A B S T R A C TBackground: Cardiovascular Disease (CVD) is one of the major concerns all around the world. It is caused by mass of atherosclerotic plaques in the walls of coronary arteries, which ends in narrowing of veins, heart failure, angina, and Myocardial Infarction (MI). The growing need for therapeutic interventions in CVD patients illustrates the importance of paying special attention to these patients' Quality of Life (QoL) and the vital interventions for their treatment. Objectives: This research aimed to evaluate patients' QoL after Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) using Seattle Angina Questionnaire (SAQ) and Short Form-36 (SF-36). Patients and Methods:This six-month cohort study aimed to evaluate the QoL among CAD patients in Shiraz, Iran via SAQ and SF-36. The study population included all the patients who had undergone CABG and PCI in the hospitals of Shiraz University of Medical Sciences from May to December 2014. A total of 200 patients were selected for each intervention. After gaining the patients' consent to take part in the research, 200 patients who applied for CABG and 198 patients who applied for PCI agreed to participate in the study. Preintervention data were gathered through a demographic data form and two valid and reliable questionnaires for QoL. The post-intervention data were also gathered six months after the treatment using the same questionnaires. Then, the data were entered in to the SPSS statistical software, version 20 and were analyzed using paired sample t-test, Kruskal-Wallis, Mann-Whitney U, ANOVA, and Spearman and Pearson correlation coefficient. Results: Intervention was proved to be the most effective factor in changing the patients' QoL (P = 0.04, mean ± SD = 4.65 ± 22.02 for PCI and 8.25 ± 22.97 for CABG using SF36; P = 0.002, mean ± SD = 10.54 ± 17.14 for PCI and 15.47 ± 16.81 for CABG using SAQ). Moreover, both intervention types boosted the patients' QoL (P < 0.001). However, CABG appeared to be more successful in boosting the QoL compared to PCI. Additionally, although CABG did notexert any significant effects on the score of physical limitation (P = 0.74), it had impacts on all the features of SAQ. Conclusions: The findings revealed that although both CABG and PCI boosted the QoL, CABG was more effective in changing this factor.
Background Cost-effectiveness analysis plays a key role in evaluating health systems and services. Coronary artery disease is one of the primary health concerns worldwide. This study sought to compare the cost-effectiveness of Coronary Arteries Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) through drug stent using Quality-Adjusted Life Years (QALY) index. Methods This is a cohort study involving all patients undergoing CABG and PCI through drug stent in south of Iran. A total of 410 patients were randomly selected to be included in the study. Data were gathered using SF-36, SAQ and a form for cost data from the patients' perspective. The data were analyzed descriptively and inferentially. Considering the analysis of cost-effectiveness, Markov Model was initially developed using TreeAge Pro 2020. Both deterministic and probabilistic sensitivity analyses were performed. Results Compared with the group treated with PCI, the total cost of interventions was higher in the CABG group ($102,103.8 vs $71,401.22) and the cost of lost productivity ($20,228.68 vs $7632.11), while the cost of hospitalization was lower in CABG ($67,567.1 vs $49,660.97). The cost of hotel stay and travel ($6967.82 vs $2520.12) and the cost of medication ($7340.18 vs $11,588.01) was lower in CABG. From the patients' perspective and SAQ instrument, CABG was cost-saving, with a reduction of $16,581 for every increase in effectiveness. Based on patients’ perspective and SF-36 instrument, CABG was cost-saving, with a reduction of $34,543 for every increase in effectiveness. Conclusion In the same indications, CABG intervention leads to more resource savings.
Background: Given the importance of medicine as a strategic commodity in the Iranian health sector, drug trafficking is one of the public health challenges. Therefore, the present study was conducted to identify and explain challenges and proper strategies to control drug trafficking in Iran. Method: This study was conducted using a qualitative content analysis based on an analysis of news media. The news was retrieved according to keywords related to drugs, medicine, and trafficking from news sources from March 21, 2017 to March 19, 2020. Special and general online news sites and agencies, including Mehr News Agency, Khabar Online, Khane Mellat News Agency, Islamic republic news agency(IRNA), Iranian students news agency(ISNA), Hamshahri, Donya-e-Eqtesad newspapers, Webda, Sepid newspapers, and Irans’ food and drug administration news agency(IFDANA) were selected by purposeful sampling method with a maximum variation. Data were analyzed using conventional content analysis by a data-driven inductive approach. All steps of data coding were done manually in Excel 2016 software. Results: Totally, 139 news met inclusion criteria. In terms of challenges and strategies, four themes were obtained separately. Challenges and strategies included ten and nine sub-themes, respectively. The four themes were economic, regulatory, structural, infrastructure, and cultural, social, and informational issues. The predominant theme in challenges was regulatory issues, and also the predominant theme was economic strategies. Conclusion: To reduce trafficking, it is necessary to review policies. Also, there is a need to focus on capacity building and support for the country's pharmaceutical companies. Also, the use of insurance capacity, e-infrastructure, and culturalization are strategies for reducing drug smuggling that must be accompanied by the full participation of stakeholders inside and outside the health system.
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