A dynamic management model for sustainable drug supply chain in hospital pharmacies in Iran.

BACKGROUND: Sustainable supply chain management encompasses the strategic coordination and control of material, information, and financial flows, as well as the collaborative efforts among the entities engaged in the medicinal supply chain. This research proposes a dynamic and sustainable supply chain management model tailored explicitly for the inpatient pharmacies of Medical Centers and Hospitals affiliated with Iran University of Medical Sciences. METHODS: This is a quantitative study in terms of research objective and a qualitative study based on the stages in the conceptual development of the model. Therefore, the current study can be considered a mixed-methods approach. After identifying the key factors influencing the sustainability of the medicine supply chain, we conducted a dynamic analysis of the problem using system dynamics methodology. In order to simulate the system's behavior over 24 months, we utilized a combination of existing documentary information and expert opinions. The developed model was implemented using Vensim PLE software, allowing us to simulate and analyze the impact of various policies on the system. RESULTS: Medicine disposal exhibited an upward trend, particularly during the second 12-month period. Conversely, the trend of medicine expirations remained relatively stable in the initial months but showed an upward trajectory after that. The cost associated with disposed medicine experienced a consistent increase, with a higher rate observed during the second 12-month period. In contrast, sales of low-consumable medicine experienced a significant initial surge followed by a slower growth rate. Finally, the pharmacy's profit demonstrated an overall increasing trend, although the rate of increase was higher during the first 12 months. CONCLUSION: Among the various scenarios considered, namely "increasing the adequacy of human resources," "increasing the speed of response," and "utilizing pharmacists in the drug prescribing team," it was found that these interventions had a substantial effect on both enhancing the pharmacy's profit and reducing medication waste. Therefore, these scenarios were identified as having the most significant impact. The proposed model can serve as a valuable tool for forecasting and informing policy-making, providing insights into addressing the challenges associated with the sustainable drug supply chain in hospital pharmacies.

Molecular weight of hyaluronic acid crosslinked into biomaterial scaffolds affects angiogenic potential.

While hyaluronic acid (HA)-based hydrogels have been used clinically for decades, the mechanisms by which HA exerts molecular weight-dependent bioactivity and how chemical modification and crosslinking may affect molecular weight-dependent bioactivity remain poorly understood. This knowledge gap presents a significant barrier to designing HA hydrogels with predictable bioactivities. As HA has been widely reported to have molecular weight-dependent effects on endothelial cells (ECs), we investigated how the molecular weight of HA in either soluble or crosslinked forms affects angiogenesis and interrogated CD44 clustering on the surface of endothelial cells as a candidate mechanism for these affects. Using soluble HA, our results show high molecular weight (HMW) HA, but not low molecular weight (LMW) HA, increased viability and tube formation in cultured human cerebral microvascular ECs (HCMVECs). No size of HA affected proliferation. When HCMVECs were cultured with crosslinked HA of varying molecular weights in the form of HA-based microporous annealed particle scaffold (HMAPS), the cell response was comparable to when cultured with soluble HA. Similarly, when implanted subcutaneously, HMAPS with HMW HA were more vascularized than those with LMW HA. We also show that antibody-mediated CD44 clustering resulted in HCMVECs with increased viability and tube-like structure formation in a manner comparable to exposure to HMW HA, suggesting that HMW acts through CD44 clustering. STATEMENT OF SIGNIFICANCE: Biomaterials based on hyaluronic acid (HA), a bioactive extracellular matrix polysaccharide, have been used in clinical products for several years. Despite the knowledge that HA molecular weight heavily influences its bioactivity, molecular weight has been largely ignored in the development of HA-based biomaterials. Given the high viscosity of high molecular weight HA typically found in native tissues, lower molecular weight polysaccharides have been used most commonly for biomaterial fabrication. By comparing the ability of injectable, microporous annealed particle scaffolds (MAPS) fabricated from variably sized HA to promote angiogenesis, this study demonstrates that MAPS with high molecular weight HA better support vascularization, likely through an unique ability to induce clustering of CD44 receptors on endothelial cells.

Intramuscular delivery of neural crest stem cell spheroids enhances neuromuscular regeneration after denervation injury.

BACKGROUND: Muscle denervation from trauma and motor neuron disease causes disabling morbidities. A limiting step in functional recovery is the regeneration of neuromuscular junctions (NMJs) for reinnervation. Stem cells have the potential to promote these regenerative processes, but current approaches have limited success, and the optimal types of stem cells remain to be determined. Neural crest stem cells (NCSCs), as the developmental precursors of the peripheral nervous system, are uniquely advantageous, but the role of NCSCs in neuromuscular regeneration is not clear. Furthermore, a cell delivery approach that can maintain NCSC survival upon transplantation is critical. METHODS: We established a streamlined protocol to derive, isolate, and characterize functional p75+ NCSCs from human iPSCs without genome integration of reprogramming factors. To enhance survival rate upon delivery in vivo, NCSCs were centrifuged in microwell plates to form spheroids of desirable size by controlling suspension cell density. Human bone marrow mesenchymal stem cells (MSCs) were also studied for comparison. NCSC or MSC spheroids were injected into the gastrocnemius muscle with denervation injury, and the effects on NMJ formation and functional recovery were investigated. The spheroids were also co-cultured with engineered neuromuscular tissue to assess effects on NMJ formation in vitro. RESULTS: NCSCs cultured in spheroids displayed enhanced secretion of soluble factors involved in neuromuscular regeneration. Intramuscular transplantation of spheroids enabled long-term survival and retention of NCSCs, in contrast to the transplantation of single-cell suspensions. Furthermore, NCSC spheroids significantly improved functional recovery after four weeks as shown by gait analysis, electrophysiology, and the rate of NMJ innervation. MSC spheroids, on the other hand, had insignificant effect. In vitro co-culture of NCSC or MSC spheroids with engineered myotubes and motor neurons further evidenced improved innervated NMJ formation with NCSC spheroids. CONCLUSIONS: We demonstrate that stem cell type is critical for neuromuscular regeneration and that NCSCs have a distinct advantage and therapeutic potential to promote reinnervation following peripheral nerve injury. Biophysical effects of spheroidal culture, in particular, enable long-term NCSC survival following in vivo delivery. Furthermore, synthetic neuromuscular tissue, or "tissues-on-a-chip," may offer a platform to evaluate stem cells for neuromuscular regeneration.

Determining the relationship between emotional intelligence and interpersonal sensitivity with quality of work life in nurses.

BACKGROUND: Emotional intelligence and interpersonal sensitivity are known as important nursing skills. They have significant role in the promotion of nurses working life and the health care which they provide. The goal of this study was the determination of the relationship between emotional intelligence and interpersonal sensitivity with quality of work life in nurses working in governmental hospitals of Tehran city in 2019. MATERIALS AND METHODS: This investigation was a descriptive-analytical and correlation study which was conducted among 256 nurses working in five governmental hospitals in Tehran. The studied nurses were selected through in access sampling method. The instruments of research included demographic, emotional intelligence, interpersonal sensitivity, and work life quality questionnaires. The analysis of data was done by descriptive and deductive statistics (t-test and Pearson correlation coefficient) and also SPSS. RESULTS: The conditions of emotional intelligence, interpersonal sensitivity, and work life quality of nurses were, in turn, in average, severe, and weak levels. The correlation between emotional intelligence and work life quality of nurses was significant (P ≤ 0.05) and they were positively correlated with each other (r = 0.311). The relationship between interpersonal sensitivity and work life quality of nurses was significant (P ≤ 0.05) and they were negatively correlated with each other (r = -0.43). CONCLUSION: The development of emotional intelligence and sensitivity in reciprocally interpersonal relations of nurses lead to fundamental changes in nurses' attitude toward themselves, their colleagues, patients and their profession and can promote their work life quality. Therefore, these two skills are necessary for nurses and they should be taken into consideration by nursing schools, faculty members, instructors, and nursing managers.

Recognition of factors affecting the use of volunteer clinical forces in hospitals in Tehran: A qualitative study.

INTRODUCTION: Volunteers are valuable human resources for service-providing organizations. Health system requires their participation and cooperation in all sectors to achieve more success. The present study was conducted to recognize factors influencing the use of volunteer clinical forces (VCFs) in Tehran hospitals from 2018 to 2020. METHODS: This is a qualitative study, based on grounded theory approach, and was done through semi-structured interviews. The studied population included the experts, managers of hospitals, and high-ranking managers in the Ministry of Health, Iranian Red Crescent Organization, and health nongovernmental organizations (NGOs). Nineteen persons were selected by purposeful sampling method and interviewed. The achieved data were analyzed by content analysis method. RESULTS: The results showed that using VCFs in Tehran's hospitals was affected by eight following factors: organizational, legal, policy-making, economic, social, security, personal, and cultural dimensions. These findings illustrated the necessity of making changes in the structures, the rules, and the culture of health system to fit the bases with new approaches. CONCLUSION: VCFs amplify the quality and structure of service providing for patients in hospitals. The focus of policymakers and high-ranking managers in health system is on accelerating their use permanently and legally. Developing health-centered NGOs facilitates the access to VCF, lessens nonclinical loads of hospitals, and improves the organization of human forces. The experiences and knowledge of VCFs cause to develop hospitals' resilience, develop social participation, and improve social capitals in medical field.

Staff perspectives on the relationship between knowledge management and social capital with organizational health in selected educational hospitals in Tehran.

INTRODUCTION: Knowledge management enhances efficiency, empowers employees, and enhances organizational health. Social capital provides a good basis for more productive human resources, and training hospitals also play a key role in the health-care system. The purpose of this study was to determine the relationship between knowledge management and social capital with organizational health in selected educational hospitals of Tehran in 2018. METHODS: This analytical cross-sectional study was performed on 310 medical staff of hospitals using proportional sampling method. The data gathering tools consisted of three standard questionnaires of knowledge management, social capital, and organizational health. Data were analyzed using descriptive and inferential statistics using SPSS version 22 software. RESULTS: Most participants in this study were male (8/66%) and in the age group 31-36 years. The mean of knowledge management and organizational health were 3.43 and 3.49, respectively. There is a significant direct relationship between knowledge management components and organizational health. Moreover, there is a significant but weak direct relationship between knowledge management and social capital with organizational health dimensions (P ≤ 0.05). CONCLUSION: Considering the relationship between knowledge management and social capital with organizational health, enhancing the level of organizational health can help to improve the dimensions of knowledge management and social capital. It is suggested that hospital managers, using knowledge management and social capital components, enhance organizational health so that the hospital is more prepared to adapt to the complexities and changes in the market providing services.

Determining the relationship between health literacy level and quality of life among the elderly living in nursing homes.

BACKGROUND: The literacy level of the elderly is predictive of health behaviors, average hospitalization in health centers, and the type of verbal interaction with health service providers; as the level of literacy changes, the quality of life may also change. This study aimed to determine the relationship between health literacy level and quality of life among the elderly living in nursing homes in 2018-2019. MATERIALS AND METHODS: This study was of a descriptive-analytic, correlation type that was performed on 175 elderly of selected nursing homes in Tehran. The research tools included the Abbreviated Mental Test; Control, Autonomy, Pleasure and Self-realization questionnaire-19; and Health Literacy of Iranian Adults Questionnaire (HELIA). Data were analyzed using descriptive and inferential statistics by SPSS 22 software. RESULTS: The total score of health literacy and the quality of life of the elderly was 51.01 and 47.75, respectively. The literacy of most of the studied samples was "inadequate" and "not much adequate" (0-66). The relationship between health literacy and quality of life in the elderly was significant, and there was a direct and statistically significant relationship between them (P = 0.003). That is, by an increase in literacy rates, the scores of quality of life of elderly people were also increased. The correlation was equal to r = -0.28. Health literacy has the ability (31.98%) to predict the quality of life. CONCLUSION: The results showed a lack of enough education literacy, the average quality of life, and the existence of a significant relationship between health literacy and quality of life in the elderly. The wide range of inadequate literacy in the elderly reveals the importance of paying more attention to the issue of literacy in health planning and health promotion at the national and local levels.