What is the mind map of the hospital's future changes in a developing country like Iran? A qualitative study.

BACKGROUND: Hospitals have a vital role in the future of health systems with upcoming structure, resources, and process changes. Identifying the potential aspects of change helps managers proactively approach them, use the opportunities, and avoid threats. This study presents a mind map of future changes in Iranian hospitals to develop a base for further related studies or prepare evidence for interventions and future-related decisions. METHODS: This study is a qualitative-exploratory one, conducted in two phases. In the first phase, in-depth and semi-structured interviews were conducted to identify future hospital changes over 15 years. The interviews were analyzed using the content analysis method and MAXQDA 2018 software and holding two expert panels to develop the mind map using the 2016 Visio software. RESULTS: In the first phase, 33 interviews led to 144 change patterns. In the second phase, a mind map of changes was drawn according to experts' opinions with ten categories: structure and role, knowledge management and research, service delivery, health forces, political and legal, economic, demographic and disease, technological, and values and philosophy, and environmental. CONCLUSIONS: Many changes affecting hospitals rooted in the past continue to the future, but the point is the increasing intensity and speed of changes. Healthcare systems need a systematic approach to monitoring the environment to be updated, agile and proactive. These monitoring systems are essential in providing evidence for Macro-level decision-makers.

What Do Future Trends in Medical Education Mean to the Scientific Development of Iran's Health System?

Background: Medical education system in Iran has an essential role in responding to scientific development targets from both education and research perspectives. Investigating future trends and analyzing how they interact with the medical education system helps increase awareness and give insight into the preferred future. Methods: The present qualitative study consists of Systematic reviews and interviews that have been analyzed using content analysis. Afterward, the themes and codes were visualized in the form of maps and presented in a focus group discussion of experts to define how medical education trends will impact scientific development. Results: The future trends of Iran's medical education system were classified into six groups: workplace changes, demographic changes, changes in concepts, the emergence of new players, structural changes in universities, and technology development. The next point is how they will influence science development. Their impact on science development is classified into five main groups or main streams of change of new financial models, open science, redesigning the research management, the role of universities, and capacity building. Conclusion: Our findings showed that redesigning the structure of medical education is the most important priority to make the system as agile as needed to capture the signs and act. New meanings and concepts should also be considered in restructuring, like power balance, competency-based and personalized education, cost-effectiveness, and openness.

Myricetin loaded in solid lipid nanoparticles induces apoptosis in the HT-29 colorectal cancer cells via mitochondrial dysfunction.

BACKGROUND: Among the flavonoids, Myricetin (MCN) has negligible side effects and anti-cancer properties. However, the therapeutic potential of MCN has been limited mainly by its low bioavailability. Nanocarriers improve the bioavailability and stability of flavonoids. The toxic effects of MCN loaded in solid lipid nanoparticles (MCN-SLNs) on the HT-29 human colorectal cancer cells were investigated in this study. METHODS AND RESULTS: HT-29 cells were exposed to the 30 µmol MCN or MCN-SLNs for 24 h. Colony formation, cell viability, apoptosis, and expression of the Bax, Bcl-2, and AIF (apoptosis-inducing factor) have been investigated. Mitochondrial membrane potential (MMP) and reactive oxygen species (ROS) generation were also measured. The MCN-SLNs with appropriate characteristics and a slow sustained MCN release until 48 h made. MCN-SLNs could diminish colony numbers and survival of the HT-29 cells. The apoptosis index of MCN-SLNs-treated cells significantly increased compared to the free MCN (p < 0.001). The expression of Bax and AIF were elevated (p < 0.01 and p < 0.001, respectively) while Bcl-2 expression was decreased in MCN-SLNs treatment (p < 0.05). Moreover, MCN-SLNs significantly enhanced the ROS formation and reduced MMP compared to the free MCN-treated cells (p < 0.01). CONCLUSIONS: The SLN formulation of MCN can effectively induce colon cancer cell death by raising ROS formation and activating the apoptosis process.

What the policy and stewardship landscape of a national health research system looks like in a developing country like Iran: a qualitative study.

BACKGROUND: The health research system (HRS) is an important national priority that requires a systematic and functional approach. Evaluating the HRS of Iran as a developing country and identifying its challenges reveals the stewardship-related role in how the whole system is operating well. This study aims to assess the HRS in terms of stewardship functions and highlight the enhancement points. METHODS: This study was carried out between March 2020 and April 2021 using a systematic review and meta-synthesis of evidence to examine the Iranian HRS stewardship challenges and interview 32 stakeholders, using a critical case sampling and snowballing approach which included both semi-structured and in-depth interviews. The interviewees were selected based on criteria covering policy-makers, managers, research bodies and nongovernmental organizations (NGOs) in health research-related fields like higher education, research, technology, innovation and science. All data were analysed using content analysis to determine eight main groups of findings under three levels: macro, meso, and micro. RESULTS: Analysis of the findings identified eight main themes. The most critical challenges were the lack of an integrated leadership model and a shared vision among different HRS stakeholders. Their scope and activities were often contradictory, and their role was not clarified in a predetermined big picture. The other challenges were legislation, priority-setting, monitoring and evaluation, networking, and using evidence as a decision support base. CONCLUSIONS: Stewardship functions are not appropriately performed and are considered the root causes of many other HRS challenges in Iran. Formulating a clear shared vision and a work scope for HRS actors is critical, along with integrating all efforts towards a unified strategy that assists in addressing many challenges of HRS, including developing strategic plans and future-oriented and systematic research, and evaluating performance. Policy-makers and senior managers need to embrace and use evidence, and effective networking and communication mechanisms among stakeholders need to be enhanced. An effective HRS can be achieved by redesigning the processes, regulations and rules to promote transparency and accountability within a well-organized and systematic framework.

Evaluating health service quality: using importance performance analysis.

Purpose Measuring healthcare service quality provides an objective guide for managers and policy makers to improve their services and patient satisfaction. Consequently, the purpose of this paper is to measure service quality provided to surgical and medical inpatients at Kerman Medical Sciences University (KUMS) in 2015. Design/methodology/approach A descriptive-analytic study, using a cross-sectional method in the KUMS training hospitals, was implemented between October 2 and March 15, 2015. Using stratified random sampling, 268 patients were selected. Data were collected using an importance-performance analysis (IPA) questionnaire, which measures current performance and determines each item's importance from the patients' perspectives. These data indicate overall satisfaction and appropriate practical strategies for managers to plan accordingly. Findings Findings revealed a significant gap between service importance and performance. From the patients' viewpoint, tangibility was the highest priority (mean=3.54), while reliability was given the highest performance (mean=3.02). The least important and lowest performance level was social accountability (mean=1.91 and 1.98, respectively). Practical implications Healthcare managers should focus on patient viewpoints and apply patient comments to solve problems, improve service quality and patient satisfaction. Originality/value The authors applied an IPA questionnaire to measure service quality provided to surgical and medical ward patients. This method identifies and corrects service quality shortcomings and improving service recipient perceptions.

Long-Term Cost-Effectiveness of Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Adults With Type 1 Diabetes in Iran.

OBJECTIVES: This study aimed to determine long-term cost-effectiveness of continuous glucose monitoring (CGM) technology versus self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes (T1D) using multiple daily injections in Iran. METHODS: According to available data, the long-term costs and clinical outcomes of CGM and SMBG were estimated using the Sheffield Type 1 Diabetes Model, with a lifetime horizon from a payer's perspective. The primary outcome was the cost per quality-adjusted life year (QALY) gained. RESULTS: The lifetime cost-effectiveness analysis demonstrated that on average, the use of CGM increased life expectancy by 1.32 years and QALYs by 1.63, compared with SMBG. The CGM group had an average discounted total cost of $40 093 US dollars, whereas the SMBG group had an average discounted total cost of $13 366. This resulted in an incremental cost-effectiveness ratio (ICER) of $16 386 per QALY gained, which is less than the threshold of 3 times the gross domestic product (GDP) per capita of Iran ($24 561). CONCLUSIONS: Considering 3 times the GDP per capita as the threshold, CGM is likely to be cost-effective in Iran. However, for CGM to be very cost-effective (ie, have an ICER less than 1 times the GDP per capita) and presumably more accessible, the price of CGM should decrease to $40 per sensor, each with a lifespan of 14 days.

Superoxide dismutase-contained solid lipid nanoparticles: Formulation development and In-vivo evaluation for second-degree burn wound healing in rats.

INTRODUCTION: Superoxide dismutase (SOD), a natural enzyme with high antioxidant activity, reduces injury and accelerates wound healing by scavenging superoxide radicals. This enzyme plays an important role in cellular defense against oxidative stress such as burn injury. The aim of this study was to load SOD into solid lipid nanoparticles for the treatment of rat burn wounds. METHODS: Solid lipid nanoparticles were prepared by Solvent Emulsification Diffusion method and evaluated for particle size, enzyme activity and enzyme entrapment efficiency. Twenty-seven rats in 3 different groups were induced with deep second-degree burns and then treated with SOD-loaded solid lipid nanoparticles, solid lipid nanoparticles without enzyme, or SOD solution. After the treatment period, the wounds were evaluated macroscopically for the area of healing and microscopically for indices of re-epithelialization, granulation tissue and angiogenesis. RESULTS: The optimized SOD-loaded solid lipid nanoparticles showed a particle size of 35-85 ± 2.41 nm, 78.4 ± 4.31 % entrapment efficiency and 90 % initial enzyme activity. Macroscopic examination showed that the best recovery rate belonged to the solid lipid nanoparticle group. Pathological studies also showed that angiogenesis and granulation tissue were significantly better in this group. Compared to the other two groups, SOD-loaded solid lipid nanoparticles showed a significant improvement in pathological factors, particularly angiogenesis and granulation tissue, as well as a faster reduction in the number of inflammatory cells. CONCLUSION: Based on this study, solid lipid nanoparticles could be used as an effective delivery system for SOD in the treatment of second-degree burns.

Entrance surface air kerma to patients during digital radiographic examinations in Tanzania.

The aim of this study was to determine the entrance surface air kerma (ESAK) in adult patients during digital radiography and to evaluate the optimisation potential in five common X-ray examinations in Tanzania. Based on a sample of 240-610 patients, ESAK was estimated using X-ray tube output measurements, patient information and backscatter factors. The results show that the mean ESAK values were higher or comparable to data from the literature. The diagnostic reference values of ESAK for digital radiography were 0.31 mGy (chest PA), 4 mGy (lumbar spine AP), 5.4 mGy (lumbar spine LAT), 3.8 mGy (abdomen AP) and 2.4 mGy (pelvis AP). For computed radiography, the mean ESAK ranges were 0.44-0.57 mGy (thoracic AP), 3.59-3.72 mGy (lumbar spine AP), 6.16-6.35 mGy (lumbar spine LAT), 3.89-3.44 mGy (abdominal AP) and 2.92-3.47 mGy (pelvic AP). In conclusion, high ESAK variations show the potential for optimising protection in digital radiology.

Radiation exposure during CT procedures in Tanzania.

The aim of this study was to evaluate optimisation status during common computed tomography (CT) procedures by determining values of volume computed tomography dose index (CTDIvol) and dose-length product (DLP) per examination. Patient and exposure data were collected from the CT console during various CT procedures. The results show that variations in CTDIvol and DLP values were mainly because of differences in the techniques used. The 75th percentile values were set as the third quartile of the median CTDIvol or DLP values for all hospitals. These values of 40.9, 9.0, 9.4 and 16.2 mGy for CTDIvol were determined for head, high-resolution chest, abdomen-pelvis and lumbar spine, respectively. The corresponding DLP values for the same sequence of CT procedures were 900, 360, 487 and 721 mGy.cm, respectively. The updated results provide a basis for optimising the procedures of CT in this country.

The Effect of Short Messaging System-Based Feedback on Physicians' Head CT Scan Ordering Behavior in Neurology and Neurosurgery Departments.

Short messaging system (SMS) works as one of the most popular strategies for physicians' behavior change via sending feedback and reminder messages. One of the areas in which SMS feedback can be effective on physicians' behavior is CT scan ordering. This study investigates the effect of mobile phone SMS feedback on residents' head CT scan ordering at a general teaching hospital in Iran. Through a three-month before-after experimental study, an intervention was conducted, and the CT scans ordered by an individual resident were evaluated every two weeks. Consequently, personal SMS-based feedback was provided to the residents, and the rate of CT per patient in the two phases of the study was analyzed. The mean CT scan ordered per patient decreased from 1.98 ± 1.09 to 1.74 ± 1.45, and this decrease was insignificant (P = 0.106). SMS-based feedback can reduce head CT scan ordering among residents; whereas this decline was not significant further studies are required to investigate its effectiveness.

Fabrication and Characterization of Glycerol/Chitosan/Polyvinyl Alcohol-Based Transparent Hydrogel Films Loaded with Silver Nanoparticles for Antibacterial Wound Dressing Applications.

BACKGROUND: Wounds have a bad prognostic nature and excessive discharges whose regular wound dressings are ineffective. Hydrogels are the best candidates for dressing such wounds due to their high water content and ability to exchange substances. Accordingly, the purpose of this study was to make a novel hydrogel wound dressing following the integration of various findings on wound healing and the use of regenerative medicine. MATERIALS AND METHODS: Various compounds were fabricated by glycerol/chitosan/polyvinyl alcohol (PVA) and then characterized to obtain the optimal composition using several techniques, including a water vapor passage test, scanning electron microscopy, water absorption, tensile strength, biodegradability, Fourier transform infrared spectroscopy, and antibacterial test. RESULTS: The findings revealed the optimal dressing ratio. Better antibacterial activity was found for the silver nanoparticle (AgNP) dressing. CONCLUSION: Our new fabricated dressing, glycerol/chitosan/PVA hydrogel loaded with AgNPs, exhibited satisfactory wound healing properties.

OCCUPATIONAL EXPOSURE TO EXTERNAL IONISING RADIATION IN TANZANIA (2011-17).

The objectives of this paper were to evaluate the occupational radiation exposure data from 2011 to 2017 and to compare the results with status in 1996-2010 periods. The evaluation was performed in terms of annual collective effective dose, the average annual effective dose, the individual dose distribution ratio and the annual collective effective dose distribution ratio. Irrespective of work category, the results indicate that the average effective dose ranged from 0.64 to 1.55 mSv and broadly comparable to data in the previous analysis. Over seven year period, the maximum annual individual dose was 4 mSv and therefore below the dose limit of 20 mSv y-1. The impact of radiological practice on the exposed population was <1.1 person.Sv. The results demonstrate satisfactory radiation protection conditions at workplaces, a situation which is mainly explained by the existing effective regulatory enforcement and improved workers' awareness.

An Investigation of Prescription Indicators and Trends Among General Practitioners and Specialists From 2005 to 2015 in Kerman, Iran.

BACKGROUND: The World Health Organization (WHO) aims to promote strategies that ensure efficacy, safety, suitability, and cost-effectiveness of medicine prescription. Health systems should design effective mechanisms to monitor prescription and rational use of medicines at all healthcare settings. This study aimed to determine and analyze prescription patterns of general practitioners and specialists in Kerman/Iran from 2005 to 2015. METHODS: This is an explanatory mixed method study. Data were gathered during two phases. At the first phase, prescriptions issued by physicians during 2005-2015 were reviewed to extract information required to develop eight main prescription indicators. In the second phase, the indicators trends were presented to experts participating in expert panel to have their opinions and analyses on the data obtained in the first phase. Experts were selected based on their experience and expertise in medicine and/or health policy and/or experience in implementation of polices to promote rational use of medicines. Some experts attending the panel were a sample of physicians whose prescriptions were included in the first phase. RESULTS: Findings revealed that two indicators of the average price of prescriptions and the maximum number of medicines in each prescription had an increasing trend over the study period. Reasons including unprecedented devaluation of the Iranian Rial and willingness of young physicians to prescribe more medications were proposed as the primary contributors to the observed increasing trends. However, other indicators including types of prescribed medicines, average number of medicines per prescription, the percentage of prescriptions with more than four medications, a percentage of encounters with a corticosteroid prescribed, a percentage of encounters with an antibiotic prescribed, and a percentage of encounters with an injection prescribed decreased in the study period. Reasons of controlling initiatives adopted by the Ministry of Health, the higher responsibility of physicians, adoption of continued medical education (CME) programs, and improved knowledge of pharmacists, physicians, and patients about irrational use of medicines were proposed by participants as the main reasons for the decreasing trend. CONCLUSION: Findings indicated that prescription indicators were better in Kerman than those of country average over the study period based on comparing the results of this study and others in Iran. However, they were non-desirable when compared to the international average. The number of factors contributes to the irrational use of medicines, including lack of knowledge among healthcare providers and patients, patients' misunderstanding about the efficacy of some particular medicines, the high cost of drug development and manufacturing, and unavailability of effective medicines.

Polymorphism rs13334190 in zinc finger protein 469 (ZNF469) is not a risk factor for keratoconus in a Saudi cohort.

OBJECTIVE: Polymorphism rs13334190 in the zinc finger protein 469 gene has been suggested to predispose toward a "thin" cornea, which then becomes keratoconic or is directly pathogenic. Thus, we genotyped polymorphism rs13334190 in 127 unrelated keratoconus cases and 168 control subjects from Saudi Arabia using Taq-Man® assay. RESULTS: The genotype frequency distribution did not deviate significantly from the Hardy-Weinberg equilibrium (p > 0.05). Overall, both the genotype and allele frequencies were not significantly different between cases and controls. A minor allele frequency of 0.068 was comparable to the aggregate rates ranging from 0.060 to 0.086 observed in other populations. Binary logistic regression analysis was performed to ascertain the effects of age, gender and genotype on the likelihood of having keratoconus. The analysis indicated that increased age was statistically significant (p = 0.000) and that females have a 2.19-fold increased risk (p = 0.018) of developing keratoconus. The genotype frequencies did not differ between the sporadic or familial keratoconus cases. Polymorphism rs13334190 is not an independent risk factor for keratoconus in the Saudi cohort.

An emergency urine bioassay method for 241Am by extraction chromatography and liquid scintillation counting.

An emergency urine bioassay method has been developed for the determination of (241)Am in human urine samples. The method is based on extraction chromatographic separation of (241)Am from urine on a single DGA (N,N,N',N'-tetraoctyldiglycolamide) resin column followed by liquid scintillation counting of (241)Am. The minimum detectable activity (MDA) for the method was 0.02 Bq. Considering the volume of urine sample (17.2 ml) used by the method; the MDA was 1.3 Bq l(-1). Measurement accuracy (relative bias, B(r)) and repeatability (relative precision, S(B)) of the method were found to be -3.4 and 8.9 %, respectively, when urine samples were spiked with (241)Am (20 Bq l(-1)). Excellent linearity (r(2) > 0.999) was established over the range of 2-200 Bq l(-1). The method was also found to be robust (S(B)=10.2 %) against matrix effects from different urine samples. Performance of the rapid bioassay method for accuracy and repeatability were evaluated against the performance criteria for radiobioassay (ANSI N13.30) and found to be in compliance. Considering the simplicity, excellent analytical figures of merit and fast sample turnaround time (<1 h), it is a very promising rapid bioassay method for supporting the medical response to an emergency where internal contamination of (241)Am is involved.