Medical Journal of the Islamic Republic of Iran最新文献

{"title":"Determining Predictive Power of Base Excess in Comparison with SOFA Score for Predicting Mortality in ICU Patients.","authors":"Omid Moradi Moghaddam, Mohammadjavad Gorjizadeh, Mohsen Sedighi, Alireza Amanollahi, Ali Khatibi, Mohammadreza Ghodrati, Mohammad Niakan Lahiji","doi":"10.47176/mjiri.38.74","DOIUrl":"https://doi.org/10.47176/mjiri.38.74","url":null,"abstract":"<p><strong>Background: </strong>Acid-base disturbances are frequently found in intensive care unit (ICU) patients. Base excess (BE) is commonly used to quantify the degree of metabolic impairment. We aimed to compare the predictive value of BE and Sequential Organ Failure Assessment (SOFA) score for mortality in ICU patients.</p><p><strong>Methods: </strong>This prospective and observational investigation was performed on 87 ICU patients who underwent mechanical ventilation. SOFA score and acid-base variables at 6 hours of ICU admission were analyzed and compared between survivors and non-survivors. Receiver-operating characteristic (ROC) curve was applied to analyze the predictive value of BE and SOFA for mortality.</p><p><strong>Results: </strong>Mean age of patients was 63.91±5.03 years, and 60 (69%) were male. The non-survived patients had significantly higher SOFA (<i>P</i> = 0.001) and APACHE II scores (<i>P</i> = 0.001). The non-survived patients had a lower bicarbonate (<i>P</i> = 0.002), PO₂ (<i>P</i> = 0.001), pH (<i>P</i> = 0.0021), and a higher PCO₂ (<i>P</i> = 0.001) compared with survivors, and most patients who died (80%) had a low BE value (< -2) (<i>P</i> = 0.002). The estimated AUC of SOFA and BE was 0.83 (95% CI, 0.73 - 0.92) and 0.71 (95% CI, 0.57 - 0.85), respectively.</p><p><strong>Conclusion: </strong>BE is, to some extent capable of predicting mortality in ICU patients. However, the SOFA score is a more accurate and reliable parameter in comparison to BE for prediction.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"38 ","pages":"74"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Dynamic and Static Compliance in Two Ventilation Methods with Tidal Volume of 6 and 10 ml/kg: Randomized Clinical Trial.","authors":"Mehryar Taghavi Gilani, Alireza Bameshki, Majid Razavi, Ghorbanali Sadeghzadeh","doi":"10.47176/mjiri.38.73","DOIUrl":"https://doi.org/10.47176/mjiri.38.73","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary compliance is an important lung factor and is affected by tidal volume. In this study, static and dynamic compliance with tidal volumes of 6 and 10 ml/kg have been evaluated in patients undergoing abdominal cancer surgery.</p><p><strong>Methods: </strong>This randomized clinical trial was conducted on 50 patients who were candidate for abdominal cancer surgery. This study was done in patients aged 20-65 years without chronic diseases. After induction of anesthesia, the first group was ventilated with a tidal volume of 10 ml/kg and 8 breaths/minute, and also the second group was ventilated with a tidal volume of 6 mL/kg and 14 breaths/minute. From the beginning and every 15 minutes, expiratory tidal volume, peak and plateau airway pressure, heart rate and blood pressure were measured for two hours. The data was analyzed with SPSS v.20 and <i>P</i> < 0.05 was meaningful.</p><p><strong>Results: </strong>There was no significant difference between the two groups for demographic characteristics. There was no significant difference between the two groups in the dynamic and static compliance of the patients during the study. However, the static compliance decreased in the 6 ml/kg group and increased in the 10 ml/kg group, but the difference was not statistically significant (<i>P</i> = 0.32). The peak, plateau pressure and hemodynamic parameters were the same in the two groups.</p><p><strong>Conclusion: </strong>In general, the static and dynamic compliance was not significantly different in the two groups despite a slight decrease in the 6 ml/kg group and a slight increase in the 10 ml/kg group.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"38 ","pages":"73"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video Training and Telepractice for Parents of Nonverbal Children with Autism Spectrum Disorder: a Randomized Control Trial.","authors":"Hossein Rezai, Hooshang Dadgar, Amir Kasaeian","doi":"10.47176/mjiri.38.72","DOIUrl":"https://doi.org/10.47176/mjiri.38.72","url":null,"abstract":"<p><strong>Background: </strong>Many children with autism spectrum disorder (ASD) are unable to benefit from timely interventions. This research aimed to indirectly enhance play and communication skills in ASD children by providing a video educational package and distance education for their parents.</p><p><strong>Methods: </strong>In this clinical trial study, 32 parents and their children with ASD were randomly assigned to either the intervention or waitlist control groups. The intervention group received an educational video package along with 24 one-hour online sessions. The frequency of communication, engagement in functional games, and the use of conventional and unconventional gestures were assessed before, immediately after, and 3 months following the completion of the intervention in the participating children. The variables were analyzed within and between the two groups using a mixed between-within-subjects analysis of variance (ANOVA).</p><p><strong>Results: </strong>The intervention group achieved significantly higher scores than the control group in the frequency of communication (<i>P</i> = 0.003), functional play (<i>P</i> < 0.001), and conventional gestures (<i>P</i> < 0.001). Conversely, the intervention group had significantly lower scores than the control group in unconventional gestures (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>The observed improvements in both parents and children within the intervention group provide compelling support for the effectiveness of telepractice in speech therapy. This suggests that incorporating remote training methods into speech therapy sessions could enhance access for children with ASD to these interventions.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"38 ","pages":"72"},"PeriodicalIF":0.0,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Are the Stakeholders in Promoting Mental Health?","authors":"Behzad Damari, Mohammad Reza Amir Esmaili, Noora Rafiee, Ahmad Hajebi","doi":"10.47176/mjiri.38.71","DOIUrl":"https://doi.org/10.47176/mjiri.38.71","url":null,"abstract":"<p><strong>Background: </strong>It is now confirmed that mental health promotion policies need innovations beyond the scope of the health sector. In this study, an attempt was made to identify the most effective stakeholders of the public sector in the field of mental health promotion in Iran to help the policy-makers and to encourage inter-sectoral collaboration and further involvement of these effective sectors in mental health promotion plans.</p><p><strong>Methods: </strong>This was a mixed-methods study. From the first step (literature review and a survey), the names of public agencies affected by mental health promotion were extracted. In the next step, a checklist for identifying the main stakeholders was developed. The data of this step were analyzed by the simple additive weighting method. Ultimately, a table was plotted in the form of institutional mapping in order to summarize the organizations affecting each risk factor of mental health promotion.</p><p><strong>Results: </strong>The Islamic Consultative Assembly, the Ministry of Interior, the Islamic Republic of Iran Broadcasting, the Ministry of Cooperatives, Labor, and Social Welfare, and the Ministry of Education were identified as the five institutions with the greatest impacts on the social determinants of mental health in Iran.</p><p><strong>Conclusion: </strong>Significant impacts can be exerted by institutions such as the Islamic Consultative Assembly (as the legislator), the Ministry of Interior, and its subsidiary entities such as municipalities and governors (as the administrators of homeland security and support for safe and appropriate urban and local facilities), the Islamic Republic of Iran Broadcasting (as the national media), the Ministry of Cooperatives, Labor, and Social Welfare (as the institution in charge of employment, job security, and social welfare), and the Ministry of Education (as the educational institution of the country).</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"38 ","pages":"71"},"PeriodicalIF":0.0,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors Associated with Neonatal Mortality and Their Status: A Matched Case-Control Study in Kurdistan.","authors":"Siros Hemmatpour, Ghobad Moradi, Mehdi Zokaie, Zhaleh Karimi, Yousef Moradi, Elham Noori","doi":"10.47176/mjiri.38.70","DOIUrl":"https://doi.org/10.47176/mjiri.38.70","url":null,"abstract":"<p><strong>Background: </strong>Neonatal mortality is a significant public health issue that can often be prevented. The present study was designed and conducted to determine the causes of neonatal mortality and the status of their mothers in Kurdistan Province in 2019.</p><p><strong>Methods: </strong>In this matched case-control study, the case group comprised 171 deceased neonates, while the control group consisted of 171 healthy neonates, along with their mothers' status in Kurdistan Province in 2019. for each case in each city, one control from the same city within the same week of the case's birth was randomly selected. Data were collected using a checklist containing information on the neonates and their mothers. The analysis was performed using STATA 17 software, which involved descriptive tests and analytical tests. These included frequency calculation, chi-square test, conditional logistic regression, and a stepwise backward elimination method for multivariate analysis with (<i>P</i> = 0.1). A significance level of <i>P</i> < 0.05 was considered.</p><p><strong>Results: </strong>The results, after matching the odds ratio with a CI 95% using the backward method, showed a significant association between prematurity (OR:15.99, 95%CI:4.38-58.31), complications during pregnancy (OR:8.64, 95% CI:2.80-26.66), weight gain during pregnancy (OR:3.04, 95% CI:1.06-8.70).</p><p><strong>Conclusion: </strong>The findings of our study suggest a positive association between neonatal mortality and specific maternal and neonatal factors, namely neonatal prematurity, complications during pregnancy, and inappropriate weight gain during pregnancy. Therefore, there is a compelling need to implement effective measures to control these identified risk factors, with the goal of reducing neonatal mortality.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"38 ","pages":"70"},"PeriodicalIF":0.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Chaos to Rationality: A Contingent Meta-Model for Evidence-Informed Health Policymaking in Diverse Contexts.","authors":"Seyyed Hadi Jabali, Shahram Yazdani, Hamid Pourasghari, Mohamadreza Maleki","doi":"10.47176/mjiri.38.69","DOIUrl":"https://doi.org/10.47176/mjiri.38.69","url":null,"abstract":"<p><strong>Background: </strong>Evidence-informed policymaking is a complex process that requires adapting to diverse contexts characterized by varying degrees of certainty and agreement. Existing models and frameworks often lack clear guidance for dealing with such contexts. This study aimed to develop a novel contingency model to guide the context-specific use of evidence in health policymaking.</p><p><strong>Methods: </strong>The study conducted a meta-ethnographic synthesis of 15 existing models and frameworks on evidence-informed policymaking, integrating key factors and concepts influencing the use of evidence in policy decisions. The study also adapted the Stacey Matrix, a tool for understanding the complexity of decision-making, into a quantitative scoring system to assess the levels of certainty and agreement in a given policy context.</p><p><strong>Results: </strong>The study proposed a contingency model that delineates seven modes of decision-making based on the dimensions of certainty and agreement, ranging from rational to molasses-slow collective. For each mode, the model suggests configuring four aspects: team composition, policy idea generation, problem analysis, and consensus building. The model also highlights the multifaceted influences of evidence, interests, values, and beliefs on policy decisions.</p><p><strong>Conclusion: </strong>The contingency model offers researchers and policymakers a flexible framework for aligning policymaking processes with available evidence. The model also underscores the importance of context-specific approaches to evidence-informed policymaking. The model could enhance evidence-informed policymaking capacity, improving health outcomes and system performance. Further research should validate and extend the model empirically across diverse contexts.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"38 ","pages":"69"},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining Risk Factors for Developmental Dysplasia of the Hip in Neonates: A Cross-Sectional Study in a Tertiary Referral Center.","authors":"Peyman Kamali Hakim, Mehrzad Mehdizadeh, Fahimeh Zeinalkhani, Arian Karimi Rouzbahani, Hadise Zeinalkhani, Hamid Rajabi, Hamed Ghorani, Sina Delazar","doi":"10.47176/mjiri.38.68","DOIUrl":"https://doi.org/10.47176/mjiri.38.68","url":null,"abstract":"<p><strong>Background: </strong>Developmental dysplasia of the hip (DDH) is used to describe a spectrum of structural abnormalities that involve the growing hip. Early diagnosis and treatment are critical to providing the best possible functional outcome. This study aimed to evaluate the prevalence of DDH in neonates with and without risk factors and determine the role of ultrasound screening on the initial diagnosis.</p><p><strong>Methods: </strong>This prospective cross-sectional study was conducted on 399 infants at the Pediatric Treatment Center, Tehran University of Medical Sciences, between December 2015 and June 2016. Infants with suspected DDH who underwent hip ultrasonography were included, and the presence or absence of each risk factor was documented according to the checklist. The ultrasound findings were also registered in the checklists. The odds ratio (OR) of each risk factor for DDH was calculated. The collected data were analyzed by SPSS software version 18 at a 0.05 significance level.</p><p><strong>Results: </strong>In 16 months of study, 174 (43.6%) male and 225 (56.4%) female infants under the age of 18 months were studied. Risk factors were detected in the medical history of 329 infants. Out of them, 230(57.6%) were firstborn children, 7 (1.75%) had a positive family history of DDH, and 26 (6.5%) had limb anomalies. There was also a history of breech presentation in 16 (4.01%) and a history of oligohydramnios in 21 (5.1%) of infants. The prevalence of DDH was 25.8% in infants with risk factors and 2.8% in those without risk factors. (OR = 11.84, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>In this study, the frequency of DDH was significantly higher in infants with risk factors. The female gender and limb anomalies were stronger risk factors for DDH. Overall, ultrasound showed great potential for DDH screening.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"38 ","pages":"68"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Prevalence of Factitious Disorder and Its Demographic and Clinical Characteristics in Psychiatric Inpatients in Iran; A Cross-Sectional Study.","authors":"Shabnam Asadi, Amirreza Haji Azizi, Shiva Soraya, Mohammad Faramarzi, Ruohollah Seddigh, Ali Asadi","doi":"10.47176/mjiri.38.67","DOIUrl":"https://doi.org/10.47176/mjiri.38.67","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing factitious disorder (FD) poses significant medical challenges; delays impact patient care and costs. Cultural factors of each country also affect illness and behavior disorders. This study examines the prevalence, demographics, and clinical features of factitious disorder patients in Iranian psychiatric hospitals.</p><p><strong>Methods: </strong>This cross-sectional study reviewed patient data from three psychiatric hospitals in Tehran from 2017 to 2022, confirming FD diagnoses by psychiatry faculty. Inclusion criteria were the diagnosis of FD according to ICD-10 in the last five years. We recorded demographic data, main stressors, symptoms and diagnoses and analyzed them with SPSS-25. Data are presented as numbers and percentages and compared between groups by chi-square test.</p><p><strong>Results: </strong>A total of 17 cases with the diagnosis of factitious disorder were investigated in 5 years (4.315 per 10,000 patients). The highest frequency age range was between 20-30 years, and most of them were male. Our results showed that in only 7 cases, there was initial suspicion of factitious disorder or factitious disorder imposed on another (factitious disorder by proxy). Most of the patients had psychiatric comorbidities, among which the most common comorbidity was substance use disorder and cluster B personality disorder. Among the evidence of suspicion for the diagnosis of factitious disorder in 65% of cases was a history of multiple previous hospitalization and more than 40% of the cases were based on the pattern of repeated symptoms.</p><p><strong>Conclusion: </strong>This study showed that FD is underdiagnosed, and more attention is needed to the signs of this diagnosis in the assessments. Also, the clinical features showed that treatment should account for comorbid disorders.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"38 ","pages":"67"},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Management of Bronchobiliary Fistula as a Complication of Liver Hydatid Cyst: A Case Report.","authors":"Faranak Rokhtabnak, Masoud Baghai-Wadji, Parinaz Morovati Sharifabadi, Nasrin Nouri","doi":"10.47176/mjiri.38.66","DOIUrl":"https://doi.org/10.47176/mjiri.38.66","url":null,"abstract":"<p><p>Bronchobiliary fistula (BBF) in adults is a quite infrequent complication characterized by the abnormal interconnection between the right bronchial system and the biliary tract. BBF may occur due to various causes, including trauma, infections, malignancies, and complications of certain surgical procedures involving the liver or the hepatobiliary system. In this paper, we report a case of BBF following liver hydatid cyst resection that developed in a 58-year-old Iranian male. The patient had acute dyspnea with yellowish sputum. After diagnostic measures such as bronchoscopy, computed tomography (CT) scan, endoscopic retrograde cholangiopancreatography (ERCP), and confirmation of the diagnosis of BBF, the patient underwent Intravenous (IV) antibiotic therapy, placement of pleural drain, sphincterotomy and CBD stents insertion but unfortunately, these measures were not effective and the patient was a candidate for thoracotomy and resection of fistula and the involved lung. During surgery, absolute lung isolation was done by insertion of a left-sided double-lumen endobronchial tube and uneventful anesthesia was maintained for about 5 hours. Patients with BBF present unique challenges in terms of anesthetic management. Sepsis, pulmonary impairment, electrolyte imbalances and malnutrition will make anesthesiologists face many perioperative challenges. During surgery, absolute lung isolation is typically necessary and achieving effective lung isolation can be quite challenging due to the presence of the fistula. Postoperatively, intensive respiratory support, chest tube drainage, and appropriate antibiotic therapy may be required .In addition, a multidisciplinary approach involving anesthesiologists, thoracic surgeons, and other specialists is crucial.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"38 ","pages":"66"},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physicians' Knowledge and Attitude about Generic Drugs in the Republic of Kazakhstan.","authors":"Zandulla Nakipov, Dinara Kaliyeva, Assiya Turgambayeva, Zakira Kerimbayeva, Zhalgaskali Arystanov, Tanagul Arystanova, Nellya Ivanchenko, Nabil Joseph Awadalla","doi":"10.47176/mjiri.38.65","DOIUrl":"https://doi.org/10.47176/mjiri.38.65","url":null,"abstract":"<p><strong>Background: </strong>One of the most effective measures to reduce the cost of medicines for both the healthcare system and patients is the use of generic drugs (GDs). The objective of this study was to identify the physicians' level of knowledge and attitude toward GDs.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted based on a specially designed validated questionnaire of 19 items. The survey was attended by doctors of various specialties working in polyclinics in six regions in the Republic of Kazakhstan. Construct validity was assessed through principal component factor analysis, whereas reliability was assessed using Cronbach's alpha coefficient. Group differences were assessed using Mann-Whitney and Kruskal-Wallis nonparametric tests when comparing two and more than two groups, respectively.</p><p><strong>Results: </strong>The study involved 450 physicians. Only 260 (57.8%) believed that GDs are bioequivalent to the brand name drug (strongly agree and agree). About 202 (45%) of respondents doubt the effectiveness of GDs, and 144 (32%) assumed that they cause more side effects compared to similar branded drugs. Also, the majority of the respondents 320 (71.2%) felt that branded drugs should be held to higher safety standards than GDs. Approximately 338 (75%) of the physicians positively expressed that both physicians and pharmacists need standardized guidelines for the brand name substitution process. Further, 372 (82.7%) proposed that more information about the safety and efficacy of GD is needed. Also, 326 (72.4%), 314 (88.2%), and 85 (18.9%) of the respondents assumed that patients' socio-economic factors, trust in manufacturers/suppliers, and bonuses on products respectively influence the prescribing of medicines.</p><p><strong>Conclusion: </strong>Although the study indicated that physicians in the Republic of Kazakhstan are acknowledging the use of GDs, concerns about the effectiveness and safety of GDs remain high. To enhance the use of GDs, physicians' targeted educational programs on GDs' bioequivalence, safety, and efficacy should be implemented.</p>","PeriodicalId":18361,"journal":{"name":"Medical Journal of the Islamic Republic of Iran","volume":"38 ","pages":"65"},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}