, burning and itching eyes, eye redness, light sensitivity, dry eyes, muscle strains, and other problems. Objectives The aim of the present study was to evaluate visual problems and major symptoms, and their associations among computer users, aged between 11 and 18 years old, residing in the Qazvin city of Iran, during year 2010. Patients and Methods This cross-sectional study was done on 642 secondary to pre university students who had referred to the eye clinic of Buali hospital of Qazvin during year 2013. A questionnaire consisting of demographic information and 26 questions on visual effects of the computer was used to gather information. Participants answered all questions and then underwent complete eye examinations and in some cases cycloplegic refraction. Visual acuity (VA) was measured with a logMAR in six meters. Refraction errors were determined using an auto refractometer (Potece and Heine retinoscope). The collected data was then analyzed using the SPSS statistical software. Results The results of this study indicated that 63.86% of the subjects had refractive errors. Refractive errors were significantly different in children of different genders (P < 0.05). The most common complaints associated with the continuous use of computers were eyestrain, eye pain, eye redness, headache, and blurred vision. The most prevalent (81.8%) eye-related problem in computer users was eyestrain and the least prevalent was dry eyes (7.84%). In order to reduce computer related problems 54.2% of the participants suggested taking enough rest, 37.9% recommended use of computers only for necessary tasks, while 24.4% and 19.1% suggested the use of monitor shields and proper working distance, respectively. Conclusions Our findings revealed that using computers for prolonged periods of time can lead to eye-related problems such as eyestrain, headaches, weak and tired eyes, blurred and double vision, weak vision, burning itching and watery eyes, etc. To correct and reduce these problems the following precautions may be helpful, using computer shields (anti-reflex glasses), proper computer workplace illumination, enough rest after working with computers, appropriate viewing distances during computer work, placing computers far from bright objects and adjusting a line of vision with the top of the monitor.

Needs analysis is an integral part of ESP courses for syllabus design, materials development, teaching and testing issues. Unfortunately there has been no formal research on needs analysis for postgraduate courses in the Ministry of Health in Iran (MOH). The recent approach to needs analysis, critical approach, is both descriptive and transformative in research method. It emphasizes on the importance of needs analysis by including different stakeholders including: teachers, students and administrators in this process which is a political/subjective activity. This study conducted in 2009 was an attempt to revise the present syllabi of ESP postgraduate courses on the basis of critical approach to needs analysis. The total population of the study was 75 people consisting of 56 postgraduate students, 10 graduates, four heads of departments, four ESP instructors and one executive manager at MOH. Ethical and demographic forms as well as a comprehensive questionnaire and a form of semi-structured interview were the instruments of the study. The questionnaire was based on Likert Scale which was then analyzed through SPSS. The result of the study showed a discrepancy between what the students expressed as their needs and what is actually in the syllabus prescribed by the MOH.

Background: Cancer is the third cause of death following cardiovascular disease and accidents, in Iran. The purpose of this study was to systematically review the economic burden of cancer studies in Iran. Methods: This systematic review examined the types of direct medical and non-medical costs and indirect costs in cancer patients and includes studies in English and Persian that were reviewed in Scopus, Web of science, SID, Iranmedex, Magiran and databases of Medline, etc., from 1995-2019. Results: Twenty-one articles were included. Most studies have examined the direct costs of all types of cancers. The articles reviewed different types of cancer, such as prostate cancer (n=2), colorectal cancer (n=2), breast cancer (n=4), gastric cancer (n=2), oral and pharyngeal cancer (n=1), lung cancer (n=3), and blood cancer (n=4). The great number of studies were related to the gastrointestinal, breast and blood cancers. The gastrointestinal (gastric and colorectal) and breast cancer had the major economic burden than others. Conclusion: It is necessary that special attention to patients, supportive measures to reduce the share of costs, and more budget allocation for prevention, screening and early detection being at priorities in the health system planning.