The use of telemedicine in orthopaedics can provide high-quality orthopaedic services to patients in remote areas. Tele-orthopaedics is widely acknowledged for decreasing travel, time and cost, ...increasing accessibility and quality of care. In the absence of a comprehensive review on tele-orthopaedics applications and services, here, we systematically identify and classify the tele-orthopaedic applications and services, and provide an overview of the trends in the field.
In this study, a systematic mapping was conducted to answer six research questions, we searched the databases Scopus, PubMed, IEEE Digital Library and Web of Science up to 2019. Consequently, 77 papers were screened and selected on the basis of specific inclusion and exclusion criteria.
We found that mobile-based teleconsultation was mostly asynchronous, while non-mobile teleconsultation was synchronous. The results showed that the physician-patient relationship was more common than other interactions, such as physician-physician and physician-robot interactions. In addition, more than half of the services provided by tele-orthopaedics have been used for orthopaedic diseases/traumas in which joint replacement and fracture reduction have been the most important orthopaedic procedures. It has been noted that more attention has been paid to tele-orthopaedics in developed countries such as the USA, Australia, Canada and Finland.
Telemonitoring (teleconsultation and telemetry) and telesurgery (telerobotics and telementoring) were found to be the two major forms of tele-orthopaedics. Mobile phones were used asynchronously in most of the teleconsultations. The development of different applications may result in the use of multiple smartphones applications in real-time teleconsultation. The use of smartphones is expected to increase in the near future.
The variety of frameworks and models to describe resilience in the health system has led researchers and policymakers to confusion and the inability to its operationalization. Therefore, the purpose ...of this study was to create a meta-framework using the Critical Interpretive Synthesis method.
For this purpose, studies that provide theories, models, or frameworks for organizational or health system resilience in humanitarian or organizational crises were systematically reviewed. The search strategy was conducted in PubMed, Web of Science, Embase, and Scopus databases. MMAT quality appraisal tool was applied. Data were analysed using MAXQDA 10 and the Meta-ethnography method.
After screening based on eligibility criteria, 43 studies were reviewed. Data analysis led to the identification of five main themes which constitute different framework dimensions. Health system resilience phases, attributes, tools, and strategies besides health system building blocks and goals are various dimensions that provide a systematic framework for health system resilience analysis.
This study provides a systemic, comprehensive framework for health system resilience analysis. This meta-framework makes it possible to detect the completeness of resilience phases. It examines the system's resilience by its achievements in intermediate objectives (resilience system attributes) and health system goals. Finally, it provides policy solutions to achieve health system resilience using tools in the form of absorptive, adaptive, and transformative strategies.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Although the importance of health promotion and empowerment of the community has been recognized for many years, there are still many barriers to adopting health promotion in the world. One of the ...solutions is socially accountable medical education and community engagement.
This study aimed to compare the medical programs of five medical schools that practiced community-engaged medical education to medical education in Iran.
This comparative study has been performed in 2022 by the four-stage Bereday method, including description (the educational programs of the selected medical schools were examined), interpretation (a validated checklist was prepared according to community-based strategies), proximity (similar and different information was identified), and comparison (solutions were recommended to improve health promotion and community engagement in Iran's medical education program. The purposive sampling method was used to select five universities.
Although successful initiatives have been attempted to integrate public health promotion and community orientation into the Iranian curriculum, they do not appear to be sufficient in comparison to leading countries. The main distinction is that the community is actively engaged in all stages of curriculum design, implementation, and evaluation.
Although Iran's medical education program has a long way to go in terms of social accountability, by including more community-oriented initiatives into the curriculum, health needs of the community can be met and physician shortages in poor areas can be alleviated. It is recommended to implement modern teaching methods, to recruit diverse faculty and community members, and to increase the community placement in medical education.
Abstract
Background
Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic ...crisis. This study aims at analysing the hospitals’ policy solutions during the economic crisis using the resilience system capacities framework.
Method
This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system’s six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment).
Findings
After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers’ competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies.
Conclusion
The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC.
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To date, there is still no uniformity in forecasting models for health workforce planning (HWFP). Different countries use various HWFP models, some of which are context-specific. The objective of ...this systematic review is to determine approaches and components of HWFP models.
A systematic review of studies published in English and Persian between 2004 and 2021 was performed by searching PubMed Central, MEDLINE, Web of Science, Scopus, Eric, and Elmnet databases. Articles that assessed HWFP models, focused on health service delivery, used input-output models, and a clear formulation process were included. Articles that scored ≥20 points on the "strengthening the reporting of observational studies in epidemiology" checklist were considered of acceptable quality for inclusion.
Twenty articles were included for qualitative synthesis based on the inclusion and exclusion criteria. Most studies used the mixed method approach "supply and demand", whereas target- and needs-based approaches were used less frequently. The number of components used to estimate supply, demand, needs, and targets were 42, 32, 11, and 6, respectively. In addition, several unique factors used in the various HWFP models were identified.
Different approaches are used in HWFP models, which is indicative of the lack of consensus on this topic. High diversity in the identified factors is related to the approach used and the context in which the model is applied.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
BackgroundThe value framework governing the health system can guide the policymaking. This study presents a set of values governing the health policies for adopting policies that are in harmony with ...the ideology of Iran. MethodsThis study was conducted in two phases. In the first phase, using the qualitative approach, Shams et al. framework was adopted to identify values. Identification of health-related national documents (nine documents) was performed purposefully. In the next phase, semi-structured interviews on individual experts in the health system were carried out. The key question was "What values and principles govern the health policy system?" Participants included 15 individuals. Both phases were analyzed based on qualitative content analysis. ResultsIn this study, a taxonomy of values governing policymaking is presented. Results show that equity in different dimensions, comprehensive health and a healthy human being, pioneering in health in the region, and accountability are the most important terminal vaqlues. Individual responsibility, government responsibility for health, endogenous and extrinsic economics, fair access, transparency, efficiency, quality and integrity in the supply, development and fair allocation of public health resources, and professional commitment are the most important instrumental values in Iran. Participants believed that, despite the many higher-order documents available, the health system policymaking was not based on a predetermined value. ConclusionsIt is not enough to provide a set of values in upstream documents for implementation. It is necessary to specify the relative weight of the reference values in policymaking and their relation to each other in order to apply them in policymaking.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
With the knowledge we have today about the concept of health and its complexities and determinants, the separation between medical and dental education (DE) does not seem reasonable anymore. ...Dentistry has mainly developed based on a mechanical approach to treat the related problems. This makes the efforts for reorientation of dental care (DC) toward a preventive approach, relying upon dentists as the chief oral health (OH)-related workforce, inefficient. This is while effective strategies have been identified for prevention, as the key to simultaneously control the burden and costs of the ubiquitous oral diseases, at both individual and population levels without dentists. We think that approaching OH as an integral part of the general well-being requires fundamental changes in the structure of OH system including a substantial revision in the current situation of dentistry as an autonomous health profession with a separate education from the main body of the medicine. In this short article, we briefly discuss the necessity of blending DE into the mainstream of medical education and actual consideration of dentistry as a medical specialty area. After discussing the subject at two levels (health-care system and national levels), the next sections draw attention to some complementary issues.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
The complexity of today's world is constantly creating new challenges for higher education institutions, and they must continually be consistent and accountable to maintain standards of excellence ...and compete in international education markets. Being or becoming an entrepreneurial higher education institution is a response to these challenges. There is no "unique" approach, but there are different ways in which higher education institutions behave in an entrepreneurial and creative way. The purpose of this article was to explain how universities can become more entrepreneurial by changing how they provide knowledge. This article is based on the results of a literature review in the fall and winter of 2020 and is in line with the doctoral dissertation that is currently being done in the "Virtual School, Medical Education and Management, Shahid Beheshti University of Medical Sciences." After 1989, a review of the limited, focused literature on service innovation, with an emphasis on knowledge-based service innovation, was done. Service innovation is multidimensional and interactive in nature and can be examined from both technological (information and communication technology developments) and non-technological (organizational innovations) aspects. Accordingly, knowledge-based services include services based on professional knowledge and technology knowledge. Universities need to focus on innovation in both aspects of knowledge-based services. If universities are to become entrepreneurial universities, it is important to explain the comprehensive model of entrepreneurial universities by focusing on the dimensions, concepts, opportunities, challenges, and requirements for knowledge service innovation and then apply it to medical universities to fits their needs.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Over the last few centuries, the overspecialization of various sciences under the pretext of benefiting from pure disciplinary knowledge led to alienation among and competition between different ...fields of science. Such competition has deviated knowledge from its main objective which is to understand and explain the phenomena. The remedy to this dilemma is to address a new approach, introduced to higher education in the late 1950s as "interdisciplinarity." Accordingly, the main purpose of this article is to propose the strategic instances of operationalizing interdisciplinarity as the key requirements to provide a guideline for designing interdisciplinarity activities.
The present survey was carried out through the framework synthesis method. To codify the instances of operationalizing interdisciplinarity, the main elements and structures of the model were set as the basis of the query for each element and structure; an independent query was carried out in the literature of the study. The correspondence of the discovered instances was once more compared with the conceptual boxes of the primary theoretical model. Ultimately, the taxonomy was concluded through the operational instances based on the primary framework.
A total of 152 strategies were identified as implications of operationalization of 13 layers and 38 sublayers of the multilayer interdisciplinary model.
The development of interdisciplinarity in the national higher education system requires several measures to be taken at different levels of a discipline or scientific field of study. Relying on this, which is the main basis of entering into interdisciplinarity activities, the present study suggests and presents strategic instances of interdisciplinarity operationalization.
The use of research evidence in policy making is a complex and challenging process that has a long history in various fields, especially in healthcare. Different terms and concepts have been used to ...describe the relationship between research and policy, but they often lack clarity and consensus. To address this gap, several strategies and models have been proposed to facilitate evidence informed policy making and to identify the key factors and mechanisms involved. This study aims to critically review the existing models of evidence informed policy making (EIPM) in healthcare and to assess their strengths and limitations.
A systematic search and review conducted to identify and critically assess EIPM models in healthcare. We searched PubMed, Web of Science and Scopus databases as major electronic databases and applied predefined inclusion criteria to select the models. We also checked the citations of the included models to find other scholars' perspectives. Each model was described and critiqued each model in detail and discussed their features and limitations.
Nine models of EIPM in healthcare were identified. While models had some strengths in comprehension, flexibility and theoretical foundations, analysis also identified limitations including: presupposing rational policymaking; lacking alternatives for time-sensitive situations; not capturing policy complexity; neglecting unintended effects; limited context considerations; inadequate complexity concepts; limited collaboration guidance; and unspecified evidence adaptations.
The reviewed models provide useful frameworks for EIPM but need further improvement to address their limitations. Concepts from sociology of knowledge, change theory and complexity science can enrich the models. Future EIPM models should better account for the complexity of research-policy relationships and provide tailored strategies based on the policy context.
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