Silymarin pretreatment protects against ethanol-induced memory impairment: Biochemical and histopathological evidence

BACKGROUND

Ethanol (Eth.) abuse induces memory impairment. Oxidative damage and apoptosis are considered the likely causes of memory impairment. Silymarin (Sil.) is a flavonoid isolated from the plant Silymarin marianum (milk thistle). While studies have reported the neuroprotective effect of Sil. against neurodegenerative processes, the precise mechanism of action of Sil. in Eth.-induced memory impairment remains unclear.

METHODS

Twenty-eight rats were equally divided into four groups: Control (saline 1 ml/rat); Sil. (200 mg/kg for 30 days); Eth. (2 g/kg/day for 30 days); and Sil. + Eth. Behavioral tests including inhibitory avoidance and open field were used to investigate memory and locomotion. Brain antioxidant parameters, including catalase, superoxide dismutase, total antioxidant capacity and total thiol group, plus oxidative parameters, including malondialdehyde and total oxidant status, followed by hippocampal apoptosis (Bax/Bcl2, cleaved caspase) and histopathological changes were evaluated in the groups.

RESULTS

While the administration of Eth. impaired memory, Sil. significantly reversed Eth-induced memory deficits. Eth. administration also augmented brain oxidative and hippocampal apoptosis parameters. In contrast, a marked reduction in brain antioxidant and anti-apoptotic parameters was observed in the Eth. group. At the tissue level, hippocampal sections from Eth.-treated animals revealed severe neuronal damage. The administration of Sil. to Eth.-treated rats remarkably alleviated all the said Eth.-induced biochemical and histopathological effects. On the contrary, Sil. alone did not change the behavior and biochemical/molecular parameters.

CONCLUSION

The memory-enhancing effect of Sil. in Eth.-induced demented rats may be partly mediated by the augmented antioxidant effects and amelioration of apoptotic and histopathological changes.

Iranian health financing system challenges to promote health outcomes: Qualitative study

BACKGROUND

Adequate health financing system should have key criteria and characteristics such as risk distribution over time, risk accumulation, sustainable resource provision, and resource allocation based on meeting essential needs. Weakness of the tariff system, lack of attention to strategic purchasing, inefficient allocation of manpower, and a weak payment system are among the problems within the Iranian financing system. Given the weaknesses of the current health financing system, it seems necessary to identify challenges and provide effective solutions to address them.

MATERIALS AND METHODS

This qualitative study was conducted to explore the views of a group of 32 major policymakers and planners in the various departments and levels of the Ministry of Health, Universities of Medical Sciences, Medical System Organization, and Health Insurance Organization in Iran (n = 32), selected through purposive sampling. The data was collected through in-depth and semi-structured interviews and analyzed using Graneheim and Lundman's conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process.

RESULTS

Based on the results of data analysis, a total of 5 categories and 28 subcategories were obtained. In this study, five main categories were obtained through the content analysis method, including (1) stewardship; (2) providing services; (3) production of resources; (4) collecting resources; and (5) purchasing and allocation of resources.

CONCLUSION

It is suggested that those in charge of the health system, following the reform of the organization of the health system, move toward the improvement and widespread implementation of the referral system and that clinical guidelines be carefully compiled. Also, appropriate motivational and legal tools should be used to implement them. However, insurance companies need to make cost, population, and service coverage more effective.

Picture of the employment status of nurses in the world: Scoping review on pros and cons

Nurses play a vital role in the delivery, quality improvement of healthcare services, and promoting patient health. Therefore, methods of providing nurses are an important issue. This study was conducted to collect evidence on the methods of providing nurses and their advantages and disadvantages by a scoping review method. The Arksey and O'Malley Framework and PRISMA were used in directing the present scoping review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to conduct the review and report on results. The ISI Web of science, PubMed, Scopus, and ProQuest electronic databases were searched for relevant articles published between January 2010 and December 2020 using the keywords and their synonyms. Finally, 19 articles out of 1813 ones to answer the research questions were selected. The results showed that although two general methods are for the employment status of nurses (full-time and part-time nurses), different classification countries are dissimilar from each other. A total of 13 advantages and 20 disadvantages of the part-time pattern and 6 advantages and 4 disadvantages were extracted from the full-time pattern of studies. None of the patterns has precedence over the other. Despite the strengths and weaknesses, each of the full-time or part-time patterns in its position is beneficial. With proper management and planning, it is possible to minimize their weaknesses and benefited from their advantages. Training part-time nurses to maintain and improve their level is a key point in reducing the disadvantages of this pattern.

In-silico investigations of haemodynamic parameters for a blunt thoracic aortic injury case

Accounting for 1.5% of thoracic trauma, blunt thoracic aortic injury (BTAI) is a rare disease with a high mortality rate that nowadays is treated mostly via thoracic endovascular aortic repair (TEVAR). Personalised computational models based on fluid-solid interaction (FSI) principals not only support clinical researchers in studying virtual therapy response, but also are capable of predicting eventual outcomes. The present work studies the variation of key haemodynamic parameters in a clinical case of BTAI after successful TEVAR, using a two-way FSI model. The three-dimensional (3D) patient-specific geometries of the patient were coupled with three-element Windkessel model for both prior and post intervention cases, forcing a correct prediction of blood flow over each section. Results showed significant improvement in velocity and pressure distribution after stenting. High oscillatory, low magnitude shear (HOLMES) regions require careful examination in future follow-ups, since thrombus formation was confirmed in some previously clinically reported cases of BTAI treated with TEVAR. The strength of swirling flows along aorta was also damped after stent deployment. Highlighting the importance of haemodynamic parameters in case-specific therapies. In future studies, compromising motion of aortic wall due to excessive cost of FSI simulations can be considered and should be based on the objectives of studies to achieve a more clinical-friendly patient-specific CFD model.

The effect of chit powder technology in the treatment of burn hazards victims: A systematic review

Objective: In order to heal burn wounds, many researches have been done, including the use of biological scaffolds due to their ability to achieve the desired properties. Owing to the appropriate biological properties of chitosan such as biocompatibility and antimicrobial properties as well as the promotion of wound healing in biomedical applications, we aimed to perform a systematic review to investigate the effect of this technology on the treatment of burn hazards victims. Methods: The present research was conducted in 2020 as a systematic review of studies related to the effect of chitosan on burns. In this study, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Critical Appraisal Skills Programme (CASP) guidelines were used to assess the articles. The key words "Chitosan," "Chitin," "victim," "Injury," "Burn," "Heal," "wound" "treat," "hazard," and "care" were used in combination with the Boolean operators OR and AND. The ISI web of science, PubMed, Scopus, Science Direct, Ovid, Pro Quest, Wiley and Google Scholar were searched. Results: Recently, chitosan and its derivatives have been proposed as suitable candidates for scaffolding and can be used as temporary scaffolds to modify and stimulate the growth of new tissues. Studies to demonstrate the use of chitosan in the treatment of burns have been limited to research on animal models and have been superior to conventional therapies in terms of time, pain, and efficacy. Conclusion: The effect of chitosan on burns has been positive in animal models and has accelerated wound healing. Since the main ingredient of chit powder is chitosan and due to the limited studies done on humans, it cannot be said with certainty that the use of chitosan and its derivatives to treat burns is better than other ways to treat burns.

The economic cost of cancer treatment in Iran

BACKGROUND

With more than 12 million new cases of cancers and nearly 7.6 million deaths worldwide in 2020, cancer is currently the third leading cause of mortality in the world. The costs spent on treating patients with cancer account for a significant amount of healthcare costs. Healthcare expenditures for cancer treatment have also increased significantly and are projected to skyrocket further over the next decade. This study was conducted to determine medical and non-medical direct costs for the prevention of cancer in patients hospitalized in 10 selected educational hospitals in Iran.

MATERIALS AND METHODS

The study employed a cross-sectional design and was conducted in 10 selected educational hospitals in Tabriz, Tehran, Isfahan, Mashhad, and Shiraz in 2020. Using a researcher-made questionnaire, we assessed direct medical costs and direct non-medical costs of cancer in patients over 20 years old with kinds of breast, prostate, leukemia, lymphatic, stomach, liver, lung, bladder, uterine, and intestine cancers who undertook oncology treatments (n = 2410). Data were analyzed using descriptive statistics including mean and standard deviation and analytic statistics such as Kolmogorov-Smirnov, analysis of variance, and t-test, using SPSS 18 and P ≤0.05.

RESULT

The mean direct non-medical cost paid out of pocket per month was $99.6 ± $10.81 USD, and the mean direct medical cost per month was $1029.4 ± $68.5 USD. The total cost paid by the patients was $889.4 ± 69.81 USD per month.

CONCLUSION

Given the increasing number of patients with cancer, it is necessary to increase the number of special centers for the prevention and treatment of cancers. Dissemination of information about the costs of illnesses and their complications enables decision-makers to make a proper comparison between different uses of resources. Moreover, to support the patients, the health system must implement plans to decrease out-of-pocket payments by patients.

Iran's Struggling Health System in the Policy of Managing the COVID-19 Pandemic

BACKGROUND

Infectious diseases are one of the most important problems that affect the whole world. The World Health Organization (WHO), an active health organization, has identified coronavirus disease 19 (COVID-19) as a public health emergency and advises governments not to waste time on effective measures and interventions to attack and suppress the virus. In Iran, so far, the total number of screening tests has exceeded 21 million tests and more than 5 million doses of vaccine have been injected. However, we are still far from controlling the epidemic wave. Given the current situation, it is necessary to identify the challenges of managing the new coronavirus epidemic (COVID-19) in the country's medical universities.

METHODS

This qualitative study was conducted from January 2020 to January 2021 to explore the views of a group of service providers and staff managers of medical universities who were selected via purposeful sampling (n = 47). Data were collected through semi-structured interviews and analyzed using Graneheim and Lundman's conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process.

RESULTS

Upon analysis of data by service providers and staff managers of medical universities, five main themes including governance and leadership, service delivery, human resources, medicine and technology, and financing and 15 sub-themes including management and leadership, culture and society, process, infrastructure, manpower, training and skills, mental pressure, work pressure, nutrition, safety, employee motivation, medical equipment, medicine, payment, and funds were found.

CONCLUSIONS

Identification of the most important challenges of service providers and staff managers can play an important role in improving the management of the new coronavirus epidemic (COVID-19). It seems that in order to solve some of these challenges, coordination is needed outside the field of health, and considering the formation of the National Corona Headquarters at the national level, it is possible to use this infrastructure to provide the necessary policies and strategies.

Explore pre-hospital emergency challenges in the face of the COVID-19 pandemic: A quality content analysis in the Iranian context

Background

pre-hospital emergency is a community-oriented system that responds to the medical needs of the injured or patients with acute and emergency illnesses outside of health care facilities until they are transferred to a medical center. This study aimed to explore pre-hospital emergency challenges in the face of the COVID-19 pandemic.

Material and methods

This study was conducted as a qualitative content analysis in Iran. Using the purposive sampling method, data were collected through in-depth individual interviews with 28 prehospital paramedic personnel from November 2020 to November 2021. Graneheim and Lundman's conventional content analysis methods were used to analyze the data and for the trustworthiness of the data, this study used Lincoln and Guba's recommendations.

Results

After multiple rounds of analyzing and summarizing the data and taking into consideration similarities and differences, four main categories and 10 subcategories were created based on the results of the data analysis and including (1) Culture and Community. (2) Service delivery (3) Human resources; (4) Medical supplies and equipment.

Conclusion

According to the findings of this study emergency medical system employees are suffering from a range of psychiatric problems as a result of a lack of equipment and job overload, which has a detrimental impact on the quality of pre-hospital emergency care. Therefore, emergency care senior management should develop comprehensive guidelines, provide more equipment and minimize professional challenges to improve the quality and safety of pre-hospital emergency care services.

Exploring the challenges of Iranian government hospitals related to Covid-19 pandemic management: a qualitative content analysis research from the nurses perspective

Background

The COVID-19 pandemic poses a major threat to global public health. As a result, to prepare healthcare systems for this unprecedented threat, a coordinated worldwide response is required. This study aimed to explore the hospitals challenges related to covid-19 pandemic management from the iranian nurses perspective.

Methods

This study was conducted as a qualitative content analysis in Iran. Using the purposive sampling method, data were collected through in-depth individual interviews with 35 nurse personnel. Graneheim and Lundman’s conventional content analysis methods were used to analyze the data and for the trustworthiness of the data, this study used Lincoln and Guba’s recommendations.

Results

After multiple rounds of analyzing and summarizing the data and taking into consideration similarities and differences, 5 main categories and 14 subcategories created based on the results of data analysis and including1) Leadership and management 2) Service delivery management 3) Human resources management 4) Equipment and Supplies Management and 5) Economic resources management.

Conclusion

Identifying the most important challenges of nursing can play an important role in improving the management of COVID-19pandemic. The analysis of the challenges by managers at local, provincial and national levels can lead to the presentation of effective solutions to address these challenges and improve the pandemic management process in the country.

Workplace violence and influencing factors among paramedic pre hospital paramedic personnel (city and road) in Iran: a quality content analysis

Background

The goal of every emergency department is to provide the highest quality services in the shortest time using limited resources. However, occupational violence is so prevalent among pre-hospital paramedic personnel that some experts claim that it is impossible to find pre-hospital personnel without an experience of violence in the workplace. Therefore, it seems necessary to investigate the causes of violence among this population group and find ways to control it.

Aim

The present study aimed to investigate the Violence and influencing factors among paramedic pre-hospital personnel.

Method

This qualitative study was conducted to explore the views of a group of pre-hospital paramedic personnel (n = 45) selected through purposive sampling. The data was collected through in-depth and semi-structured interviews and analyzed using Graneheim and Lundman’s conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process.

Results

Based on the results of the analysis of data collected from prehospital paramedic personnel, three main categories including: human factors, organizational factors, and environmental factors and 20 subcategories were detected.

Conclusion

If authorities neglect violence in the workplace and do not take serious actions to prevent it, violence and, more importantly, “hostility” will gradually prevail in the workplace. It also increases the stress and anxiety of staff and consequently severely deteriorates their job performance. Hence, authorities are strongly recommended not to ignore this issue and, instead, take measures, for instance hold workshops, to train personnel about the techniques of anger and violence control.

Different Approaches to Confronting the Biological Epidemic; Prevention Tools with an Emphasis on COVID-19: A Systematized Study

BACKGROUND

The World Health Organization has identified COVID-19 as a public health emergency and is urging governments to stop the virus transmission by adopting appropriate policies. In this regard, authorities have taken different approaches to cutting the chain or controlling the spread of the disease. The aim of this study was to determine the approaches to biological epidemics and related prevention tools with emphasis on COVID-19 disease.

METHODS

The present study was a systematize study of publications related to the prevention strategies for Covid-19 disease. The study was carried out based on the PRISMA guidelines, CASP and AACODS. The data resources included ISI/WOS, PubMed, Scopus, science direct, Ovid and ProQuest. WHO website, published reports of countries, as well as the Worldometer website were evaluated. The time-frame of the study was from 1 December 2019 to 30 May 2020.

RESULTS

The study findings showed that in order to confronting the COVID-19 epidemic, in general, there are three approaches of "mitigation", "active control", and "suppression" and four strategies of "quarantine", "isolation", "social distance", and "lockdown" in both individual and social dimensions to deal with epidemics. Selection and implementation of each approach requires specific strategies and has different effects when it comes to controlling and inhibiting the disease.

CONCLUSION

One possible approach to control the disease is to change individual behavior and lifestyle. In addition to prevention strategies, use of masks, observance of personal hygiene principles such as regular hand washing and non-contact of contaminated hands with the face, as well as observance of public health principles such as sneezing and coughing etiquettes, safe extermination of personal protective equipment must be strictly observed. The use of the previous experiences in the world, along with the current experiences of countries, can be very helpful in choosing the accurate approach for each country in accordance with the characteristics of that country and lead to the reduction of possible costs at the national and international levels.

Challenges of the Health System in Preventing Non-Communicable Diseases; Systematized Review

Background:

The basis of prevention of non-communicable diseases is the identification of primary risk factors and the prevention and control of these factors. The purpose is to prevent the spread of the disease and to control it as much as possible. If population growth continues at this rate, by 2030, 52 million people will die from these diseases each year. The aim of this study was to evaluate the challenges of preventing non-communicable diseases.

Methods:

The present study was a systematic review that conducted in July 2020 and the articles related to prevention of non-communicable diseases on databases of web of science, PubMed, Scopus, science direct, Ovid, Pro Quest and Google Scholar. Strategy for searching and selecting the articles was PRISMA Guidelines.

Results:

Challenges of non-communicable disease prevention, in 4 main codes, including infrastructure, economic, demographic and management and 12 sub-codes that include, lack of preventive infrastructure, restrictions on access to medicine, restrictions on primary health care, restrictions on access to Technology, disease-oriented disease, unsustainable financial resources, failure to implement poverty reduction projects, increase in aging population, migration, rapid and unplanned urban planning, hasty planning and lack of internal and external coordination were classified.

Conclusions:

To reduce non-communicable diseases, strengthen global capacities, reduce risk factors for NCDs and place social determinants by creating health-promoting environments, strengthen health systems to implement prevention and control of NCDs, and place determinants Social can play an effective role through people-centered primary health care.

Exploring Challenges of Health System in Iranian Traditional Medicine: A Qualitative Study

Background

Traditional medicine is a complete system, including diagnostic methods, etiology and treatment based on interpersonal differences.

Owing to a lack of investigations in the field of Iranian traditional medicine as well as its many present challenges, certain studies in this area can prove quite practical in identifying and solving ongoing challenges. This study investigates the challenges of the health system in Iranian traditional medicine in the context of control levers.

Methods

The study was qualitative content analysis. A framework analysis, “Control Knob Approach”, was considered appropriate to promote apprehension of challenges of health systems in Iranian traditional medicine. Data were collected by purposeful sampling through in-depth and semi-structured individual interviews with 35 experts of Iranian traditional medicine. Directed content analysis was used to analyze the data, which extracted the initial codes after performing the recorded interviews on paper and immersing them in the data analysis.

Results

Upon analysis of data by Iranian medicine experts, five main categories including financing, payment system, regulations, behavior and organization were defined alongside 13 subcategories.

Conclusion

According to current challenges and the tendency of society to receive traditional medicine services, as well as the long history of traditional medicine in Iran, fair access to traditional medicine services should be provided. This access must be through the production of indigenous knowledge and the formulation of regulatory and educational policies and guidelines and the empowerment of relevant, healthy, effective, evidence-based and cost-effective forces.

Strategic purchasing and the performance of health-care systems in upper middle income countries: A comparative study

BACKGROUND

Providing financial resources for health services is one of the most important issues in the study of health systems, of which purchasing health services is very essential. The World Health Organization considers strategic purchasing as a key option for improving the performance of health systems. The aim of this study was to identify payment methods for service providers and strategic purchasing strategies in upper middle income countries.

MATERIALS AND METHODS

The present study was conducted in the form of a comparative analysis involving comprehensive surveys from 2000 to 2019, by searching keywords for the objective of the study by the search engines through databases including ProQuest, PubMed, Google Scholar, Irandoc, SID, Magiran, Science Direct, Scopus, ISI Web of Science, EBSCO, and Cochrane.

RESULTS

A total of five upper middle income countries that used strategic purchases entered the study. Overall, all of them implemented rather similar strategies in terms of strategic purchasing and paying to the providers of the services.

CONCLUSION

According to the results of this study, per capita payment for primary health-care and outpatient services seems to be the best option for controlling the costs of the health sector, while the appropriate option for the inpatient department is the most common use of diagnosis-related group. The payment method is to control the costs of the inpatient department.

What is the impact of clinical guidelines on imaging costs?

Inappropriate and irrational use of numerous advanced diagnostic imaging technologies has recently been highlighted in many countries and has gathered the attention of policymakers. This matter has not only increased health costs in countries but also resulted in adverse health results. Various factors are involved in the inappropriate or unnecessary use of advanced medical imaging techniques including patient-related, physician-related, technological, and ultimately radiologist-related factors. This calls for the provision of new guidelines by policymakers to encourage all service providers to make appropriate use of such techniques. One of the main approaches in this regard is the application of clinical guidelines and decision support systems. The present study was a systematized review that conducted in January 2019, and the articles related to palliative care requirements on databases of Web of Science, PubMed, Scopus, ScienceDirect, Ovid, ProQuest, Wiley, and Google Scholar from January 1, 2009, to January 20, 2019, were searched. Strategy for searching and selecting the articles was Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. Overview of the studies shows that various reasons for the overuse of diagnostic imaging technologies and effects of applying clinical guidelines on reducing diagnostic costs of treatment are investigated in this article with respect to various aspects and viewpoints. Clinical guidelines can be significantly effective in evaluating suitability and quality of referrals for diagnostic imaging, if only adapted properly.

What must Iran do for Palliative care? A systematized review

Palliative care has been proposed as a multidisciplinary method for providing patients with care. The present study proposes to discuss the necessary principles required for any country to successfully implement a palliative medicine program. The present study was a systematic review conducted in January 2019, and the articles related to palliative care requirements on the databases of Web of Science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, and Google Scholar from January 1, 2009, to January 20, 2019, were searched. Strategy for searching and selecting the articles was Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. The findings showed that the World Health Organization has introduced for main phases for increasing these types of services including: defining and developing a national policy, training and educating healthcare employees and general public, as well as pain relief. In general, two scenarios are described in the development of palliative medicine: bottom-up and top-down approaches. In conclusion, although there seem to be progressing activities regarding the issue of making palliative medicine accessible, there are still many obstacles including lack of adequate knowledge and political support, social and cultural problems, inadequate training and education of physicians and nurses, fixed and biased attitude in medical professions, and low priority of palliative medicine among policymakers. Therefore, it could be said that implementing palliative medicine programs requires an overall change in culture, public and individual education, political support, and appropriate policies.

Model-based Cost-effectiveness Analysis of Atorvastatin Drugs for Prevention of Cardiovascular Diseases in Iran

Background:

Today, cardiovascular disease is one of the main causes of mortality and disability in most developed and developing countries. The prediction of the major causes of deaths all over the world at all ages shows that 61% of deaths are due to chronic diseases, of which 30% is due to cardiovascular disease. The aim of this study was to assess the cost-utility analysis of atorvastatin for the prevention of cardiovascular diseases using the Markov model.

Methods:

Markov model with a lifetime horizon was developed to evaluate economic and health outcomes for atorvastatin drugs for the prevention of cardiovascular diseases for a cohort of 1,000 patients. The effectiveness indicator in this study was quality-adjusted life-years (QALYs); robustness of results was examined by one-way and probabilistic sensitivity analysis.

Results:

The results showed that the use of atorvastatin compared to no drug intervention was highly cost-effective with USD173 per additional QALY. The results of one-way and probabilistic sensitivity analysis confirmed the results of this study. The findings of this study also showed that the highest cost items were hospitalization costs in the cardiac care unit (CCU). Also, the highest cost items in para-clinical services were related to echocardiography costs, and troponin constituted the largest cost of laboratory tests.

Conclusions:

Based on the results of this study, it is recommended that cardiologists use atorvastatin in the prevention of cardiovascular disease.

Clinical Comparison of Volume Support Ventilation With Pressure Support Ventilation in Patients Admitted at Intensive Care Unit

Mechanical ventilation (MV) is among the main basics of supportive treatment for respiratory failure in the intensive care unit (ICU). This supportive treatment may cause undesirable complications that led to the introduction of various MV modes. The current study was aimed to assess and compare outcomes of volume support ventilation (VSV) and pressure support ventilation (PSV) regarding spontaneous breath return, weaning and hemodynamic changes among patients admitted at ICU following surgical procedures. This single-blinded randomized-clinical-trial (RCT) was conducted on 100 patients admitted at ICU in 2018-2019. Patients were randomly divided into two fifty-member groups treated with PSV and VSV modes. Oxygen saturation, systolic (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), arterial blood gas (ABG), extubation and MV time and sedation based on RAMSY criteria were recorded and compared. Mean age (P=0.79) and gender distribution (P=0.57) were not statistically different in the two groups. Time has no effect on patients' hemodynamic (P>0.05) while hemodynamic stability was superior in VSV (P<0.05). ABG showed no statistical difference between groups (P>0.05) except for arterial oxygen pressure that was higher in the VSV group (P<0.001). The duration of MV, extubation time and duration of ICU admission was significantly lower in the VSV group. Furthermore, sedation based on RAMSY criteria showed the superiority of VSV (P<0.05). Use of VSV mode was accompanied with superior outcomes in four entities including earlier and easier weaning, shorter duration of ICU admission, least hemodynamic instabilities and least sedation requirement in comparison to PSV mode. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):416-423.

Designing a safety management system for higher education centers

INTRODUCTION

The system of safety management in higher education centers can prevent the complications caused by harmful issues to students and bring their potential talents closer to perfection. Therefore, this study aimed to design a safety management system (SMS) in higher education centers of Iran in 2016.

MATERIALS AND METHODS

This study was a descriptive study of qualitative type. This study was conducted in three independent phases, including (1) evaluating theoretical concepts, (2) developing an initial system by determining the points of sharing and differentiation of the evaluated systems, and (3) validating the SMS using the Delphi technique. Consensus on opinions and identifying similarities and differences of reviewed studies have been used for qualitative data analysis, and the descriptive statistics (sum of scores and mean) by means of SPSS version 21 has been used for quantitative data analysis.

RESULTS

In the first stage, 108 indexes were identified by reviewing the studies and evaluating the SMS in the world's educational and noneducational organizations for the 12 main categories of SMS. In the Delphi phase, 83 components were identified as a key index of the SMS in higher education centers of Iran. Furthermore, the average mean of participants' views on the dimensions of the SMS for higher education centers has been 4.32, with the highest average mean of 4.59 related to the dimension of the facility and the firefighting department and the lowest mean of 4.10 for the student dimension.

CONCLUSION

The indexes presented in this study will provide a fairly complete tool for designing SMS in higher education centers, which by applying it will provide a good opportunity to improve the performance of these systems over time.

The Viewpoints of Managers and Healthcare Providers on Individual Barriers to Perform Preconception Care for Diabetic Women

Background

Individual barriers can affect the provision of preconception care (PCC). The aim of the present study was to determine the rank of importance of individual barriers (care recipients) in the provision of PCC among diabetic women from the viewpoints of care providers.

Materials and Methods

The present cross-sectional study was conducted on 212 health managers, physicians, and midwives from December 2015 to March 2016. The data collection tool was a two-part researcher-made questionnaire consisting of a demographic characteristics and viewpoints scored on a five-point Likert scale (range: 0-4). Data were analyzed in Statistical Package for the Social Sciences software.

Results

The mean (SD) individual barriers score of physicians, midwives, and health managers were 57.33 (15.63), 61.53 (17.81), and 54.57 (16.95), respectively (range: 0-100). A significant difference was observed between the three groups in terms of the mean score of importance of individual barriers (F = 2.54, df = 2, p = 0.040). Insufficient understanding of the importance of PCC by diabetic women and their families obtained the highest mean rank of importance in all groups.

Conclusions

Although individual barriers had more importance in access to PCC by diabetic women in the view of midwives compared to the other groups, the viewpoints of the three groups were similar in most cases regarding the rank of importance of items. In order to improve the quality of PCC, the necessary measures must be taken by authorities and care providers to eliminate important barriers.

Iran's Struggling Health System: An Increase in Natural Childbirth: A Case Study

Background:

The 7^th package of health reform in Iran has been implemented in May 15, 1393, is concerned with the “promotion of natural childbirth.” It has been focusing on reducing cesarean section (CS) and promoting normal vaginal delivery (NVD) as broadly as possible. This study evaluated the changes in the vaginal delivery and cesarean before and after implementation of the 7^th package of health reform in public and private hospitals of Isfahan Province in 2014.

Methods:

This was a quasi-experimental research. The population of this study contained all public and private hospitals in Isfahan Province covered by the Health Reform Program. It included 22 public and 6 private hospitals. The data collected from the vice chancellor of treatment in 6 months before and after the implementation of the program have been analyzed. SPSS software version 18.0 (SPSS Inc., Chicago, IL, USA) and independent t-test have been employed for data analysis.

Results:

It was demonstrated that the increasing rate of NVD (P = 0.001) and decreasing rate of CS in public hospitals (P = 0.027) after the implementation of the plan were significant. On the other hand, the increasing rate of CS in private hospitals was significant (P = 0.026).

Conclusions:

Although this scheme has achieved its targets in public hospitals of Isfahan Province, it has not met its objectives in private hospitals. It seems CS operations were shifted from public hospitals to private ones, which is conflict with the objectives of the health reform plan.

Strategic Analysis of Shiraz Medical Tourism Industry: A Mixed Method Study

Background:

The connection between healthcare and tourism industries in many countries has created one of the largest service industries, i.e. "medical tourism industry" which brings significant benefits to the countries. The present study aimed to examine internal and external factors affecting Shiraz medical tourism industry along with the potential capabilities of the industry.

Materials and Methods:

This applied research is a mixed method study conducted in 2017 employing both qualitative and quantitative methods. The study population consists of all organizations involved in the medical tourism industry. Deductive qualitative content analysis was employed so as to determine the internal and external factors influencing Shiraz medical tourism industry. Furthermore, the SWOT technique was used to analyze the data obtained from individual interviews and meetings with expert panels.

Result:

Internal and external factors were classified into four main themes, namely strengths, weaknesses, opportunities and threats and ten sub-themes, of which five cases (FORMM) were related to internal factors (i.e. finance, production and products (operations), research and development, marketing and management) and five cases (STEPC) were associated with external factors: Socio-cultural, technological, economic, political and competitive. The matrix of the internal and external factors indicated an offensive zone for this industry.

Conclusion:

This industry can make use of the strengths and opportunities to confront threats and negative points through identifying internal and external factors and enjoy benefits such as job creation and revenue gains.

An Open-Label Pilot Study to Evaluate the Efficacy of Tofacitinib in Moderate to Severe Patch-Type Alopecia Areata, Totalis, and Universalis

Alopecia areata (AA) is a common autoimmune disease with a lifetime risk of ∼2%. In AA, the immune system targets the hair follicle, resulting in clinical hair loss. The prognosis of AA is unpredictable, and currently there is no definitive treatment. Our previous whole genome expression studies identified active immune circuits in AA lesions, including common γ-chain cytokine and IFN pathways. Because these pathways are mediated through JAK kinases, we prioritized clinical exploration of small molecule JAK inhibitors. In preclinical trials in mice, tofacitinib successfully prevented AA development and reversed established disease. In our tofacitinib trial in 12 patients with moderate to severe AA, 11 patients completed a full course of treatment with minimal adverse events. Following limited response to the initial dose (5 mg b.i.d.), the dose was escalated (10 mg b.i.d.) for nonresponding subjects. Eight of 12 patients demonstrated ≥50% hair regrowth, while three patients demonstrated <50% hair regrowth, as measured by Severity in Alopecia Tool scoring. One patient demonstrated no regrowth. Gene expression profiles and Alopecia Areata Disease Activity Index scores correlated with clinical response. Our open-label studies of ruxolitinib and tofacitinib have shown dramatic clinical responses in moderate to severe AA, providing strong rationale for larger clinical trials using JAK inhibitors in AA. ClinicalTrials.gov ID NCT02299297.

Dynamical analysis of the avian–human influenza epidemic model using multistage analytical method

In this paper, analytical result of avian–human influenza epidemic model has been investigated by applying homotopy analysis method (HAM) and by expanding it to hybrid numeric-analytic method which is known as multistage HAM (MSHAM). HAM is an algorithm which gives us the approximate solution of the problem in an arrangement of time interims and by modifying it to multistage one. Some advantages such as flexibility of picking the auxiliary linear operator and the auxiliary parameter are emerged, that leads us to achieve some excellent results in this work. Furthermore, in this analytical work, obtained results are compared and reported with numerical ones which were obtained previously from methods such as the Runge–Kutta (RK4) method.

An investigation on the quality of midwifery services from the viewpoint of the clients in Isfahan through SERVQUAL model

BACKGROUND

Quality of care is of great importance in health services as these services have the important mission to preserve health, and to give care to the society. The present study aimed to investigate the quality of midwifery services from the viewpoint of the clients, under coverage of health care centers in Isfahan, through SERVQUAL model.

MATERIALS AND METHODS

This descriptive and analytical study was conducted on 218 subjects in 2014. Study population comprised the women referring to midwifery services clinics in health care centers in Isfahan. Data of the subjects (n = 218) were collected by SERVQUAL model containing the dimensions of tangibles, reliability, responsiveness, assurance, and empathy. Data were analyzed by paired t-test, Spearman and Pearson correlation coefficients, and independent t-test through SPSS 20.

RESULTS

There was a negative gap in all five relevant dimensions of giving services. The widest gap was in the mean of dimension of tangibles (-1.5), and the narrowest gap was in the dimension of assurance (-0.9). There was no significant association between the scores of expectations and perceptions, and age, education level, occupation, and marital status.

CONCLUSIONS

The obtained negative gap showed that the level of service receivers' perception from existing condition was far from their expectation, and there was a wide gap between attaining their satisfaction with midwifery services and their expectation and reaching their appropriate level of services.

A generalization of (G′/G)-expansion method and its application to nonlinear reaction–diffusion equations arising in mathematical biology

In this paper, by introducing a proper transformation, the (G′/G)-expansion method is further extended into the nonlinear reaction–diffusion equations in mathematical biology whose balancing numbers may be negative integer. As a result, hyperbolic function solutions and trigonometric function solutions with free parameters are obtained. When the parameters are taken as special values the solitary wave solutions and the periodic wave solutions are also derived from the traveling wave solutions. Moreover, it is observed that the suggested techniques is compatible of such problems.

The profile of patients' complaints in a regional hospital

BACKGROUND

A hospital should be an institution of understanding and respecting patients' rights, their families, physicians and other caregivers. Hospitals and all other healthcare centers must be cautious toward respecting ethical aspects of care and treatment. On the other hand, patients' satisfaction reflects capabilities of physicians and medical staff as well as the extent patients' rights and treatment quality are observed. Nowadays, complaints handling is considered as an essential component of healthcare system in line with promoting health standards. In the present study, researchers attempt to identify the resources, individuals, complained issues, and measures which are considered to handle these issues in a regional hospital.

METHODS

We employed a descriptive, cross-sectional study to conduct this research. The research population included cases registered at the complaints unit of one of the hospitals in Isfahan in selected months of 2012 to 2013. The data were collected through observation of available documents. Excel software program was used for data analysis.

RESULTS

Findings indicate that despite a decrease in the total number of complaints, there was an increase in the number of complaints about medical staff. Nursing staff were considered as the second highly complained unit during the study period.

CONCLUSION

RESULTS obtained from the present study can be taken as experiences to modify and amend the hospital's future performance. In general, the existence of complaints in a system is an indication of gaps when providing healthcare services. Creating an organized system to collect complaints and reviewing them helps hospitals to be cognizant of their defects and plan to prevent their reoccurrence.

Stakeholders' analysis of the medical tourism industry: development strategies in Isfahan

INTRODUCTION

Policy makers and decision makers must identify the stakeholders in medical tourism, who will be affected by and/or affect this industry, and determine their status for partnership. The aim of this study was to identify the main stakeholders in Isfahan's medical tourism, analyze them, and provide strategies for developing this industry.

MATERIALS AND METHODS

A qualitative study was conducted in 2011. At first, the key stakeholders in medical tourism were identified in accordance with the experts' idea and literature review. Then we interviewed the key stakeholders. Data analysis was conducted using the stakeholders' analyses, which helped in developing strategies.

RESULTS

The result showed that the key stakeholders were made up of nine groups. They included the provincial governance of Isfahan, the Cultural Heritage and Tourism Organization of Isfahan, the Chamber of Commerce, the Medical Council, the Isfahan University of Medical Sciences, health service providers, tourism services providers, investors, and the Tosea Saderat Bank. The rate of knowledge of the Cultural Heritage and Tourism Organization of Isfahan, clinic and international relationship of Isfahan University of Medical Sciences from government policy about medical tourism were very much. Private Hospitals, the Medical Council, investors, and the University of Medical Sciences had great power. Private hospitals, clinics, the Cultural Heritage and Tourism Organization of Isfahan, and the University of Medical Sciences were in the supporter position. The effected strategies were the included strategies, focused on increasing power; increasing support, and on maintaining the position.

CONCLUSION

There are different stakeholders in the medical tourism industry. Thus, policy makers can plan, make a policy and decision, and use effective strategies to develop medical tourism by designing a medical tourism stakeholders' network, a medical tourism provincial council, and clarify the roles and responsibilities of stakeholders.

The marketing mix and development of medical tourism in shiraz

INTRODUCTION

In recent years, medical tourism market has been raised as one of the income-earning and competitive industries in the world and is considered as a modern field of advanced tourism. Therefore, a great number of countries are seeking to develop this type of tourism and one of the strategies for developing this industry is using the marketing mix elements.

METHODS

This study was a descriptive-analytic and cross sectional one. The research community included all the public and private hospitals of Shiraz among which, 7 public and 9 private hospitals were studied. The study data were collected through a researcher-made check list whose face and content validity was confirmed by the experts. Then, the data were entered into the SPSS statistical software. According to the objectives of the study, the descriptive results were presented in frequency tables and Chi-square test was used for data analysis. In addition, P<0.05 was considered as statistically significant.

RESULTS

According to the results, both public and private hospitals of Shiraz were in the best condition regarding staff and physician mix and in the worst condition concerning promoting and facilities mixes. No significant difference was found between public and private hospitals regarding the mixes.

CONCLUSION

From marketing mix elements view, paying more attention to media advertisements and providing more facilities can improve the status of the hospitals which, consequently, results in attracting more medical tourists and developing this industry in Shiraz.

Medical tourism in Iran: Issues and challenges

INTRODUCTION

Medical tourism is rapidly becoming a worldwide, multibillion-dollar industry. Iran has a high potential for this industry. The purpose of this study was to examine the medical tourism cluster, using Diamond Analysis tool.

MATERIALS AND METHODS

This study is a descriptive, analytical and qualitative one. Thirty professionals and researchers in this field were interviewed and official documents belonging to the Health ministry as well as tourism organization and finally related literature were examined. The data was analyzed using content analysis method.

RESULTS

Positive and negative parts of the medical tourism industry of Iran were determined according to diamond of advantage.

CONCLUSION

The strategic issues were identified and a number of possible solutions for addressing them were recommended. More and effective public-private participations, aggressive marketing, improving infrastructures, and international accreditation of health care facilities and human resources development could improve medical tourism industry in the country.

Role of the immune system and immunological circuits in psoriasis

Psoriasis vulgaris is a chronic skin disease in which our understanding of the pathogenesis has substantially grown in recent years. Our current appreciation of the role of the immune system is that it plays a necessary and driving role in the disease process. Investigations into the genetics of psoriasis has spurred further examinations into the contributions of immune mediators such as IL-23, IL-17, IL-22, and TNF as well as cellular mediators including a variety of dendritic cell populations of the skin and the growing number of T cell types, including the Th17 and Th22 subsets. Investigations into how these soluble and cellular elements interact with each other and the skin and form complex signal circuits to engender the psoriasis phenotype is starting to become elucidated. Furthermore, these recent advances have been fruitful in leading to the development of new classes of biologic therapeutics that are remarkably effective in halting the disease process.