Development of minimum data set and dashboard for monitoring adverse events in radiology departments

Background

To reduce the risk of errors, patient safety monitoring in the medical imaging department is crucial. Interventions are required and these can be provided as a framework for documenting, reporting, evaluating, and recognizing events that pose a threat to patient safety. The aim of this study was to develop minimum data set and dashboard for monitoring adverse events in radiology departments.

Material and methods

This developmental research was conducted in multiple phases, including content determination using the Delphi technique; database designing using SQL Server; user interface (UI) building using PHP; and dashboard evaluation in three aspects: the accuracy of calculating; UI requirements; and usability.

Results

This study identified 26 patient safety (PS) performance metrics and 110 PS-related significant data components organized into 14 major groupings as the system contents. The UI was built with three tabs: pre-procedure, intra-procedure, and post-procedure. The evaluation results proved the technical feasibility of the dashboard. Finally, the dashboard's usability was highly rated (76.3 out of 100).

Conclusion

The dashboard can be used to supplement datasets to obtain a more accurate picture of the PS condition and to draw attention to characteristics that professionals might otherwise overlook or undervalue.

Effects and characteristics of clinical decision support systems on the outcomes of patients with kidney disease: a systematic review

OBJECTIVES

This systematic review was conducted to investigate the characteristics and effects of clinical decision support systems (CDSSs) on clinical and process-of-care outcomes of patients with kidney disease.

METHODS

A comprehensive systematic search was conducted in electronic databases to identify relevant studies published until November 2020. Randomized clinical trials evaluating the effects of using electronic CDSS on at least one clinical or process-of-care outcome in patients with kidney disease were included in this study. The characteristics of the included studies, features of CDSSs, and effects of the interventions on the outcomes were extracted. Studies were appraised for quality using the Cochrane risk-of-bias assessment tool.

RESULTS

Out of 8722 retrieved records, 11 eligible studies measured 32 outcomes, including 10 clinical outcomes and 22 process-of-care outcomes. The effects of CDSSs on 45.5% of the process-of-care outcomes were statistically significant, and all the clinical outcomes were not statistically significant. Medication-related process-of-care outcomes were the most frequently measured (54.5%), and CDSSs had the most effective and positive effect on medication appropriateness (18.2%). The characteristics of CDSSs investigated in the included studies comprised automatic data entry, real-time feedback, providing recommendations, and CDSS integration with the Computerized Provider Order Entry system.

CONCLUSION

Although CDSS may potentially be able to improve processes of care for patients with kidney disease, particularly with regard to medication appropriateness, no evidence was found that CDSS affects clinical outcomes in these patients. Further research is thus required to determine the effects of CDSSs on clinical outcomes in patients with kidney diseases.

Clinical predictors of Covid-19 mortality in a tertiary hospital in Lagos, Nigeria: A retrospective cohort study

Background

The predictors of mortality among patients presenting with severe to critical disease in Nigeria are presently unknown.

Aim

The aim of this study was to identify the predictors of mortality among patients with COVID-19 presenting for admission in a tertiary referral hospital in Lagos, Nigeria.

Patients and Methods

The study was a retrospective study. Patients' sociodemographics, clinical characteristics, comorbidities, complications, treatment outcomes, and hospital duration were documented. Pearson's Chi-square, Fischer's Exact test, or Student's t-test were used to assess the relationship between the variables and mortality. To compare the survival experience across medical comorbidities, Kaplan Meir plots and life tables were used. Univariable and multivariable Cox-proportional hazard analyses were conducted.

Results

A total of 734 patients were recruited. Participants' age ranged from five months to 92 years, with a mean ± SD of 47.4 ± 17.2 years, and a male preponderance (58.5% vs. 41.5%). The mortality rate was 9.07 per thousand person-days. About 73.9% (n = 51/69) of the deceased had one or more co-morbidities, compared to 41.6% (252/606) of those discharged. Patients who were older than 50 years, with diabetes mellitus, hypertension, chronic renal illness, and cancer had a statistically significant relationship with mortality.

Conclusion

These findings call for a more comprehensive approach to the control of non-communicable diseases, the allocation of sufficient resources for ICU care during outbreaks, an improvement in the quality of health care available to Nigerians, and further research into the relationship between obesity and COVID-19 in Nigerians.

Comparative effects of Er:YAG laser, and EDTA, MTAD, and QMix irrigants on adhesion of stem cells from the apical papilla to dentin: A scanning electron microscopic study

Background

Dentin conditioning can affect the adhesion of stem cells in endodontic regenerative treatments. This study aimed to assess the effects of the most commonly used endodontic irrigants, namely, ethylenediaminetetraacetic acid (EDTA), MTAD, and QMix in comparison with Er:YAG laser (as a novel modality for root canal disinfection) on the adhesion of stem cells from the apical papilla (SCAPs) to dentin.

Material and Methods

Forty dentin specimens were prepared and subjected to different treatments in 5 groups (n=8) of control, irrigation with EDTA for 1 minute, irrigation with MTAD for 5 minutes, irrigation with QMix for 5 minutes, and Er:YAG laser irradiation. SCAPs were isolated from third molar tooth buds that two-thirds of their roots had formed. The cells were cultured on dentin specimens for 3 days and were counted using scanning electron microscopy (SEM).

Results

MTAD resulted in significantly lower adhesion of cells to dentin compared with other groups (P<0.05). All other modalities induced cell adhesion with no significant difference with each other (P>0.05).

Conclusions

Despite many favorable properties, MTAD cannot serve as an optimal irrigant in endodontic regenerative procedures since it inhibits the adhesion of SCAPs to dentin and impairs an important step in tissue engineering.

Key words:Endodontic Regeneration, Er-YAG laser, MTAD, QMix, EDTA, SCAP, stem cell adhesion.

Covid 19: A Prospective Observational Study on the Cutaneous Manifestations of Patients in Lagos, Nigeria

BACKGROUND

Cutaneous manifestations of COVID-19 have been documented from Europe, USA, and China but none from Africa to date. Skin findings among Africans differ from Caucasians and it is important to report these in Nigerians with COVID-19.

METHODS

A prospective observational review involving patients seen at the Emergency triage, and Isolation wards of the Lagos University Teaching Hospital. Demographic and clinical data were captured; skin and appendages were examined by a dermatologist between 0800hrs and 1600hours to minimise visual errors of artificial light masking cutaneous lesions.

RESULTS

Of 235 participants, 17 (7.23%) had recent onset skin rash, with 7 (41.2%) experienced itching and 11 confirmed with COVID-19. There was a male: female ratio of 97:43 (2.3:1) among COVID-19 patients. Cutaneous findings were seen in 12 (5.1%) participants, with the face and trunk mostly affected and acne plus papular eruptions predominating. There was no significant relationship between COVID-19 and recent onset skin rash (χ2, p = 0.87). Only 2 of the 17 participants had a previously existing dermatoses ((χ2, p = 0.84). There was no significant relation between use of medications and onset of rashes (χ2, p = 0.72) or between those with co-morbidities and onset of rashes (χ2, p = 0.51).

CONCLUSION

Cutaneous manifestations were found among Nigerian patients with SARS-CoV-2 infection. Most presented with pruritus and papular eruptions and no morphologic pattern was demonstrated. Physicians and dermatologists need to be aware and look out for skin changes in SARS-CoV-2 infection as they may be early pointers to COVID-19. Keywords: Cutaneous findings, manifestations, Skin, COVID-19, Nigeria.

Osteoprotegerin changes in saliva and serum of patients with knee osteoarthritis

OBJECTIVE

The scope of this study was to assess salivary and serum osteoprotegerin (OPG) levels in knee osteoarthritis (OA).

METHODS

Serum and saliva OPG levels of 30 knee OA and 30 matched healthy controls in this cross-sectional study was assessed by ELISA. Knee pain was assessed by WOMAC. Data were analyzed by Student's t-test, Spearman correlation test and ROC.

RESULTS

The mean serum but not saliva OPG level was lower in knee OA than that of the healthy group. WOMAC negatively correlated with serum OPG (r=-0.501; P=0.000). The serum OPG cutoff value was 237.5pg/ml for the diagnosis of knee OA.

CONCLUSIONS

As serum OPG was lower in knee OA and negatively correlated with WOMAC, it seems that detection of OPG in serum but not in saliva may be a probable marker to the diagnosis of knee OA.

KEY MESSAGES

Osteoprotegerin decreases in knee osteoarthritis.

Epidemiologic profile of nosocomial infections among paediatric patients in a referral hospital in Hamadan, west of Iran

Healthcare-associated infections (HC-AI) are major health problem with high financial impact. HC-AIs are one of the main causes of morbidity and mortality in paediatric hospitals. This study was performed to determine the epidemiology of HC-AIs in children admitted to medical wards of Besat Hospital in Hamadan, west of Iran. Data on cases of HC-AIs in paediatrics were collected from March 2017 to February 2018 in Besat Hospital. The medical records of eligible cases were extracted from Iranian Nosocomial Infections Surveillance Software. During the study period, a total of 355 HC-AIs in children were detected, 213 (60%) in boys and 214 (60.3%) in the 0-4-year age group. Of these, bloodstream infection was the most frequent infection in both age groups (37.38% in 0-4 years and 34.75% in 5-14 years). Escherichia coli was the common detected microorganism in girls (25.84% in those aged 0-4 years and 24.53% in 5-14 years), whereas Staphylococcus was more prevalent in boys (33.6% in those aged 0-4 years and 29.55% in 5-14 years). HC-AIs were more prevalent in burn, haematology and intensive care unit wards. In Besat Hospital, bloodstream infection and urinary tract infection were the most frequent infections among paediatric patients, and E. coli and Staphylococcus were the commonest detected microorganism in girls and boys respectively. Preventive activities should be targeted to reduce the rate of HC-AIs in wards associated with more contamination.

The occurrence and impact of blood transfusion in cardiogenic shock patients supported by an Impella device: a retrospective study

Background

Cardiogenic shock (CS) patients are frequently supported by mechanical devices, such as the Impella. The use of these devices is associated with device-related complications, such as hemolysis and bleeding, which may necessitate blood transfusion. Blood transfusion has been associated with worse clinical outcome. Information on the occurrence and impact of blood transfusion in these patients is scarce.

Purpose

To assess the incidences of hemolysis, bleeding and red blood cell (RBC) transfusion in CS patients receiving Impella support, to identify patients at risk for RBC transfusion and to assess mortality in transfused and non-transfused patients.

Methods

We performed a single center retrospective cohort study between August 2006 and April 2019, collecting data on all patients supported by an Impella device (type 2.5, CP or 5.0) for more than 24 hours. Patient baseline characteristics, clinical course and outcomes were compared between patients transfused with RBCs and non-transfused patients. Multivariate logistic regression analysis was used to identify factors associated with RBC transfusion. Correlations between patient characteristics and the number of units of RBCs administered were tested using the Spearman's Rank correlation coefficient.

Results

We included 122 CS patients who received Impella support for longer than 24 hours. Seventy-eight percent was male and the median age was 60.0 years. Transfused patients had a longer support duration compared with non-transfused patients (respectively; 97 (52–173) hours versus 51 (39–76) hours, p&lt;0.001). Of all included patients, 68% received RBC transfusion. Transfused patients received a median of 1.5 (0.6–2.8) units of RBCs per day. The incidence of hemolysis was 10% in transfused patients and 11% in non-transfused patients (p=NS). Bleeding occurred in 61% of the transfused patients and 11% of the non-transfused patients (p&lt;0.001). Higher age, lower hemoglobin level prior to Impella implant and longer support duration increased the odds of receiving RBC transfusion. The 30-day mortality was similar in transfused and non-transfused patients, respectively 58% and 42% (p=NS) (Figure 1. Kaplan-Meier Curve showing 30-day mortality of transfused and non-transfused patients).

Conclusion

RBC transfusion was required in more than two-third of the CS patients who received Impella support for longer than 24 hours. Higher age, lower hemoglobin level prior to implant and longer support duration were independent risk factors for RBC transfusion. In contrast to previous studies, transfusion was not associated with 30-day mortality. Future research should focus on the effects of RBC transfusion on morbidity and mortality and investigate the optimal transfusion criteria and aims.

Funding Acknowledgement

Type of funding source: None

Development of Decision Support System to Predict Neurofeedback Response in ADHD: an Artificial Neural Network Approach

Introduction:

Clinical decision support system (CDSS) is an analytical tool that converts raw data into useful information to help clinicians make better decisions for patients.

Aim:

The purpose of this study was to investigate the efficacy of neurofeedback (NF), in Attention Deficit Hyperactivity Disorder (ADHD) by the development of CDSS based on artificial neural network (ANN).

Methods:

This study analyzed 122 patients with ADHD who underwent NF in the Parand-Human Potential Empowerment Institute in Tehran. The patients were divided into two groups according to the effects of NF: effective and non-effective groups. The patients’ record information was mined by data mining techniques to identify effective features. Based on unsaturated condition of data and imbalanced classes between the patient groups (patients with successful NF response and those without it), the SMOTE technique was applied on dataset. Using MATLAB 2014a, a modular program was designed to test both multiple architectures of neural networks and their performance. Selected architecture of the neural networks was then applied in the procedure.

Results:

Eleven features from 28 features of the initial dataset were selected as effective features. Using the SMOTE technique, number of the samples rose to around 300 samples. Based on the multiple neural networks architecture testing, a network by 11-20-16-2 neurons was selected (specify>00.91%, sensivity=100%) and applied in the software.

Conclusion:

The ANN used in this study has led to good results in sensivity, specificity, and AUC. The ANN and other intelligent techniques can be used as supportive tools for decision making by healthcare providers.

Semantic Web Technologies for Sharing Clinical Information in Health Care Systems

Introduction:

Semantic Web (SW) technologies is capable of facilitating the management and sharing of knowledge and promote semantic interoperability among healthcare information systems.

Aim:

This article is designed to provide an overview of the SW technologies.

Methods:

This article was performed based on a literature review and Internet search through scientific databases such as PubMed, Scopus, Web of Science and Google Scholar.

Result:

The literature on SW addresses the technical and content aspects of SW technologies including description of ontology, interoperability standards in SW, creating ontology, types of ontologies, ontology editors, ontologies in healthcare.

Discussion:

The discussion on this forum aims to help understand the benefits of SW technologies in healthcare.

Conclusion:

SW promotes a shift from the “syntactic” level to the “semantic” level of services, applications, and people and finally to pragmatic level by sharing knowledge among clinicians, researchers and healthcare providers.

Quality of patient information in emergency department

PURPOSE

Data comprise one of the key resources currently used in organizations. High-quality data are those that are appropriate for use by the customer. The quality of data is a key factor in determining the level of healthcare in hospitals, and its improvement leads to an improved quality of health and treatment and ultimately increases patient satisfaction. The purpose of this paper is to assess the quality of emergency patients' information in a hospital information system.

DESIGN/METHODOLOGY/APPROACH

This cross-sectional study was conducted on 385 randomly selected records of patients admitted to the emergency department of Shahid Beheshti Hospital in Kashan, Iran, in 2016. Data on five dimensions of quality, including accuracy, accessibility, timeliness, completeness and definition, were collected using a researcher-made checklist and were then analyzed in SPSS. The results are presented using descriptive statistics, such as frequency distribution and percentage.

FINDINGS

The overall quality of emergency patients' information in the hospital information system was 86 percent, and the dimensions of quality scored 87.7 percent for accuracy, 86.8 percent for completeness, 83.9 percent for timeliness, 79 percent for definition and 62.1 percent for accessibility.

ORIGINALITY/VALUE

Increasing the quality of patient information at emergency departments can lead to improvements in the timely diagnosis and management of diseases and patient and personnel satisfaction, and reduce hospital costs.

Adoption of Hospital Information System Among Nurses: a Technology Acceptance Model Approach

Introduction:

The successful implementation of Hospital Information Systems (HIS) depends on user acceptance. Nurses are the largest group of HIS users in hospitals. This study aims to evaluate some factors may affect the utilization of the Hospital Information System.

Aim:

To explore factors that contribute to using of Hospital Information System.

Methods:

In this cross-sectional study, 325 nurses from training Hospitals affiliated with Lorestan University of Medical Sciences (LUMS) were chosen. A valid and reliable structured questionnaire based on Technology Acceptance Model 1&2 and Unified Theory of Acceptance and Use of Technology was used as the data collection tool. Descriptive statistics, Correlations analysis, multiple regression analysis, path analysis technique, Structure Equation Model using AMOS software was used to examine factors that influenced the Adoption of Hospital Information System.

Results:

The findings indicate a significant direct relationship between Management Support and Perceived Usefulness of HIS. Perceived Usefulness has a significant effect on attitudes. While there was no significant effect of perceived ease of use on attitude. Attitude has a significant effect on behavioral intention.

Conclusion:

This research provides a tool to realize what factors undertake the behavioral intention of healthcare professionals to use hospital information system and how this may affect future use.

Evaluation of Effective Dashboards: Key Concepts and Criteria

OBJECTIVE

The aim of this study is to offer appropriate criteria to evaluate effective dashboards for healthcare organizations.

METHOD

In a Delphi study, a team of information technology consultants were asked to determine a set of user interface requirements for evaluating, building or selecting the dashboard. In the first round, a list of main features or criteria to be used was determined based on the panel's rating,.

RESULTS

In this study, it was revealed that a set of key criteria for evaluating the dashboards can be used for all types of dashboards. These criteria were classified into 7 main categories including user customization, knowledge discovery, security, information delivery, alerting, visual design, and integration and system connectivity.

CONCLUSION

Choosing good criteria for selecting effective dashboards for healthcare organizations is very critical because these organizations follow a data-intensive and technology-driven environment. This study revealed the importance of key criteria which can guarantee development of an evaluation checklist.

Enhancing Patient Safety Using Medical Imaging Informatics

A set of performance indicators and metrics related to patient safety that classifies and measures mistakes can prevent errors in medical imaging. The potential of harm in this department is high since it is a complicated environ- ment in terms of diversity of services, patient mix, personnel, equipment, tech- nology, and information. In such an environment, it is necessary to define aframeworkto identify safety inci- dents, analyze them, provide solutions for preventing them, and give feedback on the results. Using medical imaging informatics can be effective in monitor- ing these indicators. Benefits such as reducing radiation expo- sure and reducing medication errors and adverse effects can be achieved. It can also promote knowledge through acces- sibility of resources and useful informa- tion in order to optimize decision making.

The Effect of Information Technology on Healthcare Improvement from Clinicians’ Perspective

<p><strong>OBJECTIVE: </strong>This study investigated the perspective of clinicians about the effect of information technology (IT) on healthcare improvement.</p><p><strong>METHODS: </strong>This cross-sectional study conducted in 2014-15, developed a questionnaire to evaluate of the perspective of 281 employees at two general hospitals affiliated with Zahedan University of Medical Sciences to measure the effect of IT on improving the healthcare system. The data was analyzed using the descriptive Kolmogorov-Smirnov and Kruskal-Wallis tests. One-way ANOVA was used to compare groups.</p><p><strong>RESULTS: </strong>The overall attitude of the research population about the effect of IT on healthcare was positive, with an average score of 3.29 ± 0.90. The most influential effects of IT on the healthcare were accelerated diagnosis and treatment. The use of standardized messaging was the most effective approach for improving the healthcare system. Developing a standard mechanism for protection of data and establishing clear rules for acceptance of computer documentation by the judicial authorities were the most influential cases to increase IT effects in the healthcare system.</p><p><strong>CONCLUSION: </strong>Physicians play important roles in the successful implementation of IT because they are directly involved in the treatment of patients. Their opinions should be considered when providing or creating any type of system. The importance of budgeting for IT should be considered, because applying these systems can be capital intensive. Because application of such systems requires acceptance by legal circles of the information obtained, it is necessary for preparations to be made.</p>

From Information Management to Information Visualization: Development of Radiology Dashboards

OBJECTIVE

The development and implementation of a dashboard of medical imaging department (MID) performance indicators.

METHOD

Several articles discussing performance measures of imaging departments were searched for this study. All the related measures were extracted. Then, a panel of imaging experts were asked to rate these measures with an open ended question to seek further potential indicators. A second round was performed to confirm the performance rating. The indicators and their ratings were then reviewed by an executive panel. Based on the final panel's rating, a list of indicators to be used was developed. A team of information technology consultants were asked to determine a set of user interface requirements for the building of the dashboard. In the first round, based on the panel's rating, a list of main features or requirements to be used was determined. Next, Qlikview was utilized to implement the dashboard to visualize a set of selected KPI metrics. Finally, an evaluation of the dashboard was performed.

RESULTS

92 MID indicators were identified. On top of this, 53 main user interface requirements to build of the prototype of dashboard were determined. Then, the project team successfully implemented a prototype of radiology management dashboards into study site. The visual display that was designed was rated highly by users.

CONCLUSION

To develop a dashboard, management of information is essential. It is recommended that a quality map be designed for the MID. It can be used to specify the sequence of activities, their related indicators and required data for calculating these indicators. To achieve both an effective dashboard and a comprehensive view of operations, it is necessary to design a data warehouse for gathering data from a variety of systems. Utilizing interoperability standards for exchanging data among different systems can be also effective in this regard.

Auditing Knowledge toward Leveraging Organizational IQ in Healthcare Organizations

Objectives

In this study, a knowledge audit was conducted based on organizational intelligence quotient (OIQ) principles of Iran's Ministry of Health and Medical Education (MOHME) to determine levers that can enhance OIQ in healthcare.

Methods

The mixed method study was conducted within the MOHME. The study population consisted of 15 senior managers and policymakers. A tool based on literature review and panel expert opinions was developed to perform a knowledge audit.

Results

The significant results of this auditing revealed the following: lack of defined standard processes for organizing knowledge management (KM), lack of a knowledge map, absence of a trustee to implement KM, absence of specialists to produce a knowledge map, individuals' unwillingness to share knowledge, implicitness of knowledge format, occasional nature of knowledge documentation for repeated use, lack of a mechanism to determine repetitive tasks, lack of a reward system for the formation of communities, groups and networks, non-updatedness of the available knowledge, and absence of commercial knowledge.

Conclusions

The analysis of the audit findings revealed that three levers for enhancing OIQ, including structure and process, organizational culture, and information technology must be created or modified.

Antihypoxic activities of Eryngium caucasicum and Urtica dioica

OBJECTIVE

Urtica dioica and Eryngium spp. have been used in traditional medicine for many years. In spite of many works, nothing is known about their protective effect against hypoxia-induced lethality.

MATERIALS AND METHODS

Protective effects of U. dioica (UD) aerial parts and E. caucasicum (EC) inflorescence against hypoxia-induced lethality in mice were evaluated by three experimental models of hypoxia, asphyctic, haemic and circulatory.

RESULTS

Statistically significant protective activities were established in some doses of extracts in three models. Antihypoxic activity was especially pronounced in polyphenol fractions in asphyctic model. EC polyphenol fraction at 400 mg/kg prolonged survival time (48.80 ± 4.86, p < 0.001) which was comparable with that of phenytoin (p > 0.05). It was the most effective extract in circulatory model, too. It prolonged survival time significantly respect to control group (p < 0.001). UD extracts protected the mice but the response was not dose-dependent. In haemic model, extracts of EP significantly and dose dependently prolonged survival time as compared to control group (p < 0.001). At 600 mg/kg, EP was the most effective one, being capable of keeping the mice alive for 12.71 ± 0.75 min. Only the concentration of 300 mg/kg of UD was effective (p < 0.001).

CONCLUSIONS

Extracts showed remarkable antihypoxic effects. Pharmacological effects may be attributed to the presence of polyphenols in the extracts.

Value Innovation in Hospital: Increase Organizational IQ by Managing Intellectual Capitals

Hospital is a complex organization rich in intellectual capitals. Effective management of these assets in line with innovating value to reach strategic goals and objectives can lead to increasing organizational IQ. In hospital with high organizational IQ, Increasing syntropy in intellectual capitals can convert it to an agile, learner, innovative, and smart organization.

Clinical Decision Support Systems and Medical Imaging

Clinical decision support systems (CDSS) can help clinicians make correct and timely decisions about patient care, reduce errors, comply with standard treatment and medication guidelines, reduce costs, and ultimately improve the quality of healthcare. An overview of various models is provided. This tool can apply to six areas of healthcare, all of which have a significant impact on improving care and provider performance: diagnosis, disease progress management, care and treatment, drug prescribing, evaluation, and prevention. Beginning in January 2017, referring physicians must use appropriateness criteria when ordering advanced imaging for Medicare patients. CDSS will be a critical part of this process. In the medical imaging chain, from ordered study to communicating results, such systems can help achieve best practices.

A design protocol to develop radiology dashboards

Aim:

The main objective of this descriptive and development research was to introduce a design protocol to develop radiology dashboards.

Material and methods:

The first step was to determine key performance indicators for radiology department. The second step was to determine required infrastructure for implementation of radiology dashboards. Infrastructure was extracted from both data and technology perspectives. The third step was to determine main features of the radiology dashboards. The fourth step was to determine the key criteria for evaluating the dashboards. In all these steps, non-probability sampling methods including convenience and purposive were employed and sample size determined based on a persuasion model.

Results:

Results showed that there are 92 KPIs, 10 main features for designing dashboards and 53 key criteria for dashboards evaluation. As well as, a Prototype of radiology management dashboards in four aspects including services, clients, personnel and cost-income were implemented and evaluated. Applying such dashboards could help managers to enhance performance, productivity and quality of services in radiology department.

Organizational Factors that Affect the Implementation of Information Technology: Perspectives of Middle Managers in Iran

Objective:

to examine the organizational factors affecting the application of information technology in hospitals. Since the organizational factors are one of the most important determinants of successful projects, by understanding their impact and identifying them it can help planning a systematic IT implementation.

Methods:

In this cross-sectional descriptive study 110 middle managers were chosen from teaching hospitals. Structured questionnaire was used for the data collection.

Results:

There was a significant relationship between organization resource, organizational knowledge, process, management structure and values and goals with implementation of information technology.

Conclusion:

Findings showed that organizational factors had a considerable impact on implementation of information technology. Top managers must consider the important aspects of effective organizational factors.

Enhance hospital performance from intellectual capital to business intelligence

Business intelligence (BI) refers to technologies, tools, and practices for collecting, integrating, analyzing, and presenting large volumes of information to enable better decision making. The aim of this study is to provide a general overview of BI and its impacts on improving hospital performance. In this paper, literature is reviewed on the concept, classification, and structure of intellectual capital and BI. Research on the building of BI and its impact on the performance of hospitals are briefly summarized. Some areas in healthcare which can utilize BI benefits, including radiology, are also discussed. Used properly, BI is an effective communication tool that can enable hospitals to reach strategic goals and objectives and can also help eliminate information asymmetry.

Comparison antinociceptive activity of the aqueous methanolic extracts of Salvia Hypoleuca and Phytolacca americana in mice

OBJECTIVES

Anti-nociceptive activity of aerial parts of Phytolacca (P.) americana and Salvia Hypoleuca were investigated, using the hot plate method in mice.

MATERIALS AND METHODS

Antinociceptive activity of aerial parts of Phytolacca americana and Salvia Hypoleuca were investigated using the hot plate method. In addition, the effect of its aerial parts on morphine dependence was investigated in mice. After induction of dependence by morphine, different concentrations of plants aerial parts extract were injected to treated groups. To assess morphine withdrawal, mice were injected naloxone (5 mg/kg) i.p. on the 5th day. After four consecutive days of morphine injection, withdrawal syndrome was assessed by placing each mouse in a 30 cm high glass box and recording the frequency of escape jumps for 60 minutes.

RESULTS

The aqueous methanolic extract of aerial parts of P. Americana and S. Hypoleuca produced a statistically significant increase in pain threshold after 30 min of i.p. injection of extract, in comparison with the control groups, at adose of 190 and doses of 500, 1000 and 1500 mg/kg (p < 0.001) respectibility. The activity was comparable to that of morphine (30 mg/kg i.p., p > 0.05). The anti-nociceptive activity of P. Americana and S. Hypoleuca increased until the 60th min (p < 0.05 compared to morphine).

CONCLUSIONS

The results of this study support the extensive use of S. Hypoleuca and P. americana in Western Asia and America. The LD50 of extracts S. Hypoleuca and P. americana following a 14 days acute toxicity study were calculated to be a bout 1800 and 208 mg kg-1 i.p. respectability.

[Periapical regeneration. About one case of necrotic immature tooth treated with mineral trioxide aggregate (MTA)]

Therapeutic of apexification with calcium hydroxide has been extensively used in clinical practice, but this technique has some drawbacks (long duration of treatment, weakening of the radicular walls). Different studies have proposed to close the apex opened with MTA (Mineral trioxide Aggregate) which is biocompatible, bacteriostatic, this material induces regeneration of the periapical region through the formation of cementum, bone and periodontal ligament (1, 2). This case report describes the technique of setting up in a single step of the Mineral trioxide Aggregate as an apical barrier for immature permanent roots. This method has allowed us an immediate apical sealing and a root canal filling and a coronary restore permanently as soon as possible. The radiological control confirmed that this type of apexification could be successful with periapical regeneration ad-integrum.

Predictive factors of response to phase I complete decongestive therapy in upper extremity lymphedema following breast carcinoma in Iran

Post-mastectomy chronic lymphedema as a complication of breast cancer treatment is primarily managed with Complete Decongestive Therapy (CDT). We examined various factors for correlating with results of Phase I CDT treatment in controlling the upper extremity lymphedema. Study population consisted of patients with lymphedema referred to the Lymphedema Clinic of the Iranian Breast Cancer Research Center for control of arm edema. After obtaining the demographic and clinical data, patients were treated with CDT for 2 - 3 weeks. One hundred and thirty seven patients (mean age +/- SD; 53.5 +/- 10 years) were studied. In 48.7% of patients, the affected arm was the dominant limb. Fifty percent of patients experienced lymphedema during the first year after surgery, and mean duration of lymphedema was 35 +/- 43 months. Mean volume reduction was 43% +/- 14.87% (p = 0.03). There was a significant relationship between the percent of volume reduction and initial lymphedema volume (p=0.003) as well as duration of lymphedema (p=0.002). Our results demonstrate that Phase I CDT treatment is very effective for post mastectomy lymphedema, and particularly if it is provided in earlier stages of disease. In addition, CDT also has an important role in reducing clinical symptoms and improving limb function. In the appropriate setting, Phase I CDT has been an effective method of controlling post mastectomy lymphedema in this Iranian population.

Effective radiology dashboards: key research findings

Innovative organizations have access to information for business intelligence through the objectives displayed in dashboards. In healthcare organizations, where the goal is to improve quality of care along with reducing costs, the radiology department is important from both financial and clinical aspects. Therefore, how to manage this department has critical impact on the effectiveness and efficiency of the organization. Today, since the information in this department not only has different data structure but also is gathered from different data sources, a well defined, comprehensive dashboard can be an effective tool to enhance performance.

The effect of palm oil or canola oil on feedlot performance, plasma and tissue fatty acid profile and meat quality in goats

Twenty-four entire male Kacang kid goats were fed diets containing 3% canola (n=12) or palm oil (n=12) supplements for 16 weeks. The goats had an initial live weight of 14.2±1.46 kg and were fed a mixed ration ad libitum (10.4 MJ/ME and 14% crude protein). There was no difference in feedlot performance due to diet. Inclusion of canola oil reduced (P<0.05) kidney fat weight and increased (P<0.05) linolenic acid (18:3n-3) concentration in the blood plasma, m. longissimus lumborum (LL), liver, and kidney. The palm oil diet increased (P<0.05) myristic (14:0) and palmitic (16:0) acid content in the blood, but this did not alter these fatty acids in the LL muscle. Lipid oxidative substances in the liver and LL from palm oil fed kids were higher (P<0.05) than those from canola supplemented kids. The incorporation of canola oil into the goats' diet increased muscle omega-3 fatty acid content, but lipid oxidation was lowered in the blood and muscle LL.

Phylogenetic status of brown trout Salmo trutta populations in five rivers from the southern Caspian Sea and two inland lake basins, Iran: a morphogenetic approach

Interrelationships, origin and phylogenetic affinities of brown trout Salmo trutta populations from the southern Caspian Sea basin, Orumieh and Namak Lake basins in Iran were analysed from complete mtDNA control region sequences, 12 microsatellite loci and morphological characters. Among 129 specimens from six populations, seven haplotypes were observed. Based on mtDNA haplotype data, the Orumieh and southern Caspian populations did not differ significantly, but the Namak basin-Karaj population presented a unique haplotype closely related to the haplotypes of the other populations (0·1% Kimura two-parameter, K2P divergence). All Iranian haplotypes clustered as a distinct group within the Danube phylogenetic grouping, with an average K2P distance of 0·41% relative to other Danubian haplotypes. The Karaj haplotype in the Namak basin was related to a haplotype (Da26) formerly identified in the Tigris basin in Turkey, to a Salmo trutta oxianus haplotype from the Aral Sea basin, and to haplotype Da1a with two mutational steps, as well as to other Iranian haplotypes with one to two mutational steps, which may indicate a centre of origin in the Caspian basin. In contrast to results of the mtDNA analysis, more pronounced differentiation was observed among the populations studied in the morphological and microsatellite DNA data, except for the two populations from the Orumieh basin, which were similar, possibly due to anthropogenic causes.

The effect of participatory community-based diabetes cares on the control of diabetes and its risk factors in western suburb of Yasouj, Iran

This study aimed to investigate whether a community-based participatory diabetes care program could efficiently improve diabetic care and reduce its risk factors. To induce a participatory approach, a local group was established in partnership with academics, local leaders, health providers and public representatives. The group conducted community needs assessment and priority setting process. Diabetes was identified as the first priority health problem in this area. A total of 2569 30- to 65-year-old residents were screened for diabetes and 405 of them took part in a 13-week nutrition education and physical exercise intervention. Out of 1336 high-risk individuals, 17% had fasting blood sugar (FBS) ≥126 mg/dl and 13.5% with FBS between 110 and 125 mg/dl. Percentages of participants with triglycerides (TG) ≥150 mg/dl and cholesterol ≥200 mg/dl were 33.8% and 23.5%, respectively. After completion of the intervention, the mean FBS, HbA1C, TG and cholesterol were decreased significantly. Although systolic and diastolic blood pressure and body mass index were decreased too, the differences were not statistically significant. The mean physical activity increased and consumption of fried foods and saturated oil decreased significantly. The results suggest that participatory community-based care could be a feasible model for control of diabetes and its risk factors.

Life expectancy at birth in rural areas based on corrected data of the Iranian vital horoscope

BACKGROUND

Life expectancy at birth as an alternative summary measure of mortality represents number of years which a newborn will be alive based on the current age specific death rates. As it summarizes death rates across all age range in a given population is the most common summary measure of mortality. The aim of this study was to correct death rates for underreport and estimate life expectancy at birth in rural population of Iran in 2008. In addition, this study aimed to assess the Vital Horoscope system's data quality.

METHODS

Data were obtained from all Health Houses in Iranian villages in 2008. In order to adjust over 5 years old death rates for underreport, we used Brass Growth Balance method. Since this method is not applicable to under 5 years old, we used child mortality rates projected based on the Iranian Demographic and Health survey 2000 to correct death rates.

RESULTS

Adjusted life expectancy at birth for males was 71.5 year and for females was 74.4 year. Completeness of the death data was 88% for males and 79% for females. Adjusted child (under 5) mortality rate by sex in males and females was 25.9 and 23.8 per 1000 live births respectively. Adult mortality for males was 167.2 and 98.3 for females per 1000.

CONCLUSION

Data based on Vital Horoscope system are a suitable source to estimate life expectancy and other mortality statistics. Also has an acceptable completeness on death registration. Further studies to investigate accuracy of data from the Vital Horoscope system are suggested.

Estimating the proportion of diabetes to the attributable burden of cardiovascular diseases in iran

BACKGROUND

This study aimed at estimating the proportion of diabetes as a risk factor to the attributable burden of cardiovascular diseases in Iran.

METHODS

Comparative Risk Assessment methodology was used to calculating Potential Impact Fraction (PIF). To calculate PIF, data on the prevalence of newly diagnosed diabetes mellitus (NDM) and known diabetes mellitus (KDM) were obtained from 3rd Iranian surveillance of risk factors of non-communicable diseases and data on corresponding measures of effect were derived from a cohort study. PIF were estimated on both theoretical minimum and feasible minimum risk. Uncertainty for the attributable burden was estimated by Monte Carlo simulation-modeling techniques incorporating sources of uncertainty.

RESULTS

According to multivariate-adjusted hazard ratios, by reducing the prevalence of Iranian women with diabetes from 10.05 percent to the feasible minimum risk level i.e. 5 percent, 6.8% (95% uncertainty intervals: 3.5-9.8) of attributable Disability Adjusted Life Years (DALYs) to CVD are avoidable and the corresponding value for men were 3.1% (95% uncertainty intervals: 1.4-4.8).

CONCLUSION

Although data on the prevalence of diabetes and corresponding measures of associations were obtained from an updated and country-specific source, but to better priority setting, PIF should be applied to updated and revised burden of CVDs.

Estimating the contribution of selected risk factors in attributable burden to stroke in iran

BACKGROUND

Knowledge of the magnitude of avoidable burden by risk factors is needed for health policy, priority setting, and preventing stroke. The aim of this study was to estimate the contribution of selected risk factors including hypertension, overweight, obesity, tobacco use, and physical inactivity to the attributable burden of stroke in Iran.

METHODS

The World Health Organization Comparative Risk Assessment (CRA) methodology was employed to calculate the Potential Impact Fraction (PIF) and percentage of avoidable burden of stroke, which attributed to its risk factors among Iranian adults in 2009. Prevalence of risk factors was obtained from the 5(th) STEPS survey of chronic disease risk factors which conducted in 2009. PIF was estimated on both theoretical minimum and feasible minimum risk. A simulation procedure incorporating sources of uncertainty was used to estimate the uncertainties for the attributable burden.

RESULTS

About 15.7% (95% uncertainty intervals: 5.8- 23.5) of attributable Disability Adjusted Life Years (DALYs) to stroke in adult males and 15.8% (95% uncertainty intervals: 5.8- 23.5) in adult females are avoidable after changing the current prevalence (16.0% and 16.1% for males and females, respectively) of hypertension to 10% in both sexes.

CONCLUSION

This work highlighted the important role of hypertension and overweight. Accordingly, policy makers are advised to consider these risk factors once implementing interventional program in Iran.

Antinociceptive activity and effect of methanol extract of Salvia limbata on withdrawal syndrome in mice

OBJECTIVES

Salvia (S.) is an important genus consisting of about 900 species in the Lamiaceae family. They are several reports that some Salvia spp. has effects on the central nervous system (CNS). The present experiments were undertaken to study the protective effect of S. limbata on the development of dependence to morphine in mice.

MATERIAL AND METHODS

Antinociceptive activity of aerial parts of S. limbata was investigated using the hot plate method. In addition, the effect of its aerial parts on morphine dependence was investigated in mice. After induction of dependence by morphine, different concentrations of plant aerial parts extract were injected to treated groups. To assess morphine withdrawal, mice were injected naloxone (5 mg/kg) i.p. on the 5th day. After four consecutive days of morphine injection, withdrawal syndrome was assessed by placing each mouse in a 30 cm high glass box and recording the frequency of escape jumps for 60 minutes.

RESULTS

Animal receiving acute treatment with morphine displayed dependence. The animals treated with different extract concentrations could decrease frequency of escape jumps in number or decrease development of morphine dependence. Addiction was observed following naloxone administration. Methanol extract of S. limbata produced a statistically significant inhibition of pain induced by hot plate latency at 500, 1000 and 1500 mg/kg i.p. A significant increase in pain threshold was observed after 30 and 60 min (p < 0.001). The activity was comparable to that of morphine (30 mg kg(-1) i.p., p > 0.05). The anti-nociceptive activity of S. limbata increased until the 60th min (p < 0.05 compared to morphine).

CONCLUSIONS

S. limbata extract produced statistically significant inhibition of pain and development of morphine dependence in mice.

Findings on the phytoextraction and phytostabilization of soils contaminated with heavy metals

As a result of human activities such as mining, metal pollution has become one of the most serious environmental problems today. Phytoremediation, an emerging cost-effective, non-intrusive, and aesthetically pleasing technology that uses the remarkable ability of plants to concentrate elements can be potentially used to remediate metal-contaminated sites. The aim of this work was to assess the extent of metal accumulation by plants found in a mining area in Hamedan province with the ultimate goal of finding suitable plants for phytoextraction and phytostabilization (two processes of phytoremediation). To this purpose, shoots and roots of the 12 plant species and the associated soil samples were collected and analyzed by measurement of total concentrations of some elements (Fe, Mn, Zn, and Cu) using atomic absorption spectrophotometer and then biological absorption coefficient, bioconcentration factor, and translocation factor parameters calculated for each element. Our results showed that none of the plants were suitable for phytoextraction and phytostabilization of Fe, Zn, and Cu, while Chenopodium botrys, Stipa barbata, Cousinia bijarensis, Scariola orientalis, Chondrila juncea, and Verbascum speciosum, with a high biological absorption coefficient for Mn, were suitable for phytoextraction of Mn, and C. bijarensis, C. juncea, V. speciosum, S. orientalis, C. botrys, and S. barbata, with a high bioconcentration factor and low translocation factor for Mn, had the potential for the phytostabilization of this element.

Trends in incidence of gastrointestinal tract cancers in Western iran, 1993-2007

BACKGROUND

Few studies have addressed the secular trend of malignancies in developing countries such as Iran. This study aimed to determine the trend in the incidence of gastrointestinal cancers during a period of 15 years in Kermanshah, Iran.

METHODS

All of the confirmed positive pathologic reports for esophageal, gastric and colorectal cancers from 1993 to 2007 were collected and compared with the data compiled in the provincial health center. The incidence rate was standardized for world population using a direct method. The Fay and Feuer method was used to calculate the 95% confidence intervals for each cancer in each year. Trends were investigated using linear regression.

RESULTS

Over the period, 2951 cases of gastrointestinal cancer were reported in Kermanshah Province. The age-standardized incidence rates for gastric, esophageal and colorectal cancers were 9.2, 8.1 and 4.5 per 100,000 respectively over 15 years. In all types, the incidence increased with age. The study showed that the incidence of gastric and esophageal cancers decreased annually by 0.28 (-0.67-0.11) and 0.36 (-0.70 - (-0.02)), respectively. Colorectal cancer demonstrated an increase in the incidence [0.14 (95% CI: -0.01-0.29) annually].

CONCLUSION

A decrease in the incidence of gastric and esophageal cancers and an increase in the incidence of colorectal cancer are in line with reports from other developing countries in epidemiologic transition. Such trends warrant in depth investigation for the exact reasons.