Genome editing approaches with CRISPR/Cas9: the association of NOX4 expression in breast cancer patients and effectiveness evaluation of different strategies of CRISPR/Cas9 to knockout Nox4 in cancer cells.

BACKGROUND: The increasing prevalence of cancer detection necessitated practical strategies to deliver highly accurate, beneficial, and dependable processed information together with experimental results. We deleted the cancer biomarker NOX4 using three novel genetic knockout (KO) methods. Homology-directed repair (HDR), Dual allele HITI (Du-HITI) and CRISPR-excision were utilized in this study. METHODS: The predictive value of the NOX4 expression profile was assessed using a combined hazard ratio (HR) with a 95% confidence interval (CI). With a 95% confidence interval, a pooled odd ratio (OR) was used to calculate the relationship between NOX4 expression patterns and cancer metastasis. There were 1060 tumor patients in all sixteen research that made up this meta-analysis. To stop the NOX4 from being transcribed, we employed three different CRISPR/Cas9-mediated knockdown methods. The expression of RNA was assessed using RT-PCR. We employed the CCK-8 assay, colony formation assays, and the invasion transwell test for our experiments measuring cell proliferation and invasion. Using a sphere-formation test, the stemness was determined. Luciferase reporter tests were carried out to verify molecular adhesion. Utilizing RT-qPCR, MTT, and a colony formation assay, the functional effects of NOX4 genetic mutation in CRISPR-excision, CRISPR-HDR, and CRISPR du-HITI knockdown cell lines of breast cancer were verified. RESULTS: There were 1060 malignant tumors in the 16 studies that made up this meta-analysis. In the meta-analysis, higher NOX4 expression was linked to both a shorter overall survival rate (HR = 1.93, 95% CI 1.49-2.49, P < 0.001) and a higher percentage of lymph node metastases (OR = 3.22, 95% CI 2.18-4.29, P < 0.001). In breast carcinoma cells, it was discovered that NOX4 was overexpressed, and this increase was linked to a poor prognosis. The gain and loss-of-function assays showed enhanced NOX4 breast carcinoma cell proliferation, sphere-forming capacity, and tumor development. To activate transcription, the transcriptional factor E2F1 also attaches to the promoter region of the Nanog gene. The treatment group (NOX4 ablation) had substantially more significant levels of proapoptotic gene expression than the control group (P < 0.01). Additionally, compared to control cells, mutant cells expressed fewer antiapoptotic genes (P < 0.001). The du-HITI technique incorporated a reporter and a transcription termination marker into the two target alleles. Both donor vector preparation and cell selection were substantially simpler using this approach than with "CRISPR HDR" or "CRISPR excision." Furthermore, single-cell knockouts for both genotypes were created when this method was applied in the initial transfection experiment. CONCLUSIONS: The NOX4 Knockout cell lines generated in this research may be used for additional analytical studies to reveal the entire spectrum of NOX4 activities. The du-HITI method described in this study was easy to employ and could produce homozygous individuals who were knockout for a specific protein of interest.

Post-discharge follow-up system in psychiatric patients: A case study of Farabi Hospital in Isfahan.

BACKGROUND: Mental illness is one of the most common problems in human societies and the continuation of care and post-discharge follow-up. This study was conducted to define a post-discharge follow-up framework for Farabi Hospital in Isfahan. MATERIAL AND METHODS: This was a multistage study, including, interviews literature review, and focus group discussions. Participants included 18 purposefully selected nurses, physicians, and managers, directly involved in the discharge process of Farabi Hospital in Isfahan. The interviews were semi-structured. Data were organized using MAXQDA10 software. The initial framework was set through the extraction of semantic main and secondary codes. The framework was finalized through three several focus group discussion sessions. RESULTS: Results included of 17 sub-categories and seven main categories as "education," organizational arrangement," "team-building," "patient and family participation and trust," "engaging some supportive institutions of community," "process management" and "information management." CONCLUSIONS: To implement a post-discharge follow-up system for psychiatric patients in Farabi Hospital of Isfahan must be concentrated to patient and family education, team building, organizational arrangements, participation, and trust of patients and family, while engaging community health centers and notice to information and management and process management.

Impact of NOX4 Knockout by CRISPR/Cas9 on the MCF-7, HCA-7 and UM-RC-6 Cancer Cells.

Background: The second most common cause of mortality is cancer. Increased NOX4 expression is linked to cancer development and metastasis. However, the significance of NOX4 in cell growth and assault, remains unclear. Objective: This study aimed to evaluate the effect of NOX4 knockouts in MCF7, UM-RC-6, HCA-7 cell lines. Materials and Methods: The NOX4 gene was knocked out in MCF7, UM-RC-6, and HCA-7 cell lines through using CRISPR Cas-9 genetic engineering techniques. After transfection, the CRISPR Cas-9 cassette, the T7 endonuclease I, qPCR, and western blotting assay detected the NOX4 knockouts. MTT and Annexin assessed the percentage of cell proliferation and apoptosis. Real-time PCR was used to measure the expression of pro- and anti-apoptotic genes. Results: Occurrence of NOX4 gene knockout in the examined cell lines, was confirmed by q-PCR and Western blot (P<0.001). The NOX4-deleted cell lines with increased sub-G1 caused lowered cell proliferation and population at S / G2/ M phases. In Vitro, NOX4 silencing caused lowered expressions of anti-apoptosis genes BCL-2 and SURVIVIN (P<0.0001), leading to increased tendency of apoptosis in the cell lines (P<0.0001) of the apoptotic genes BAX, P53, FAS. Additionally, the MTT and Annexin results of the target gene NOX4 knockout inhibited proliferation, increased mortality rates (P<0.01), and increased apoptosis. Conclusion: The findings of this study indicate that using NOX4 as a target can have therapeutic value for creating potential treatments against breast, colorectal, and kidney cancers which shows a need for a deeper understanding of the biology of these cancers with direct clinical outcomes for developing novel treatment strategies.

How the service delivery works in the Iranian specialised burns hospitals? A qualitative approach.

As burn injuries are a major cause of death and infirmity, successful service delivery is vital in health systems. In Iran, a few specialised burns hospitals (SBHs) located in big provinces provide burn services in which burn patients with more severe conditions are referred to. However, SBHs are faced with several challenges for delivering due treatment for burn patients. So, for the first time in Iran, the main aim of the study was to identify the challenges of delivering burn services in SBHs. For this purpose, we conducted a qualitative study during February 2017 to April 2018. Key informants were purposefully selected and interviewed at national and provincial levels from the Ministry of Health, medical universities, and informants working in eight SBHs. The saturation point was reached at 21 face-to-face semi-structured interviews. A thematic analysis approach was employed to analyse transcribed documents assisted by MAXQDA Plus version 12. Our results reveal four themes and twelve subthemes on the challenges of delivering services in SBHs. Themes and (subthemes) including burn care continuum (preventive care, pre-hospital care, hospital care, follow-up, and home care), regionalisation of burning services (access to other specialties and medical services, access to specialized care in provinces without a SBH, standardised regionalisation system for burn related services (BRSs), costs of providing BRSs (expensive services and supplies and long hospitalisation), and non-compliance with standardised care (guidelines to provide burn care and physical space to provide BRSs). Results suggest that improving BRSs delivery in Iran may be reached by strengthening burn care continuum, regionalising burn care, allocating sufficient budgets to burn services and formulating burn care guidelines. These policy actions can be better addressed via intra-sectoral collaborations.

The impact of the customer relationship management on organizational productivity, customer trust and satisfaction by using the structural equation model: A study in the Iranian hospitals.

CONTEXT: One of the challenges in the fiercely competitive space of health organizations is responding to customers and building trust and satisfaction in them in the shortest time, with best quality and highest productivity. Hence the aim of this study is to survey the impact of customer relationship management (CRM) on organizational productivity, customer loyalty, satisfaction and trust in selected hospitals of Isfahan (in Iran). MATERIALS AND METHODS: This study is a correlation descriptive research. Study population was the nurses in selected hospitals of Isfahan and the sampling has been conducted using stratified random method. Data collection tool is a researcher-made questionnaire of CRM and its effects (organizational productivity, customer loyalty, satisfaction and trust) which its validity and reliability has been confirmed by researchers. Structural equation method was used to determine the impact of variables. Data analysis method was structural equation modeling and the software used was SPSS version 16 (IBM, SPSS, 2007 Microsoft Corp., Bristol, UK) and AMOS version 18 (IBM, SPSS, 2010 Microsoft Corp, Bristol, UK). RESULTS: Among the dimensions of CRM, diversification had the highest impact (0.83) and customer acquisition had the lowest (0.57) CRM, had the lowest impact on productivity (0.59) and the highest effect on customer satisfaction (0.83). CONCLUSIONS: For the implementation of CRM, it is necessary that the studied hospitals improve strategies of acquiring information about new customers, attracting new customers and keeping them and communication with patients outside the hospital and improve the system of measuring patient satisfaction and loyalty.

Health Promoting Hospitals Model in Iran.

BACKGROUND: Hospitals are the central entity of each health care system and Health Promoting Hospitals (HPH) was launched by WHO in 1988. However, there has not been any accurate and detailed model for establishing a HPH in Iran up to now. Therefore, this study aimed to determine factors affecting the establishment of a health promoting hospital in Iran using factor analysis method. METHODS: This applied, cross-sectional and descriptive-analytical study was conducted in Iran in four steps. Confirmatory Factor Analysis (CFA) was used for determining factors affecting the establishment of a HPH. RESULTS: Society (0.97) and Policy (0.74) had the highest regression weights (effects) and management had the lowest one. CONCLUSION: Community assessment was the most important dimension of proposed conceptual model for establishing a HPH.

Study of relationship between the organizational structure and market orientation from the viewpoint of nurse managers.

BACKGROUND: Considering globalization of health care and quality improvement trend to respond to competition and customer orientation, attention to organizational structure and its relationship with market orientation is essential. Therefore, this study reviews the relationship between organizational structure and market orientation in selected hospitals of Isfahan (Iran). MATERIALS AND METHODS: This study was a descriptive survey. The study population comprised nurse managers from selected hospitals (n = 80). Data collection tools were two questionnaires (market orientation questionnaire and organizational structure) that the validity and reliability were confirmed (r = 0.83 for market orientation questionnaire and r = 0.87 for organizational structure). SPSS (Ver. 16) software was used for the analyses. RESULTS: The mean score of organizational structure was 65.4 (11.2) and total mean of market orientation was 51.14 (17.6). All aspects of the organizational structure (Organization Centralization, Formalization in Organization, and Organization Complication) and market orientation (responding to competition, accountability, customer satisfaction, intelligent organization)-except by responding to clients with Formalization in Organization-as well as all aspects of the Systemic attitude (the system of internal coordination and communication systems_ and market orientation (responding to competition, accountability, customer satisfaction, intelligent organization), there was a meaningful relationship (P < 0.05). CONCLUSION: Market orientation and its dimensions have a significant relationship with organizational structure and can lead managers' view to the analysis and recognizing elements of success and achievement to goals. With increasing competition in markets, globalization of health services, and presence in international markets and more attention to patients' satisfaction, hospitals need to understand and use of market orientation in order to promote quality and services in the health care system.

Investigating selected patient safety indicators using medical records data.

INTRODUCTION: Medical errors in hospitals kill more people every year than AIDS, breast cancer and auto accidents combined. Widespread consensus exists that health care organizations can reduce patient injuries by improving the environment for safety from implementing different alternatives from technical and managerial improvements to considering medical record data. Considering the preventability of medical errors, the Agency for Healthcare Quality and Research (AHRQ) developed patient safety indicators (PSIs). This study analyzes the PSIs calculated in Alzahra Hospital of Isfahan. MATERIALS AND METHODS: This study was conducted retrospectively using the inpatient medical record data of hospitalized patients in a six month period, from October 2010 to March 2011. An experienced team in the fields of medical record, health management and health information technology was involved in data reviewing. Based on a prior consultation and reviewing, some PSIs were selected. Indicators were calculated considering AHRQ guidelines. Excel software and hospital information system software were used. RESULTS: Across all studied medical records of patients, out of 25,164 discharges, below measures were calculated. -8 Foreign Body cases (PSI 5) (0.31 per 1000). -30 Postoperative Hemorrhage or Hematoma cases (PS I9) (2.2 per 1000). -5 Accidental Puncture or Laceration cases (PSI 15) (0.3 per1000). -8 Complications of Anesthesia cases (PSI 1) (2.2 per 1000). -96 Selected Infections Due to Medical Care cases (PSI 7) (3.8 per1000). -17 cases of Postoperative Wound Dehiscence (PSI 14) (3.7per1000). -1 Birth Trauma - Injury to Neonate case, and (PSI 17) (1.7 per 1000). - 18 Obstetric Trauma - Cesarean Delivery cases (PSI 20) (40 per 1000) were flagged by studied PSIs developed by AHRQ. CONCLUSION: Comparing with the reported rates by other studies and AHRQ study in 2006, all of calculated indicators have inadequate condition; i.e. these are far from empirical estimated rates. The hospital administrators should be more sensitive to this issue and perform some improvement programs.

Health promoting Hospitals in Iran: How it is.

BACKGROUND: The World Health Organization (WHO) produced the Ottawa Charter for Health Promotion (HPH) back in 1986. Then expressed the Budapest Declaration of Health Promoting Hospitals and after determined standards for reorienting hospitals towards health promotion So, this study evaluated Iranian hospitals based on WHO-HPH standard. MATERIALS AND METHODS: This study was a descriptive - analytical survey in selected hospitals of Iran (38 hospitals from 5 provinces). Method of data collecting was through review of documentation related to each of the standards. WHOs self-assessment tool for health promotion was used. RESULT: Overall the mean score of health promotion standard in the state hospital was 54.1 ± 15.1 that means the private hospitals have higher score. In general, patient information and intervention standard had the highest score (70. 8 ± 8. 1) both in private and government hospitals and the patient assessment standard had the lowest score (44. 2 ± 20.1). CONCLUSION: [corrected] Hospitals must design a specific system for improving and evaluating health promotion in order to encourage policy-makers and health service administrators to invest resources.

A study of determining factors affecting the performance of nurses based on the achieve model in selected hospital of Isfahan (Iran).

BACKGROUND: The achieve uses 7 variables: ability; clarity; help; incentive; evaluation; validity; and environment, to provide leaders and staffs with the necessary tools to improve performance, and help managers to determine cause of performance problem. And create change strategy for solving those problems. We try to determine factors affecting the performance of nurses, base on this model in selected hospital of Isfahan (Iran). MATERIALS AND METHODS: This was a descriptive-correlation survey. The population of study was 85 nurses of 9 hospitals in Esfahan. Data gathering was done via achieve questionnaire. Reliability was calculated by Cronbach's alpha (r = 0.85). Data analysis was done by using SPSS 16. RESULT: The ability and help variables were the most important factors in improving performance of nurses and validity and evaluation were less important. CONCLUSION: [corrected] Today, staff effectiveness is one of the important problems in health care organization. In fact, performance improvement is the most important step for organization improvement.

Applying theory of planned behavior in predicting of patient safety behaviors of nurses.

BACKGROUND: Patient safety has become a major concern throughout the world. It is the absence of preventable harm to a patient during the process of health care, ensuring safer care is an enormous challenge, psychosocial variables influences behaviors of human. The theory of planned behavior (TPB) is a well-validated behavioral decision-making model that has been used to predict social and health behaviors. This study is aimed to investigate predictors of nurse's patient safety intentions and behavior, using a TPB framework. METHODS: Stratified sampling technique was used to choose 124 nurses who worked at the selected hospitals of Isfahan in 2011. Study tool was a questionnaire, designed by researchers team including 3 nurses a physician and a psychologist based on guideline of TPB model. Questionnaire Validity was confirmed by experts and its reliability was assessed by Cronbach's alpha as 0.87. Binary logistic regression analysis was performed to evaluate how well each TPB variables predicted the variance in patient safety behavior. Analyzing was done by SPSS18. RESULTS: Finding revealed that "normative beliefs" had the greatest influence on nurses intention to implement patient safety behaviors. Analyzing data by hospital types and workplace wards showed that both in public and private hospitals normative beliefs has affected safety behaviors of nurses more than other variables. Also in surgical wards, nurses behaviors have been affected by "control beliefs" and in medical wards by normative beliefs. CONCLUSION: Normative beliefs, and subjective norms were the most influential factor of safety behavior of nurses in this study. Considering the role of cultural context in these issues, it seemseducation of managers and top individuals about patient safety and its importance is a priority also control believes were another important predicting factor of behavior in surgical wards and intensive care units. Regarding the complexity of work in these spaces, applying medical guidelines and effective supervision must be seriously followed.

A Survey on Clients' Opinions in Isfahan's Public Hospitals About Effective Factors in the Fulfillment of Referral System.

INTRODUCTION: Cutting back on the staff and equipment and also reduction of costs and devices, balanced distribution of resources for optimal use and prevention of unreasonable costs for patients are some advantages of the fulfillment of referral system process. Accordingly the purpose of the present study is to determine factors affecting the fulfillment of referral system process from the viewpoints of clients of Isfahan's public hospitals so that health system could benefit its advantages. METHODOLOGY: The research is a descriptive-analytic survey and the population consisted of clients referring to public hospitals of Isfahan Province. Hospitals conforming to health network in cities of Falavarjan, ShahinShahr, Shahreza, Naein and some public hospitals of Isfahan city were selected for study. Cluster sampling was applied and at the end 400 subjects were selected by simple random sampling. FINDINGS: Results showed that awareness and satisfaction in urban communities and motivation in rural are of higher levels. Regarding insurance status, those covered by Social Security have the most referrals to all levels and those covered by Health Service Insurance have more referral to the first level. The mean score of awareness of clients about referral system among the hospitals investigated shows a significant difference (p-value≤0.05). CONCLUSION: Results indicate that from the viewpoints of urban clients, the rate of the awareness of and satisfaction with the way of offering health services at primary levels and from that of rural clients motivation affect the fulfillment of referral system process. Therefore improvement of these factors could make the system more efficient.

Health system responsiveness: a case study of general hospitals in iran.

BACKGROUND: Considering patients' needs and expectations in the process of healthcare delivery improves the quality of services. This study aimed to investigate the responsiveness of general public and private hospitals in Mashhad, Iran. METHODS: In this cross-sectional and explanatory study, hospitalized patients (with at least 2 days of stay) in general private and public hospitals in Mashhad were investigated. In total 425 patients (259 from private and 166 from public hospitals) were selected using a stratified and simple random sampling. Standard responsiveness questionnaire was used as the data collection tool. Data were analysed using descriptive statistics, independent t-tests and ANOVA by SPSS 16 at a significance level of 0.05. RESULTS: Access to the social support during hospitalization as well as confidentiality of the patient's information achieved the highest score (3.21±0.73) while the patient participation in decision-making process of treatment received the least score (2.34±1.24). Among the research population 1.6%, 4.1%, 17.6%, 63.3% and 13.2% commented on the responsiveness level as very low, low, moderate, good, and excellent, respectively. There was no significant difference between the overall responsiveness scores of public and private hospitals ( P ≥0.05). CONCLUSION: The hospitals have enough potential to improve various aspects of their responsiveness. We suggest a number of measures can help improve the non-clinical aspects of care. These include: using educational courses to improve the knowledge and attitudes of medical and nonmedical staff, changing the resource allocation method, and using quality tools such as reengineering to modify the healthcare delivery processes.

A study of relationship between the organizational justice and organizational citizenship behavior among nurses in selected hospitals of Isfahan University of Medical Sciences.

CONTEXT: Numerous researches have been carried out to indicate that organizational justice (OJ) is a variable that anticipates many other variables in organizations, especially in hospitals. Organizational behavior (OCB) is one of the most important variables. AIMS: We aimed to study the relationship between OJ and OCB of nurses in selected hospitals in Isfahan. MATERIALS AND METHODS: This was a descriptive correlational study. The research was conducted among nurses of selected hospitals in Isfahan. STATISTICAL ANALYSIS USED: Data were gathered using two questionnaires of OJ, and OCB. The t-test, chi-square, and Pearson correlation test were used to analyze the data through SPSS version 13. RESULTS: In general, the mean score (SD) of OJ among nurses was 41.2 (16.2) and the mean score of OCB was 57.7 (18). Finally, there was no significant relationship between OJ, civil virtue, and sportsmanship. There was a significant relationship between OJ, OCB, courtesy, and conscientiousness. CONCLUSION: As the scores of OCB and OJ among nurses were average in selected hospitals, the managers of the hospitals should improve the perception of justice among nurses. Today, organizations need efficient and expert workers to achieve their goals, and to grow and improve in all aspects. In fact, the efficiency and effectiveness of organizations depend on the staffs, especially in hospitals.

Function of nurses and other staff to minimize hospital waste in selected hospitals in Isfahan.

CONTEXT: Medical waste (MW) is all waste materials generated at health care facilities. MW naturally is hazardous for environment and subsequently for human. Waste minimization (WM) is the latest alternative for risk reduction. All hospital staff generally and nurses specially can play an active role through education and the implementation of measures to reduce medical wastage and their environmental effects. AIMS: This study is aimed to compare nurses and other staff functions in selected hospitals in Isfahan about waste minimization strategies. SETTINGS AND DESIGN: This is a descriptive analytical study. The study tool was a researcher -designed questionnaire in five area of waste minimization based on WHO recommendation. MATERIALS AND METHODS: There were 90 nurses and other staff from randomized selected public and private hospitals of Isfahan as the sample of this research. This study was done in 2009. STATISTICAL ANALYSIS USED: Data were analyzed by t-test using SPSS16. RESULTS: Nurses mean score of WM performance was 58.16 (12), and others was 58.56 (12.18) (of max 100). There was no significant difference between nurses and others mean score of WM performance according to t-test. There was not significant difference between WM performances of two studied groups in public and private hospitals based on t-test. Comparing between two studied groups mean scores by waste minimization areas indicated that nurses have done significantly better in source reduction area and other staffs have acted better in waste segregation (P < 0.05). CONCLUSIONS: All of hospital staff specially, nurses have an important role in qualified waste management practice of hospitals. Totally mean score of WM performance in hospitals (nurses and other) was average. With regard to other countries activities, this result is disappointing. So, it is necessary to plan educational programs for hospital staff, especially nurses.

Comparison of patients' and nurses' viewpoints about responsiveness among a sample from public and private hospitals of Isfahan.

BACKGROUND: Health systems search for ways of making their services more responsive to patients and the public The new framework of the World Health Organization (WHO) for assessment of health system performance has determined health, responsiveness and fairness of financing as the main goals. This study aimed to compare patients' and nurses' view points about responsiveness among a sample of public and private hospitals of Isfahan, Iran. METHODS: A descriptive study was conducted on 160 nurses and also equal number of patients. Data were collected by a valid and reliable questionnaire designed by WHO. Data were analyzed using SPSS software. Scores were reported as mean (standard deviation). RESULTS: Mean score of responsiveness was 2.4(0.58) in nurses and 2.3(0.54) in patients but the difference was not statistically significant (out of a maximum of 4). The corresponding figures were significantly different (p = 0.009) regarding patients' viewpoints in public [2.2(0.4)] and private hospitals [2.3(0.5)]. CONCLUSIONS: Proper satisfaction about responsiveness was not provided in studied hospitals, based on the nurses' and patients' points of view. Public hospitals, in spite of their high costs, had a worse situation about responsiveness; the improvement of this situation necessitates managerial policies.