Qualitative Analysis of Newborn Hearing Screening Program in Iran.

Background: Early diagnosis of hearing loss and timely interventions are important to minimize the consequences of this condition, especially for children. This research was conducted to analyze the newborn hearing loss screening program in Iran. Methods: This qualitative study was conducted using the content analysis method and based on the CIPP model in 2023. The snowball method was used to recruit a sample with maximum diversity. The criteria for selecting people for interviews included having at least three years of experience in the newborn hearing loss screening program and sufficient knowledge in the field. To ensure the reliability of the results, four criteria proposed by Lincoln and Guba were used. Data analysis was conducted by MAXQDA2022 software. Results: In the current research, using content analysis in the form of the CIPP model, based on the viewpoints of the interviewees (40 people), the management requirements of the newborn hearing loss screening program were categorized into the four main categories of context (texture), input, process, and output. Eight subcategories were identified in the context dimension, four subcategories in the input dimension, seven subcategories in the process dimension, and four subcategories in the output dimension. Conclusion: According to the findings of this research, in order to properly implement the newborn hearing loss screening program, there is a need to conduct pilot studies, need assessments, evidence-based programs, and epidemiological studies and to prioritize services and resources. Also, communication between service delivery levels needs to be improved, and attention should be paid to personnel motivation and screening programs.

Acinetobacter baumannii Sampled from Cattle and Pigs Represent Novel Clones.

Acinetobacter baumannii is a very important human pathogen. Nonetheless, we know very little about nonhuman isolates of A. baumannii. Here, we determine the genomic identity of 15 Scottish cattle and pig isolates, as well as their antibiotic and virulence genetic determinants, and compare them with 148 genomes from the main human clinical international clones. Our results demonstrate that cattle and pig isolates represent novel clones well separated from the major international clones. Furthermore, these new clones showed fewer antibiotic resistance genes and may have fewer virulence genes than human clinical isolates. IMPORTANCE Over the last decades, huge amounts of information have been obtained for clinical isolates of A. baumannii and the clones they belong to. In contrast, very little is known about the genomic identity and the genomic basis for virulence and resistance of animal isolates. To fulfil this gap, we conducted a genomic epidemiology study of 15 Scottish cattle and pig isolates in the context of almost 150 genomes belonging to the main international clones of A. baumannii. Our findings show that these animal isolates represent novel clones clearly different from the major international clones. Furthermore, these new clones are distinct in nature considering both antibiotic resistance and virulence when compared with their human clinical counterparts.

Identification of Remarkable Dimensions in Management and Evaluation of Non-Communicable Disease Programmes: A systematic review and meta-synthesis.

OBJECTIVES: This study aimed to identify indicators of proper programme development in the field of non-communicable diseases through the systematic review of existing literature. METHODS: In this systematic review, a search was conducted through PubMed, Scopus, EMBASE, Web of Science, Google Scholar, Cochrane Library, ProQuest and grey literature. The search was limited to literature published between January 2000 and January 2019. RESULTS: A total of 36 articles were found relevant to the study objectives. Data were obtained through these articles based on the context, input, process and product (CIPP) model. Seven subsets for context, five subsets for input, four subsets for process and six subsets for the product were identified. CONCLUSION: According to CIPP subsets, indicators such as programme definition, appropriate organisational culture, structure and evaluation must be considered to develop an appropriate programme to improve health services.

Perceived Asthma Control Care and Health Care Participation in Patients with Asthma.

BACKGROUND: Asthma is one of the most severe and life-threatening health problems, the better control of which is one of the main goals in asthma management to be achieved by patients' balanced participation in the treatment process. This study aimed to investigate asthma control, perceived care, and health care participation in patients with asthma. MATERIALS AND METHODS: This descriptive-analytical study included 221 asthmatic patients, who were selected using the convenience sampling method from those referring to pulmonary clinics in Kerman, Iran. The required data were collected using three questionnaires including Asthma Control Test (ACT), Perceived Care of Asthma Questionnaire (PCAQ), and Partners in Health Scale (PIH). The linear regression test was used to analyze the collected data with SPSS software version 21. RESULTS: In this study, 14.31, 42.22, and 87.33% of the patients had a favorable condition in asthma control, perceived asthma care, health participation, respectively. The disease duration was significantly associated with the level of perceived asthma care. Moreover, perceived asthma care had a significant relationship only with occupation. From another perspective, the relationship between marital status, level of education, city of residence, disease duration, and occupation with health care participation was significant. CONCLUSION: Patients would have more control over asthma if there were training programs underpinned by disease-based strategies and educational content regarding the risk factors of the disease, and the patients' experience and knowledge of the disease were promoted. Furthermore, reinforcing self-control and perceived asthma care skills and involving patients in healthcare process would also enhance the disease control.

Challenges of implementing the accreditation model in military and university hospitals in Iran: a qualitative study.

BACKGROUND: The aim of this study was to present challenges of implementing the accreditation model in university and military hospitals in Iran. METHODS: In this qualitative study, purposive sampling was used to select hospital managers and implementers of the model working in 3 hospitals affiliated to Kerman University of Medical Sciences and in 3 military hospitals in Kerman, Iran. A total of 39 participants were interviewed, and semi-structured questionnaires and thematic analysis were used for data collection and analysis, respectively. RESULTS: In this study, 5 major codes and 17 subcodes were identified: (1) perspectives on accreditation model with 5 subcodes: a difficult and time-consuming model, less attention to the patient, accreditation as a way of money acquisition, not being cost-effective, and accreditation means incorrect documentation; (2) absence of appropriate executive policy, with 3 subcodes: lack of financial funds and personnel, disregarding local conditions in implementation and evaluation, and absence of the principle of unity of command; (3) training problems of the accreditation model, with 2 subcodes: absence of proper training and incoordination of training and evaluation; (4) human resources problems, with 3 subcodes: no profit for nonphysician personnel, heavy workload of the personnel, and physicians' nonparticipation; (5) evaluation problems, with 4 subcodes: no precise and comprehensive evaluation, inconformity of authorities' perspectives on evaluation, considerable change in evaluation criteria, and excessive reliance on certificates. CONCLUSIONS: This study provided useful data on the challenges of implementing hospitals' accreditation, which can be used by health policymakers to revise and modify accreditation procedures in Iran and other countries with similar conditions. The accreditation model is comprehensive and has been implemented to improve the quality of services and patients' safety. The basic philosophy of hospital accreditation did not fully comply with the underlying conditions of the hospitals. The hospital staff considered accreditation as the ultimate goal rather than a means for achieving quality of service. The Ministry of Health and Medical Education performed accreditation hastily for all Iranian hospitals, while the hospitals were not prepared and equipped to implement the accreditation model.

Administrative challenges of clinical governance in military and university hospitals of Kerman/Iran.

BACKGROUND: Over the recent years, clinical governance model has been applied to improve the quality of university and private hospitals in Iran. In addition to university hospitals, military hospitals have an effective role in the preservation and promotion of public health. The challenges of clinical governance implementation have not been investigated in such settings. Hence, the present study objective is to identify the administrative challenges of clinical governance in military and university hospitals of Kerman/Iran METHODS: This qualitative study was carried out through phenomenology in 2017. A sample of managers and experts in the implementation and execution of clinical governance was purposefully selected from three university hospitals and three military hospitals in Kerman, Iran. A total of 39 managers and experts were interviewed, and data were gathered via semistructured interviews with open questions. For data analysis, conventional content analysis method was employed. RESULTS: In this study, five main codes and 17 subcodes were obtained. Main codes were structural challenges, educational challenges, limitations, evaluation, and human resource challenges. CONCLUSIONS: Clinical governance is being implemented hastily with no appropriate structural, financial, and training facilities, ensuing a waste of resources, more difficult work for staff and a negative view of personnel.

Investigating inappropriate admissions and hospitalizations in Yasuj educational hospitals based on appropriateness evaluation protocol (AEP): A case study in the internal and surgical wards.

BACKGROUND: Examining the conditions for hospital admission and its appropriateness, and continuous investigation of hospital services are important issues that can improve resource productivity, service quality, and hospital efficacy. So, the present study was conducted to determine the appropriateness of the services provided in Yasuj educational hospitals. METHODS: This descriptive-analytical study was carried out on 204 hospitalized patients who were selected through multistage quota sampling in 2016. The appropriateness evaluation protocol (AEP) was used to collect the data. Analytical tests such as paired t-test, chi-square test, and Fisher's exact test were used to determine the relationship between appropriate and inappropriate admission and hospitalization and demographic characteristics. The data were analyzed using the SPSS18 statistical software. RESULTS: A total of 980 days of stay were evaluated, and according to the AEP, 35 days of hospitalization were considered inappropriate (3.57%). The mean hospitalization duration was 6/16 ± 5/53 days. The results showed that inappropriate admission and hospitalization rates were respectively 0.6% and 13.8%. CONCLUSION: Unnecessary admissions and hospitalizations can be considered as one of the challenges of the health system. Reducing unnecessary hospitalization will increase hospital productivity, reduce the waiting list and hospitalization costs, and also reduce the risk of exposure to hospital infections. In order to prevent inappropriate admissions and unnecessary hospitalizations, special measures can be taken, including the use of clinical guidelines, modification of the discharge process, and modification of the lower levels of the service providing system.

The Challenges of Iran's Type 2 Diabetes Prevention and Control Program.

BACKGROUND: Incidence and prevalence of type 2 diabetes are one of the major challenges of Iran health system. Despite policies on diabetes prevention and control, Iran is faced with many problems in prevention and control of this disease at the executive level. This study seeks to identify the problems of Type 2 diabetes prevention and control program in Iran. METHODS: In this qualitative study, 17 participants were interviewed purposefully. The semi-structured interview guide was designed based on literature review and four initial in-depth interviews. Framework analysis method was used for the analysis of qualitative data. RESULTS: Six themes and 29 subthemes explaining the problems of type 2 diabetes prevention and control program were identified: Referral system, human resources, infrastructure, cultural problems, access, and intersectoral coordination issues. CONCLUSIONS: Despite the well-developed policy of type 2 diabetes prevention and control, the implementation is faced with some problems which endangers the effectiveness of the plan. Any attempt to improve the successful implementation of the type 2 diabetes prevention and control program requires effective measures, deep understanding of the problems and solving them.

Chlorpromazine versus piperacetazine for schizophrenia.

BACKGROUND: Schizophrenia is a severe mental disorder with a prevalence of about 1% among the general population. It is listed among the top 10 causes of disability-adjusted life years (DALYs) worldwide. Antipsychotics are the mainstay treatment. Piperacetazine has been reported to be as clinically effective as chlorpromazine, a well established 'benchmark' antipsychotic, for people with schizophrenia. However, the side effect profiles of these antipsychotics differ and it is important that an evidence base is available comparing the benefits, and potential harms of these two antipsychotics. OBJECTIVES: To assess the clinical and side effects of chlorpromazine for people with schizophrenia and schizophrenia-like psychoses in comparison with piperacetazine. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Trials Register (6 June 2015 and 8 October 2018) which is based on regular searches of CINAHL, CENTRAL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO and registries of clinical trials. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA: We included randomised controlled trials (RCTs) focusing on chlorpromazine versus piperacetazine for people with schizophrenia, reporting useable data. DATA COLLECTION AND ANALYSIS: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS: We found 12 records referring to six trials. We included five trials, all from the 1970s, randomising 343 participants. We excluded one trial. The overall methodology and data reporting by the trials was poor. Only short-term data were available.Results from the included trials found that, in terms of global state improvement, when rated by a psychiatrist, there was no clear difference between chlorpromazine and piperacetazine (RR 0.90, 95% CI 0.80 to 1.02; participants = 208; studies = 2; very low-quality evidence). One trial reported change scores on the mental state scale Brief Psychiatric Rating Scale (BPRS); no clear difference was observed (MD -0.40, 95% CI -1.41 to 0.61; participants = 182; studies = 1; very low-quality evidence). Chlorpromazine appears no worse or better than piperacetazine regarding adverse effects. In both treatment groups, around 60% of participants experienced some sort of adverse effect (RR 1.00, 95% CI 0.75 to 1.33; participants = 74; studies = 3; very low-quality evidence), with approximately 40% of these participants experiencing some parkinsonism-type movement disorder (RR 0.95, CI 0.61 to 1.49; participants = 106; studies = 3; very low-quality evidence). No clear difference in numbers of participants leaving the study early for any reason was observed (RR 0.50, 95% CI 0.10 to 2.56; participants = 256; studies = 4; very low-quality evidence). No trial reported data for change in negative symptoms or economic costs. AUTHORS' CONCLUSIONS: The results of this review show chlorpromazine and piperacetazine may have similar clinical efficacy, but data are based on very small numbers of participants and the evidence is very low quality. We can not make firm conclusions based on such data. Currently, should clinicians and people with schizophrenia need to choose between chlorpromazine and piperacetazine they should be aware there is no good quality evidence to base decisions. More high quality research is needed.

The Challenges and Barriers to the Integration of Laboratory Services in Iran from Laboratory Experts' Point of View.

BACKGROUND: Laboratory services fragmentation creates problems such as non-accountability for costs and quality, not being patient-centered and unsustainability of services in long run. Therefore, health systems consider laboratory services integration an inevitable way. This study aimed to investigate the challenges and barriers to the integration of laboratory services in Iran. METHODS: This qualitative case study was conducted in 2016. Using purposive sampling, semi-structured interviews were conducted with 34 informed participants. Each interview lasted between 30 to 60 min. Acceptability, transferability, reliability, and verifiability were used to assess the validity, accuracy and reliability of qualitative data. Framework approach was used to analyze data. RESULTS: Lack of economy of scale, unfair access, lack of grading, low quality, development of national strategies to create an integrated network of laboratories, criteria of the laboratories establishment, creation of necessary infrastructure, empowering the private sector and standardization of indicators were considered the most important problems of laboratory services integration in Iran; they were classified into two main themes. CONCLUSION: Identified issues are challenges which adversely impact the integration of laboratory services. Therefore, providing infrastructures with increased cooperation between various organizations to increase access to laboratory services in the form of an integrated network is essential.

Measuring the net profit of laboratory services: A case study in Iran.

Background: Clinical laboratories need to manage resources properly and scientifically to survive in today's highly competitive environment. In this context, scientific-economic principles should be considered to determine the profitability or loss of laboratories. Thus, in this study, the net profit of laboratory services was measured based on scientific-economic principles. Methods: This was an applied research with descriptive-retrospective approach. A laboratory was selected from 61 laboratories of Kerman, Iran, which performed the highest number of tests among the laboratories of this city. In addition, due to easy access, it was the most visited laboratory by patients. The present study had 2 main phases: (1) measuring the price of services and (2) calculating the net profit of the studied laboratory. Data analysis was performed using activity- based costing (ABC) as an econometric model and Excel software. Results: The highest charges were related to direct costs (78.28%); consumable goods (47.26%) and professional and logistic human resources (46.31%) had the highest share of these costs. In the test groups, the most expensive tests belonged to the hormones (23.03%) and clinical chemistry (20.84%). Total cost, revenue, and the net profit of the studied laboratory were 641 645, 1 390 942, and 749 297 USD, respectively. After doing sensitivity analysis (50% increase in the frequency of tests), the following values were obtained: 987 071, 2 086 413, and 1 099 342, respectively. Conclusion: Some test groups in the studied laboratory were not profitable, and this was due to the high cost of these tests and illogical tariffs. One way to overcome this problem is to increase the frequency of laboratory tests.

Success rate evaluation of clinical governance implementation in teaching hospitals in Kerman (Iran) based on nine steps of Karsh's model.

BACKGROUND: One of the ways to improve the quality of services in the health system is through clinical governance. This method aims to create a framework for clinical services providers to be accountable in return for continuing improvement of quality and maintaining standards of services. OBJECTIVE: To evaluate the success rate of clinical governance implementation in Kerman teaching hospitals based on 9 steps of Karsh's Model. METHODS: This cross-sectional study was conducted in 2015 on 94 people including chief executive officers (CEOs), nursing managers, clinical governance managers and experts, head nurses and nurses. The required data were collected through a researcher-made questionnaire containing 38 questions with three-point Likert Scale (good, moderate, and weak). The Karsh's Model consists of nine steps including top management commitment to change, accountability for change, creating a structured approach for change, training, pilot implementation, communication, feedback, simulation, and end-user participation. Data analysis using descriptive statistics and Mann-Whitney-Wilcoxon test was done by SPSS software version 16. RESULTS: About 81.9 % of respondents were female and 74.5 have a Bachelor of Nursing (BN) degree. In general, the status of clinical governance implementation in studied hospitals based on 9 steps of the model was 44 % (moderate). A significant relationship was observed among accountability and organizational position (p=0.0012) and field of study (p=0.000). Also, there were significant relationships between structure-based approach and organizational position (p=0.007), communication and demographic characteristics (p=0.000), and end-user participation with organizational position (p=0.03). CONCLUSION: Clinical governance should be implemented by correct needs assessment and participation of all stakeholders, to ensure its enforcement in practice, and to enhance the quality of services.

Characterization of Heterogeneous MRSA and MSSA with Reduced Susceptibility to Chlorhexidine in Kuwaiti Hospitals.

The objective of this investigation was to identify the lineages of MRSA and MSSA with reduced susceptibility to chlorhexidine in Kuwaiti hospitals. 121 clinical MRSA and 56 MSSA isolates were included in this study. Antimicrobial susceptibility testing was performed for a selection of agents including chlorhexidine and resistance genes were amplified and sequenced. PFGE, spa typing, and MLST were completed for a selection of isolates. The results showed SCCmec II, III, IV, and V were present in 0.8, 21.5, 69.4, and 8.3% of the MRSA isolates. agr-1Sa was the most prevalent type in both MSSA (48%) and MRSA (54%). Forty-five percentage of MRSA contained pvl and 39% contained lukE-lukD, however, as many as 86% of MSSA contained pvl and 96.4% contained lukE-lukD. qac A-C genes were identified in 12.3% of MRSA, norA was present in 82.6% and blaZ in 94.2%. Among MSSA only 5.4% harbored qacA, 83% contained norA, and 91% blaZ. Multi-drug resistant ST239/t945 lineage containing a qac gene was the most identified S. aureus. However, other lineages, including ST772-MRSA-V/t4867/pvl(+)qacC/smr and non-qac harboring lineages of ST217-MRSAIV/t3244/pvl(-), ST34-MSSA/t161/pvl(+), ST5-MSSA/t688/pvl(+), ST5-MSSA/t4867/norA(+), and ST672-MSSA/t003/pvl(-), also showed reduced susceptibility to chlorhexidine. The observed reduced susceptibility of non-qac dependent MSSA isolates to chlorhexidine suggests the involvement of other elements in promoting higher MBC (≥30 mg/L). Our results confirm that monitoring MSSA is essential as they may have the potential to survive low level biocide exposure.

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.

Risk factors associated with musculoskeletal disorders of the neck and shoulder in the personnel of Kerman University of Medical Sciences.

BACKGROUND: Musculoskeletal disorders (MSDs) of the neck and shoulder are the most common and most influential factors causing disorder in the performance and absenteeism of work in administrative personnel. AIM: To identify risk factors which affect musculoskeletal disorders of neck and shoulder areas in headquarters staff of Kerman University of Medical Sciences. METHODS: The present cross-sectional study was conducted in 2015 on 282 headquarters personnel of Kerman University of Medical Sciences (Kerman, Iran). The desired headquarters staff were selected from seven Deputy Vice-Chancellors of Kerman University of Medical Sciences, including Deputy of Health; Deputy of Treatment; Deputy of Education; Deputy of Students and Cultural Affairs; Deputy of Food and Drugs; Deputy of Management Development and Resource Planning; Deputy of Research and Technology, and data were gathered by using a standard Nordic musculoskeletal questionnaire NMQ (Nordic) and were analyzed by using SPSS version 16. The impact of various factors on the most common complications (neck and shoulder pains) was analyzed separately through logistic regression analysis and detailed Odds Ratio (OR) was calculated for each individual. RESULTS: The occurrence of neck and shoulder pains in headquarters staff were 42.14% and 40.71%, respectively. In the prevalence of neck pain variables such as marital status (single than married p=0.01, OR=0.24), work experience (p=0.03, OR=1.07 ), education (bachelor's degree and lower than master's degree and higher p=0.003, OR=2.69), right / left-handedness (left than right p=0.03, OR=0.33), weight (p=0.04, OR=1.04), place of work (p<0.05); as well as in the prevalence of shoulder pain variables such as marital status (single than married p=0.04, OR=0.48), work experience (p=0.01, OR=1.20), education (bachelor and lower than master and higher p=0.04, OR=1.97), right / left handedness (left than right p=0.01, OR=0.42), age (p=0.02, OR=1.05), and gender (male than female p=0.03, OR=0.65) affected. CONCLUSION: The results of this study showed that the prevalence of neck and shoulder pains is influenced by various risk factors and some of which were identified and an amount of their influence in this study was found. Therefore, it is suggested by considering the risk factors and planning control programs, a major step is taken in reducing the musculoskeletal disorders of office staff.

Cost-price estimation of clinical laboratory services based on activity-based costing: A case study from a developing country.

BACKGROUND: It is believed that laboratory tariffs in Iran don't reflect the real costs. This might expose private laboratories at financial hardship. Activity Based Costing is widely used as a cost measurement instrument to more closely approximate the true cost of operations. OBJECTIVE: This study aimed to determine the real price of different clinical tests of a selected private clinical laboratory. METHODS: This study was a cross sectional study carried out in 2015. The study setting was the private laboratories in the city of Kerman, Iran. Of 629 tests in the tariff book of the laboratory (relative value), 188 tests were conducted in the laboratory that used Activity Based Costing (ABC) methodology to estimate cost-price. Analyzing and cost-price estimating of laboratory services were performed by MY ABCM software Version 5.0. RESULTS: In 2015, the total costs were $641,645. Direct and indirect costs were 78.3% and 21.7% respectively. Laboratory consumable costs by 37% and personnel costs by 36.3% had the largest share of the costing. Also, group of hormone tests cost the most $147,741 (23.03%), and other tests group cost the least $3,611 (0.56%). Also after calculating the cost of laboratory services, a comparison was made between the calculated price and the private sector's tariffs in 2015. CONCLUSION: This study showed that there was a difference between costs and tariffs in the private laboratory. One way to overcome this problem is to increase the number of laboratory tests with regard to capacity of the laboratories.

Quantitative optimization of emergency department's nurses of an educational hospital: a case study.

INTRODUCTION: Nurses account for the majority of human resources in hospitals, as such that 62% of the workforce and 36% of hospital expenditures are related to nurses. Considering its vital role in offering round-the-clock emergency healthcare services, an Emergency Department (ED) requires adequate nurses. Therefore, this study was conducted to optimize the number of nurses in ED. METHODS: This was an applied study conducted using a Linear Programming (LP) model in 2015. The study population were selected by census who were all ED nurses (n=84) and patients referred to ED (n=3342). To obtain the statistics related to the number of patients and nurses, the hospital information system and human resources database were employed respectively. To determine the optimum number of nurses per shift, LP model was created via literature review and expert advice, and it was executed in WinQSB software. RESULTS: Before implementing the model, the number of nurses required for ED morning shift, evening shift, and night shift (2 shifts) was 26, 24 and 34 respectively. The optimum number of nurses who worked in ED after running the model was 62 nurses, 17 in the morning shift, 17 in the evening shift and 28 in the night shift (2 shifts). This reduced to 60 nurses after conducting sensitivity analysis. CONCLUSION: The estimated number of nurses using LP was less than the number of nurses working in ED. This discrepancy can be reduced by scientific understanding of factors affecting allocation and distribution of nurses in ED and flexible organization, to reach the optimal point.

The effect of arsenite on spatial learning: Involvement of autophagy and apoptosis.

Spatial learning plays a major role in one's information recording. Arsenic is one of ubiquitous environmental toxins with known neurological effects. However, studies investigating the effects of arsenic on spatial learning and related mechanisms are limited. This study was planned toexaminethe effects of bilateral intra-hippocampal infusion of different concentrations of sodium arsenite (5, 10 and 100nM, 5µl/side) on spatial learning in Wistar rats. Moreover, we evaluated levels of LC3-II, Atg7 and Atg12 as reliable biomarkers of autophagy and caspase-3 and Bax/Bcl-2 ratio as indicators of apoptosis in the hippocampus. Interestingly, low concentrations of sodium arsenite (5 and 10nM) significantly increased spatial acquisition but pre-training administration of sodium arsenite100nM did not significantly alter spatial learning. LC3-II levels were significantly increased in groups treated with sodium arsenite 5 and 10nM and decreased in the group receiving arsenite 100nM compared to the control group. Atg7 and Atg12 levels were obviously higher in all groups treated with sodium arsenite compared to control. However, caspase-3 cleavage and Bax/Bcl-2 ratio were notably greater in 100nM, and lesser in 5nM arsenite group in comparison with control animals. The results of this study showed that the low concentrations of sodium arsenite could facilitate spatial learning. This facilitation could be attributed to neuronal autophagy induced by low concentrations of sodium arsenite. These findings may help to clarify the regulatory pathways for apoptosis and autophagy balance due to sodium arsenite.

Determining the Prevalence of Retinopathy and Its Related Factors among Patients with Type 2 Diabetes in Kerman, Iran.

OBJECTIVES: To determine the prevalence of retinopathy and its associated factors in diabetic patients referred to a diabetes center in an Iranian city. METHODS: This was a cross-sectional, descriptive-analytical study in which a researcher-made checklist was used to collect the data of patients with type 2 diabetes in 2015. The statistical population consisted of 11,770 health records of diabetic patients registered in a second-level diabetes center. Of the 11,770 health records, 206 records with the most complete data about patients with type 2 diabetes were selected through census method. Chi-square test and logistic regression through SPSS were used for data analysis. RESULTS: In this study, 93/206 diabetic patients (45.1%) had retinopathy. Female sex, age over 60, lower education level, being housewife, family history of having diabetes, longer years of having the disease, and higher level of hemoglobin A1c (HbA1c) were associated with higher risk of retinopathy. However, the association was statistically significant only for the HbA1c level (p ≥ 0.05). CONCLUSION: According to this study, HbA1c level is a predictor of diabetes complications. Therefore, it is necessary for health authorities to improve diabetes management through different strategies to prevent complications to control blood sugar effectively.

Investigating Knowledge Management Status among Faculty Members of Kerman University of Medical Sciences based on the Nonaka Model in 2015.

INTRODUCTION: Education and research are two major functions of universities, which require proper and systematic exploitation of available knowledge and information. Therefore, it is necessary to investigate the knowledge management status in an education system by considering the function of faculty members in creation and dissemination of knowledge. This study was conducted to investigate the knowledge management status among faculty members of the Kerman University of Medical Sciences based on the Nonaka and Takeuchi models in 2015. METHODS: This was a descriptive-analytical and cross-sectional study. It was conducted on 165 faculty members at the Kerman University of Medical Sciences, who were selected from seven faculties as weighted using a random stratified sampling method. The Nonaka and Takeuchi knowledge management questionnaire consists of 26 questions in four dimensions of socialization, externalization, internalization, and combination. Scoring of questions was conducted using the five-point Likert scale. To analyze data, independent t-test, one-way ANOVA, Pearson correlation coefficients, and the Kruskal-Wallis test were employed. RESULTS: The four dimensions in the Nonaka and Takeuchi model are based on optimal indicators (3.5), dimensions of combination, and externalization with an average of 3.3 were found in higher ranks and internalization and socialization had averages of 3.1 and 3. According to the findings of this study, the average knowledge management among faculty members of the Kerman University of Medical Sciences was estimated to be 3.1, with a bit difference compared to the average. According to the results of t-tests, there was no significant relationship between gender and various dimensions of knowledge management (p>0.05). The findings of Kruskal-Wallis showed that there is no significant relationship between variables of age, academic rank, and type of faculty with regard to dimensions of knowledge management (p>0.05). In addition, according to the results of Pearson tests, there is no significant relation between employment history and dimensions of knowledge management (p>0.05). CONCLUSION: Considering the function and importance of knowledge management in education and research organizations including universities, it is recommended to pay comprehensive attention to establishment of knowledge management and knowledge sharing in universities and provide the required background to from research teams and communication networks inside and outside universities.