Hospital Practices and Research

Abstract Background: Quality of life (QOL) is a powerful phrase that reflects maintaining health and well-being in different societies and cultures, reflecting the positive and negative aspects of people’s lives. Patients with liver cirrhosis (LC) have an undesirable QOL, and this has become one of the most important causes of mortality in the world.
Objective: This review article aimed to summarize the results of previous studies on health-related QOL in patients with LC to determine their problems and needs.
Methods: This review was conducted using Cochran’s seven-step model. This paper is the result of research on QOL in patients with LC through searches conducted in Google Scholar, PubMed, and Science Direct using the keywords liver cirrhosis, chronic liver disease, quality of life, health-related quality of life, and self-care for articles published between 2012-2018. Ultimately, 11 articles were obtained and analyzed.
Results: The results of this review showed that the QOL in patients with LC is poor and is lower than in other populations. Many factors, such as age, gender, and education, influence QOL and should be addressed in order to solve the challenges and problems faced by these patients. Increasing awareness and education are the most important issues for LC patients.
Conclusion: QOL in patients with LC is affected by many factors. The lack of awareness about the disease and its complications is considered the biggest problem for these patients. To improve the QOL and care of these patients, nursing care guidelines, awareness raising, and education about the disease and its complications, treatment, and new treatments are needed.

Abstract Background: Seeking local evidence on treatment efficacy is necessary if cultural factors are involved, as in psychotherapy for Chronic Pain (CP). Yet, local evidence is known to be prone to bias, making it difficult to reach reliable conclusions.
Objectives: This study aimed to critically evaluate our local evidence on the efficacy of psychotherapy on quality of life and disability in CP. It has been elaborated that, with some requirements, common meta-analytic tools can be utilized to detect and correct local evidence bias.
Methods: The protocol was registered on PROSPERO, Record [deleted for blind review]. Elmnet, Pubmed, and ProQuest were searched for randomized trials. A multilevel meta-analysis was used to capture the hierarchical structure of the data, and robust variance estimation was used for inference. Several moderation analyses were conducted, and publication and other related sources of bias were examined.
Results: Forty-two trials were initially included. Six were excluded before the analysis due to serious reporting problems undermining their validity. The SMD from 185 effect sizes was 1.08 [.87, 1.3]. The funnel plot showed a strong bias. The bias-corrected estimate from a regression-based method was 0.45 [0.04, 0.87], and from the trim-and-fill was 0.75 [0.48, 1.0].
Conclusion: While our original estimate was large, the corrected estimation showed a medium effect, fairly comparable to the international estimates. Current evidence on different sources of bias in our literature suggests low quality and questionable research practice as the first suspects for our local evidence bias.

Abstract Background: Knee Osteoarthritis (OA) is a common degenerative joint disease characterized by ongoing pain and reduced physical function.
Objectives: We aimed to systematically review and meta-analyze the clinical trials that evaluated the impact of transcranial Direct Current Stimulation (tDCS) on knee OA pain.
Methods: A comprehensive search was performed on Scopus, Web of Science, PubMed/MEDLINE, EMBASE, ProQuest, CENTRAL via Cochrane, and PEDro from the inception of these databases until May 31, 2023 with no language restrictions. The objective of the search was to find publications that examined the impact of active tDCS compared to sham tDCS or other interventions in individuals with knee OA.
Results: The meta-analysis comprised ten studies including 517 patients with knee OA. Active tDCS resulted in significantly lower pain scores compared to sham tDCS/ Transcutaneous Electrical Nerve Stimulation (TENS) immediately (effect sizes from pre-test–post-test-control design (dppc2) = -0.83, I² = 61.8%), short-term (dppc2 = -0.74, I² = 43.5%), and mid-term (dppc2 = -1.94, I² = 87.8%) follow-ups, but not in the long term (dppc2 = -0.25, I² = 29.6%). However, the certainty of the evidence was assessed as low to very low.  Moreover, function was significantly improved with active tDCS immediately after the last treatment session either by McMaster Universities Osteoarthritis Index (WOMAC) or Knee Injury and Osteoarthritis Outcome Score (KOOS) (dppc2 = -0.38, I² = 6.6% and dppc2 = 0.87, I² = 60.1%, respectively). The certainty of the evidence was very low. No serious adverse effects of tDCS were reported by the majority of studies.
Conclusion: More than half of the included trials had unclear or high risk of bias and there were no patient follow-ups beyond three months. Given the criteria of reduced I² and sufficient number of studies, no potential sources of heterogeneity were identified. Further high-quality randomized clinical trials with extended follow-up periods are required to determine the true effects of tDCS on knee OA.

Abstract Background: Smart hospitals today use Artificial Intelligence to improve the quality of their services. In this sense, optimizing the patient's electronic medical record is one of the most significant issues that these hospitals face.
Objectives: This study aimed to determine the role of AI in patient electronic records in a smart hospital.
Methods: This study was a systematic review, with keywords searched in PubMed, Scopus, Google Scholar, and SID databases. In Persian and English, the keywords were artificial intelligence algorithms, electronic medical records, service quality, and hospital. The inclusion criteria included publication in Persian or English, full-text papers, current publications, and a focus on the use of AI in electronic medical records. Finally, about 57 papers related to the investigation were picked.
Results: After reviewing previous related studies, it was discovered that AI can play a role in various aspects of electronic patient records, such as disease diagnosis, predicting relapse and recovery periods, improving treatment accuracy and reducing medical errors, digital care, and decision-support systems. This can result in a 20-30% improvement in resource planning, a 30% decrease in wait times, better resource use, and more accurate predictions.
Conclusion: Leveraging AI in electronic patient records is critical for maximizing benefits while minimizing hazards. Despite the limitations, AI has the potential to become a critical tool for smart hospitals in improving healthcare delivery and efficiency. Accordingly, healthcare leaders that incorporate AI algorithms into their systems can give more effective and up-to-date care to their patients.

Abstract Background: Digital transformation through the use of technologies like blockchain, Artificial Intelligence (AI), and the Internet of Things (IoT) is the main focus of the 4th generation technology. In smart hospitals, the 4th generation technology boosts productivity while cutting expenses, permits monitoring and early diagnosis, and enhances the quality of medical services.
Objectives: This study was carried out with the intention of implementing the 4th generation technology tools in smart hospitals, given the current technological breakthroughs and the need for smart hospitals in Iran.
Methods: The current research is bibliometric in nature. All the papers published between 2000 and 2024 that had focused on the themes of smart hospitals and the 4th generation technologies which contained keywords like blockchain, AI, the IoT, and smart hospitals make up the study's population. Advanced searches in the citation ScienceDirect and PubMed databases were used to gather the data for this investigation. The citation network was visualized and examined using VOSviewer software.
Results: According to this survey, when it comes to the use of the 4th generation technology tools in smart hospitals, 40% of the articles mention improving patient care, 35% highlight operational efficiency, and 25% stress data driven decision making as important elements.
Conclusion: In addition to boosting patient safety, monitoring, early diagnosis, and the quality of medical services, the 4th generation technology tools are essential for converting a conventional hospital into a smart hospital and cutting expenses. These instruments are therefore crucial for enhancing patients' comfort and well-being in smart hospitals.

Abstract Background: Infection prevention, control, and health workers’ safety in the face of biological agents are among the vital issues in healthcare systems worldwide. Considering the high prevalence of COVID-19 infection and its high mortality rate, this epidemic can be tackled to some extent through infection control in the general population and promoting the safety of health centers.
Objectives: The aim of this study was to scrutinize the literature regarding measures adopted for infection control and safety of healthcare workers in health centers during the beginning of COVID-19.
Methods: A systematic review following the PRISMA guidelines was performed. Keywords related to the study namely, “prevention and control”, “safety”, “coronavirus”, “COVID-19”, and “health personnel” in PubMed, Web of Science, ScienceDirect, Scopus databases, and Google Scholar using AND/OR functions from February 2020 to July 2020 were searched. To select the documents, the titles of the retrieved studies were first evaluated for relevance; then, the abstracts and full texts of the papers with relevant titles were inspected.
Results: Out of 136 retrieved studies, 10 were relevant and their data were analyzed. Four articles highlighted the importance of prevention, three enunciated the importance of control, and three related to care providers’ safety. The results showed that the COVID-19 epidemic has affected the healthcare providers’ health; however, it is possible to prevent a catastrophe through strategic planning, prevention, and control measures.
Conclusion: Considering the importance of healthcare workers’ health, it is necessary to implement COVID-19 prevention and control management principles based on scientific evidence.

Abstract Background: Primiparous lactating women experience complex hormonal, physical, and psychological changes that often impair their sexual function. Non-pharmacological interventions like acupressure and auriculotherapy are promising complementary approaches to address these issues.
Objectives: This systematic review aims to synthesize evidence on the effects of acupressure and auriculotherapy on sexual function, sexual satisfaction, and related health outcomes in primiparous lactating women.
Methods: Electronic databases were searched for relevant studies. We searched for randomized controlled trials, clinical trials, and pilot studies that investigated acupressure or auriculotherapy interventions. Outcomes of interest included sexual function, sexual quality of life, anxiety, depression, sleep quality, and lactation performance. Findings were categorized by intervention type and outcomes.
Results: For this purpose, 13 studies published between 2015 and 2025 met the inclusion criteria. The available evidence suggests that acupressure at specific points (e.g., SP6, CV4) can improve sexual function and increase breast milk volume. Auriculotherapy targeting specific ear points has been shown to improve sexual function, alleviate symptoms of postpartum anxiety and depression, enhance sleep quality, and reduce perineal pain. Both interventions are reported as safe, non-invasive, and low-risk. However, the current body of evidence is limited by small sample sizes, short intervention durations, and limited long-term follow-up.
Conclusion: Overall, this study showed that acupressure and auriculotherapy represent promising complementary therapies for enhancing sexual function and overall well-being in primiparous lactating women. Further large-scale, long-term randomized controlled trials are necessary to confirm these findings and establish standardized clinical protocols.