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BackgroundImmune checkpoint therapies have led to significant breakthroughs in cancer patient treatment in recent years. However, their efficiency is variable, and resistance to immunotherapies is common. VISTA is an immune-suppressive checkpoint inhibitor of T cell response belonging to the B7 family and a promising novel therapeutic target. VISTA is expressed in the immuno-suppressive tumor microenvironment, primarily by myeloid lineage cells, and its genetic knockout or antibody blockade restores an efficient antitumor immune response.MethodsFully human monoclonal antibodies directed against VISTA were produced after immunizing humanized Trianni mice and sorting and sequencing natively-linked B cell scFv repertoires. Anti-VISTA antibodies were evaluated for specificity, cross-reactivity, monocyte and T cell activation, Fc-effector functions, and antitumor efficacy using in vitro and in vivo models to select the KVA12123 antibody lead candidate. The pharmacokinetics and safety profiles of KVA12123 were evaluated in cynomolgus monkeys.ResultsHere, we report the development of a clinical candidate anti-VISTA monoclonal antibody, KVA12123. KVA12123 showed high affinity binding to VISTA through a unique epitope distinct from other clinical-stage anti-VISTA monoclonal antibodies. This clinical candidate demonstrated high specificity against VISTA with no cross-reactivity detected against other members of the B7 family. KVA12123 blocked VISTA binding to its binding partners. KVA12123 induced T cell activation and demonstrated NK-mediated monocyte activation. KVA12123 treatment mediated strong single-agent antitumor activity in several syngeneic tumor models and showed enhanced efficacy in combination with anti-PD-1 treatment. This clinical candidate was engineered to improve its pharmacokinetic characteristics and reduce Fc-effector functions. It was well-tolerated in preclinical toxicology studies in cynomolgus monkeys, where hematology, clinical chemistry evaluations, and clinical observations revealed no indicators of toxicity. No cytokines associated with cytokine release syndrome were elevated.ConclusionThese results establish that KVA12123 is a promising drug candidate with a distinct but complementary mechanism of action of the first generation of immune checkpoint inhibitors. This antibody is currently evaluated alone and in combination with pembrolizumab in a Phase 1/2 open-label clinical trial in patients with advanced solid tumors.

Abstract Background In light of the multi-faceted challenges confronting health systems worldwide and the imperative to advance towards development goals, the contribution of health policy graduates is of paramount importance, facilitating the attainment of health and well-being objectives. This paper delineates a set of core skills and competencies that are requisite for health policy graduates, with the objective of preparing these graduates for a spectrum of future roles, including both academic and non-academic positions. Methods The study was conducted in three phases: a scoping review, qualitative interviews and the validation of identified competencies through brainstorming with experts. In the initial phase, a scoping review was conducted on the databases. The following databases were searched: PubMed, Scopus, Web of Science and Google Scholar search engine. Additionally, the WebPages of universities offering health policy programmes were manually searched. In the second phase, 36 semi-structured interviews were conducted with students, graduates and distinguished academics from Iran and other countries. These interviews were conducted in person or via email. In the third phase, the draft version of the competencies and their associated learning objectives, derived from the preceding stages, was subjected to independent review by an expert panel and subsequently discussed. In light of the expert panel’s findings, the authors undertook a subsequent revision of the list, leading to the finalization of the core competencies through a process of consensus. Results In the scoping review phase, the analysis included six studies and nine university curricula. The results of the scoping review could be classified into five domains: health system understanding, health policy research, knowledge translation, multidisciplinary work and knowledge of public health. In the second phase, six core competencies were extracted from the interviews and combined with the results of the first phase, which were then discussed by the expert panel at the third phase. The final five core competencies, derived from the brainstorming session and presented in no particular order, encompass health policy research, policy analysis, educational competencies, decision-making and multidisciplinary work. Conclusions It is essential that the curriculum is appropriate and contextually tailored, as this is crucial to foster multi-dimensional competencies that complement the specific disciplines of future health policy scholars. These scholars must possess the ability to genuinely serve their health systems towards achieving health-system goals and sustainable development.

Cancer of the thyroid has become the fastest-growing cancer among women in the past several decades. This study is aimed at using scientometric methods to identify research frontiers and development trends in the field of thyroid cancer (TC) research. We used the Scopus database to collect articles and reviews related to TC in November 2022. R software and Bibliometrix software package were used for scientometric analysis. More than 28,000 articles were obtained from Scopus using the defined specific keywords. The United States, France, and England published the most publications. Journal of Clinical Endocrinology and Metabolism and Cancer were found as the core journals in this field. Morris LGT, Sikora AG, and Davies L authored the most publications. National Cancer Institute, National Cancer Institute at NIH, and the University of Washington contributed the most publications. The most cited evidence was related to the articles of Bray (2018), Sung (2021), and Parkin (2005). Using scientometric analysis, this study mapped and visualized the knowledge landscape in the field of TC. The analysis showed that scientists in the field of TC are working collaboratively to tackle one of the most prevalent cancers in the world. This analysis showed that scientists in the field of TC are working with a scientific framework as a team to tackle one of the most common cancers in the world.

Abstract Actions that are taken to preserve effective antibacterial agents and eliminate transmission of resistant organisms are crucial to prevent a catastrophic postantibiotic era. In this systematic review, we searched and appraised relevant texts and expert opinions to determine effective strategies to tackle bacterial resistance worldwide. We considered expert opinions, consensus, current discourses, comments, assumptions or assertions and discussion papers published in English. We searched following databases for expert opinion‐based literature: MEDLINE, CINAHL, ISI Web of Knowledge, SCOPUS, Cochrane Central Register of Controlled Trials and World Health Organization (WHO). We extracted the textual data from texts using a standardised data extraction tool. Textual pooling was not possible, so the conclusions were presented in a narrative form. Eighteen texts were included in this review. The findings show that, the most repeated policies and strategies include implementing and strengthening bacterial resistance surveillance, developing national guidelines, improving public awareness; enhancing home and everyday life hygiene; improving prescribing patterns, improving laboratories capacity, promoting innovation and research in new drugs and technology and strengthening coordination. This review systematically gathered strategies that were recommended by textual publications. To our knowledge, this was the first systematic review of text and opinion in the field of bacterial resistance. These results can be used by policymakers, hospital managers, and governments, alongside the results of quantitative and qualitative systematic reviews.

Introduction: During the unprecedented COVID-19 lockdowns, road traffic was limited, and a change in the traumatic emergency admission pattern was anticipated. We conducted the current systematic review and meta-analysis to assess the impact of the COVID-19 pandemic on hospital admissions due to road traffic crashes. Methods: This systematic review and meta-analysis was conducted based on the Joanna Briggs Institute (JBI) instructions. The following databases were searched: PubMed, ISI Web of Knowledge, Scopus, ProQuest, and the Cochrane Library. Two independent reviewers screened articles based on the inclusion criteria for the review and assessed the methodological quality of the included studies using an appropriate appraisal checklist, introduced by the JBI, based on the study type. The meta-analysis was performed using Comprehensive meta-analysis (CMA) software. Considering the heterogeneity among studies, a random effect model was adopted to estimate the pooled effect with 95% confidence interval (CI) for binary outcomes. Results: A total of 13 studies were included in this systematic review, and all of them were considered for meta-analysis. According to the meta-analysis, differences in hospital admission rates during the COVID-19 pandemic and one year before this pandemic were statistically significant [RR: 0.685 CI 95% (0.578 -0.813) p

Abstract The total fertility rate in Iran has declined to below replacement level recently, and a new approach has been taken to tackle this issue. Thus, this study aimed to identify the involved stakeholders and their characteristics in the new population policy change in Iran. We employed a qualitative approach using the purposive sampling of key informants and the identification of relevant documents. The main stakeholders were divided into seven key groups: religious, political, governmental, professional, international sectors, media, and nongovernmental organizations. In addition, there was no centralized, clear, and comprehensive mechanism to guide the activities of stakeholders to coordinate and bring the total fertility rate to the replacement level in Iran. Despite the importance of the new population policy in Iran, in recent years, we still experience dispersion and inconsistency among various actors in this area. It is imperative to go through a consensus and coalition at macro-level authorities alongside evidenced-based population policymaking.

Background: Development plans aimed at macro-management planning in a country significantly impact all functional fields. This study investigated the status and significance of the health sector in the first to sixth economic, social, and cultural development plans in Iran. Methods: This was a review study using documentary analysis method. The review was conducted with an emphasis on purposefully selected upstream information. Then, the obtained data were analyzed by the second-hand documents, including authentic reports and published studies on this topic. The data collection instrument was a researcher-made checklist. Data analysis was run using content analysis. Results: There has been increasing attention to the health sector issues throughout development plans. Civil engineering, pharmaceuticals supply, and population control in the first and second plans; the extension of public insurance and service ranking in the third plan; formation of the Supreme Council of Health, and attention to medical emergencies in the fourth plan; targeting subsidies in the fifth plan; and policies to encourage population increase and reduce out-of-pocket expense have been the most critical concerns in the sixth development plan. Conclusion: Failure to achieve the expected results in the plans and repeating the same text in the following plan indicates the government’s poor commitment to some plan aspects provision, especially at a particular time. Moreover, they paid insufficient attention to international trends and health promotion issues. These issues must be an urgent concern in future development plans.

Abstract Background A huge number of people living with HIV/AIDS lives in developing countries. Thus, strengthening health systems in these countries is a prerequisite for improving disease prevention and care. After three decades of HIV/AIDS policy-making in Iran, conducting a comprehensive analysis on the policy process seems to be essential. In the present study, we aimed to analyse the HIV/AIDS policy-making process in Iran from 1986 to 2016. Methods This was a theory-based, multi-method and retrospective study. Interviewing of key informants and review of policy documents were concurrently conducted to identify and include further key informants (39 participants) and documents in the study. Framework analysis was used to analyse data. Results The mean age of participants working in HIV/AIDS policy-making was of 48 years and participants had a mean of 14 years of working experience. Findings were categorized as contextual factors, content of HIV/AIDS policies, actors involved in the policy process, and evidence use in the policy process. Contextual effective factors on the HIV/AIDS policy-making process were categorized into five major themes, namely situational factors, structural-managerial factors, socioeconomic factors, political and legal factors, and international factors. The HIV/AIDS phenomenon in Iran was identified to be deeply rooted in the culture and traditions of society. The HIV/AIDS policy content has, recently, been crystallized in the national strategic plans and harm reduction policies of the country. The policy process has been conducted with a solely governmental top-down approach and is now suffering from poor evidence and lack of sufficient consideration of contextual factors. Conclusions There is a great need for change in the approach of government towards the issue and to increase the participation of non-governmental sectors and civil society in the policy process.

Immediate access to special clinical services remotely has an important role in transferring information, informing clinical diagnosis, and distance learning. Health systems have faced with various opportunities and challenges during implementation of telemedicine. This study aimed to explore the challenges and opportunities in health systems for implementation of telemedicine. In this comprehensive review, local and international databases were searched according to a search strategy from January 2000 to January 2018. Then, an analysis was conducted on 24 selected papers. Use of telemedicine technology results in many challenges related to informational and communicational infrastructures, health, standards, laws and regulations, training, and security. Despite these challenges, significant opportunities are also presented specially in regards to pervasiveness of informational and communicational information, providing universal access to updated information, and disappearance of technology gaps through globalization, which can be suitable methods for eliminating the aforementioned challenges.

Background Gastrointestinal cancers in Iran are among the major non-communicable diseases with a considerable burden on the health system. Changes in lifestyles as well as environmental factors have resulted in the emergence of these cancers. Objective To elicit and quantitatively verify experts’ opinions regarding the potential public health impact, feasibility, economic impact, and budgetary impact of gastrointestinal cancer prevention policies in Iran. Methods Sixteen experts from Iran were recruited in an email-based, two-round Delphi study. In each round, a questionnaire of policy options for preventing gastrointestinal cancers, which adhered to the new policy framework of the World Cancer Research Fund International, was given to participants. In the first round, experts were asked to provide opinions for and against the policy options. The second round evaluated the policy options for their public health impact, feasibility, economic impact, and budgetary impact. Results A total of 32 policy options were organized based on three domains: health-enhancing environments, system changes, and behavior change communications. Of the 32 policy options, there were consensus in 31 (96%) and 30 (93%) options for public health impact and feasibility, respectively. On study completion, experts reached a consensus in 29 of 32 (90%) policy options for economic impact; only on 26 (81%) of these policy options did participants reached consensus for budgetary impact. Conclusion Findings indicated that although nearly all policy options reached a consensus for their public health impact, some options are not feasible or do not appear to have an economic rationale for being implemented. Moreover, it is crucial to take into account the inter-sectoral collaboration between health and non-health sectors. Findings from this study can be helpful for health policymakers in identifying support for evidence-informed approaches regarding gastrointestinal cancer prevention.

This qualitative systematic review was conducted to summarize the policies for prevention of common gastrointestinal cancers worldwide. This study was conducted using PubMed, Web of Science, SCOPUS, and ProQuest databases. Two independent reviewers assessed included studies for methodological quality and extracted data by using standardized tools from Joanna Briggs Institute (JBI). Primary study findings were read and reread to identify the strategies or policies used in the studies for prevention of gastrointestinal cancers. The extracted findings were categorized on the basis of their similarity in meaning. These categories were then subjected to a meta-synthesis. The final synthesized findings were graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis. From the nine included studies in this review, 39 findings were extracted and based on their relevance in meaning were aggregated into 12 categories. Four synthesized findings were developed from these categories. We used World Health Organization report on 2000 for synthesizing the findings. The four synthesized findings were “service provision”, “resource generation”, “financing”, and “stewardship”. In order to reach a comprehensive evidence informed policy package for the prevention of gastrointestinal cancers, there should be a great communication among the interventions conducted directly on patients, health system infrastructures, and resources.

Background & Objective: Recognition and elimination of weaknesses in the internship courses of health service management are essential to improving their quality and efficacy. The present study aimed to evaluate the viewpoints of health service management students toward the challenges in the design and implementation of internship courses at the Faculty of Management and Information in Tabriz University of Medical Sciences, Iran. Materials and Methods: This qualitative research was conducted on the health service management students at the Faculty of Management and Information in Tabriz University of Medical Sciences in 2014. Data were collected via focused group discussions attended by 8-10 individuals per session. Data analysis was performed using content analysis. Results: Challenges in internships 1-4 for bachelor’s degree students were assessed in three areas, including the problems relating to instructors, internship courses, and cartable from the perspective of the students. In total, 8 main themes and 30 subthemes were extracted in each area. Conclusion: According to the results, the internship curricula of health service management students should be completely modified to eliminate the weaknesses. These changes must include the correction of the course design and syllabi and essential revision of the cartable based on the latest information on health systems and labor market needs.

Background and Objectives: Training courses are held in order to fulfill the trainee’s educational needs. So, the first step in educational planning is recognizing the needs that increase participation of trainees in planning and quality improvement of the courses. This study was conducted to assess the accordance of nurses’ in-service training with their educational needs in hospitals of Tabriz University of Medical Sciences. Material and Methods: A cross-sectional descriptive study was conducted. A sample size of 324 nurses was chosen in a systematic random way from the nurses who had entered the study and wished to participate in the study. A questionnaire with three questions was used for data collecting. We used descriptive statistics for analyzing data. Results: There were 324 nurses in 10 hospitals who participated in the current study. The highest and lowest numbers of nurses (25.9% and 2.2%) were from Imam Reza, Alavi, and Taleghani hospitals, respectively. The findings showed that 49.59% of the courses were related to nurses’ needs. Sina and Taleghani hospitals had the highest and lowest accordance rate, respectively (68% and 40%). Conclusion: Regarding the importance of need-based training courses on quality improvement, with the gap between nurses’ needs and the courses, it could be suggested that before holding such courses, needs assessment of trainees should be done in order to have better efficiency and quality. Planning for evaluating educational needs of nurses also has important effect on improving the results.

Background: Performance assessment tries to find the best, valid and cost-effective way of measuring performance and work satisfaction. There are several indicators for health systems performance evaluation which ignore the managerial aspect. We aimed at evaluating the validity and reliability of managerial performance assessment tool for Iranian hospitals. Methods: The current study is a part of larger study which aims at developing a reliable and valid tool for managerial performance assessment tool. The intended tool has seven dimensions of planning, organizing, leadership, information management, resource management, clinical governance, and performance indicators. We conducted a 2-round Delphi study with 18 experts whom were selected purposefully to evaluate the validity of the tool. Reliability was assessed through implementing the tool in three randomly chosen hospitals of Tabriz. Content Validity Index (CVI) and Content Validity Ratio (CVR) along with internal consistency and Cronbach's alpha were calculated for this reason. Results: A checklist with 117 indicators was prepared. After determining the validity and reliability of checklist, scores for these indicators were calculated given the importance scores. The whole tool has the score of 1000. Cronbach's alpha coefficient was 0.76 for the whole checklist. Conclusion: The validated tool in the current research can be used in performance assessment, evidence-based dismissal, installation, and upgrading of hospital managers in order to avoid non proper selection of these managers. Further researches are needed to apply this tool in managerial performance assessment of hospitals in order to measure probable bugs of this model.

Background and Objectives: Evaluating higher education is a systematic process for identifying student’s progress in order to reach predefined goals. In this study we aimed at evaluating educational program of Bachelor of Sciences in health services management using CIPP model in Tabriz. Material and Methods: A descriptive-analytical study was conducted with the sample size of 94 people, of which 18 were faculty members, 55 were students and the others were graduated. A questionnaire was used to collect data which its validity and reliability were confirmed in Kerman University of Medical Sciences. We used SPSS software and descriptive and analytical statistics to analyze the data. Results: Total scores of the studied curriculum in aspects of context, input, process, and product were 64.96, 64.11, 63.45, and 63.97 percent, respectively. Generally, the curriculum was assessed as partly appropriate. Conclusion: It seems that considering revision in some lessons and putting the major focus on teaching skills can improve the utility of the curriculum.

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Background: Pay-for-performance (P4P) is a payment model which tries to pay for the measured aspects of performance and encourage health care providers by providing financial incentives in order to achieve pre-defined goals. This research was done to assess the impact of P4P on efficiency of medical laboratory of Imam Reza hoapital in Tabriz in 2013. Materials & Methods: This interventional research was a before-and-after study. In order to recognize any changes, efficiency indexes of laboratory were measured and compared whole the year. The data were collected manually assessing the related documents. For comparing efficiency before and after intervention, descriptive statistics were used. Results: Findings showed that costs didn’t differ significantly after the intervention, but revenue was a little increased slightly (14364 to 16874). Laboratory errors were also increased after the intervention. (0 to 17 cases). Conclusion: Regarding the results of survey , it seems that we can conclude that this bonus payment system can be used in all levels in which care is provided such as primary health care centers, drug stores, diagnostic centers and hospitals through setting pre-defined goals and considering negative point for any staff who makes an error.

​ Background and objectives : Health care organizations require clinical accreditation standards for improving high quality, assured and safe services. Considering importance of clinics in hospitals’ quality improvement and lack of accreditation measures in adapted model for clinics, this study is aimed at developing accreditation measures for the adapted model and accredited the clinic of Tabriz Aali Nasab hospital using this model. Material and Methods : This is a descriptive study which was conducted at autumn 1391. Measures were developed for the standards of the adapted model. Accreditation team used these measures for accrediting the clinic of Tabriz Aali Nasab hospital. Data were collected by interviews, observation and surveying documents. Results : Findings showed that the clinic of Tabriz Aali Nasab hospital got the 65% of the scores. This clinic in 6 standards in the fields of clinical effectiveness, referral, transfer, discharge and registration of patients achieved less than 25% score, full score in 9 standards, and in 21 standards got upper than 75% score in respect, authority, safety, accessibility, complaint system and prevention of hazards. Conclusion : The Study results showed that the clinic of Tabriz Aali Nasab hospital is in a mediocre condition in observing standards which can be improved with a proper planning.

Background and Objectives : Tracer methodology is a novel evaluation method which its purpose is to provide an accurate assessment of systems and processes for the delivery of care, treatment, and services at a health care organization. This study aimed to assess student care process in Tabriz using Tracer methodology. Material and Methods : This cross-sectional study was conducted in autumn 1391. Population study consisted of all the students who were covered by Tabriz health care center and study sample included an urban health care center, a rural health care center, a health house, and two schools in urban and rural areas which were selected by simple sampling method. Also, all the complicated and problematic processes were chosen to be assessed. Data were collected by interviewing, observing, and surveying documents and were compared with current standards. Results : The results of this study declared the percentage of points that each target group gained from tracer evaluation in student care process was 77% in health house, 90% in rural health care center and 83% in urban health care center. Findings indicated that documentation was the main weak point. Conclusion : According to the results of this study, student care process is sufficient; despite the fact that there are some deficiencies in caring process, as it may be improved through appropriate strategies. Furthermore, tracer methodology seems to be a proper method to evaluate various levels of health care system. ​

​ Background and Objectives : For a successful accreditation program, it is necessary to have adequate resources and infrastructures. The aim of this study was to evaluate existing resources and infrastructures to implement the accreditation system. Material and Methods : This descriptive study was conducted in the universities of East Azerbaijan and Ardabil in 2011. A total number of 150 individuals were selected using census sampling. The data were collected by a structured questionnaire whose validity was confirmed by library validity method and its reliability was measured using split-half method (α=89.4). Data analysis was performed using SPSS 16. Results: The participation rate was 82% (123 individuals out of 150). Average work experience was 16.88 years. The bachelor degree was the highest frequency among participants (66%). 80% of the participants stated that the organizational culture and financial resources are inadequate, 54% expressed there is a lack of top management support and 77% stated that the expected information does not exist in the hospitals. Yet, 55% of the participants declared that the probability of a successful implementation of accreditation is higher than average. Conclusion: In a successful implementation of accreditation system, it is important to mobilize adequate resources and develop suitable cultural statuses. Also, it is needed to provide sufficient education about accreditation and how to implement and benefit the manpower’s potential capabilities.