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1.
Int J Health Plann Manage ; 34(2): e1293-e1301, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30924978

RESUMO

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.


Assuntos
Governança Clínica/organização & administração , Hospitais Militares/organização & administração , Hospitais Universitários/organização & administração , Administradores Hospitalares , Humanos , Entrevistas como Assunto , Irã (Geográfico) , Inovação Organizacional , Administração de Recursos Humanos em Hospitais , Melhoria de Qualidade/organização & administração
2.
Int J Health Plann Manage ; 34(2): 636-643, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30609065

RESUMO

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.


Assuntos
Mau Uso de Serviços de Saúde/estatística & dados numéricos , Departamentos Hospitalares/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Medicina Interna/estatística & dados numéricos , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Revisão da Utilização de Recursos de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Irã (Geográfico) , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Revisão da Utilização de Recursos de Saúde/métodos , Adulto Jovem
3.
Cochrane Database Syst Rev ; 10: CD011709, 2018 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-30378678

RESUMO

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.


Assuntos
Antipsicóticos/uso terapêutico , Clorpromazina/uso terapêutico , Fenotiazinas/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/efeitos adversos , Clorpromazina/efeitos adversos , Feminino , Humanos , Masculino , Fenotiazinas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
4.
Iran J Public Health ; 47(6): 884-892, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30087875

RESUMO

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.

5.
Med J Islam Repub Iran ; 32: 12, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30159263

RESUMO

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.

6.
Electron Physician ; 9(7): 4841-4846, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28894544

RESUMO

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.

7.
Int J Health Care Qual Assur ; 30(7): 656-663, 2017 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-28809594

RESUMO

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.


Assuntos
Benchmarking/métodos , Benchmarking/normas , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem
8.
Front Microbiol ; 8: 1359, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28775716

RESUMO

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.

9.
Electron Physician ; 9(5): 4341-4348, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28713505

RESUMO

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.

10.
Electron Physician ; 9(4): 4077-4083, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28607638

RESUMO

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.

11.
Electron Physician ; 9(2): 3803-3809, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28465810

RESUMO

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.

12.
Eur J Pharmacol ; 796: 54-61, 2017 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-27993642

RESUMO

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.


Assuntos
Apoptose/efeitos dos fármacos , Arsenitos/farmacologia , Autofagia/efeitos dos fármacos , Compostos de Sódio/farmacologia , Aprendizagem Espacial/efeitos dos fármacos , Animais , Biomarcadores/metabolismo , Relação Dose-Resposta a Droga , Hipocampo/citologia , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Hipocampo/fisiologia , Masculino , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos , Proteína X Associada a bcl-2/metabolismo
13.
Osong Public Health Res Perspect ; 7(5): 296-300, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27812487

RESUMO

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.

14.
Electron Physician ; 8(8): 2738-2746, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27757183

RESUMO

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.

15.
Int J Infect Dis ; 41: 42-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26518066

RESUMO

OBJECTIVES: The aim of this study was to identify the genetic relatedness of multiple drug-resistant (MDR) Acinetobacter baumannii clinical isolates recovered from a hospital in Los Angeles. METHODS: Twenty-one MDR A. baumannii isolates were collected and their antibiotic susceptibilities determined according to Clinical and Laboratory Standards Institute guidelines. Genes coding for antibiotic resistance were identified by PCR, and their identities were confirmed by DNA sequencing. Clonal relationships were studied by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). RESULTS: MDR consistently correlated with the presence of oxacillinases, mostly in the form of the plasmid-mediated OXA-23 enzyme, which was detected in 12 (57.1%) isolates. GES-type carbapenemases were found in 20 (95.2%) strains, AAC in all 21 (100%) strains, and PER in seven (33.3%) strains, and ISAba1 was detected in 16 (76.2%) isolates. The association between ISAba1 and resistance genes confirms insertion elements as a source of ß-lactamase production. Of the 21 clinical isolates, five were found to be related to sequence type 1 (ST1) and 16 to ST2, as analyzed by MLST. PFGE demonstrated that the majority of clinical isolates were highly related (>85%). CONCLUSIONS: This study supports a more complete understanding of genotyping of antibiotic resistance for better assessment of MDR strain transmission.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/genética , Farmacorresistência Bacteriana Múltipla , Epidemiologia Molecular , Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/isolamento & purificação , Elementos de DNA Transponíveis , DNA Bacteriano/genética , Eletroforese em Gel de Campo Pulsado , Regulação Bacteriana da Expressão Gênica , Genótipo , Hospitais , Humanos , Los Angeles/epidemiologia , Tipagem de Sequências Multilocus , Reação em Cadeia da Polimerase , Análise de Sequência de DNA
16.
Pharmacol Biochem Behav ; 139(Pt A): 47-58, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26484504

RESUMO

Crocin, as a carotenoid, is one of the main and active constituents of saffron stigmas (Crocus sativus L.) that is widely used in folk medicine. Several studies have pointed out the potent antioxidant and neuroprotective properties of crocin which may have therapeutic values for management of neurodegenerative disorders such as Alzheimer's disease. Alzheimer's disease is the most common form of dementia among the elderly and is characterized by massive neuronal loss and progressive cognitive impairment. Beta amyloid hypothesis is the main theoretical research framework for Alzheimer's disease which states that extracellular aggregation of beta amyloid results in synaptic loss and eventually cell apoptosis. Recent findings suggest that autophagy and apoptosis are extensively involved in Alzheimer's disease. In order to investigate therapeutic values of crocin, we examined the effect of crocin on memory, cell apoptosis, and autophagy using in vivo models of Alzheimer's disease. We also compared the effect of crocin administration on spatial memory with nicotine as positive control. Morris water maze results show that intra-peritoneal and intra-hippocampal administration of crocin significantly improve spatial memory indicators such as escape latency, traveled distance and time spent in target quadrant when compared to beta amyloid injection. Furthermore, we measured certain biomarkers of cell autophagy and apoptosis using Western blot analysis. Our results reveal that crocin administration does not cause any significant alteration in Beclin-1 and ratio of LC3-II/LC3-I compared to the group received beta amyloid by hippocampal injection. However, in contrast to autophagy, crocin administration significantly decreases Bax/Bcl-2 ratio and cleaved Caspase-3 level. This demonstrates that crocin inhibits beta amyloid induced apoptosis, which is possibly associated with its antioxidant properties. Our results further confirm the neuroprotective properties of crocin as a potential pharmaceutical agent for management of Alzheimer's disease.


Assuntos
Peptídeos beta-Amiloides/antagonistas & inibidores , Proteínas Reguladoras de Apoptose/metabolismo , Apoptose/efeitos dos fármacos , Autofagia/efeitos dos fármacos , Carotenoides/uso terapêutico , Transtornos da Memória/tratamento farmacológico , Fragmentos de Peptídeos/antagonistas & inibidores , Peptídeos beta-Amiloides/administração & dosagem , Peptídeos beta-Amiloides/efeitos adversos , Animais , Comportamento Animal/efeitos dos fármacos , Carotenoides/administração & dosagem , Carotenoides/farmacologia , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Transtornos da Memória/induzido quimicamente , Microinjeções , Fármacos Neuroprotetores/administração & dosagem , Fármacos Neuroprotetores/farmacocinética , Fármacos Neuroprotetores/uso terapêutico , Nicotina/farmacologia , Fragmentos de Peptídeos/administração & dosagem , Fragmentos de Peptídeos/efeitos adversos
17.
Glob J Health Sci ; 8(2): 106-16, 2015 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-26383203

RESUMO

INTRODUCTION: The productivity of healthcare staff is one of the main issues for health managers. This study explores the concept of executive regulation of Productivity Improvement Act of clinical staff in health. METHODS: In this study phenomenological methodology has been employed. The data were collected through semi-structured interviews and focus group composed of 10 hospital experts and experts in human resources department working in headquarter of Mashhad University of Medical Sciences and 16 nursing managers working in public and private hospitals of Mashhad using purposive sampling. Findings were analyzed using Colaizzi's seven step method. RESULTS: The strengths of this Act included increasing spirit of hope in nurses, paying attention to quality of nursing care and decreasing problems related to the work plan development. Some of the weaknesses of Productivity Improvement Act included lack of required executive mechanisms, lack of considering nursing productivity indicator, increasing non-public hospitals problems, discrimination between employees, and removal of resting on night shifts. Suggestions were introduced to strengthen the Act such as increased organizational posts, use of a coefficient for wage in unusual work shifts and consideration of a performance indicator. CONCLUSION: The results may be used as a proper tool for long term management planning at organization level. Finally, if high quality care by health system staff is expected, in the first step, we should take care of them through proper policy making and focusing on occupational characteristics of the target group so that it does not result in discrimination among the staff.


Assuntos
Eficiência Organizacional/legislação & jurisprudência , Eficiência , Política de Saúde/legislação & jurisprudência , Recursos Humanos de Enfermagem no Hospital/legislação & jurisprudência , Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Melhoria de Qualidade , Adulto , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa
18.
Front Microbiol ; 6: 743, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26257720

RESUMO

Acinetobacter baumannii is one of the most important opportunistic pathogens that causes serious health care associated complications in critically ill patients. In the current study we report on the diversity of the clinical multi-drug resistant (MDR) A. baumannii in Kuwait by molecular characterization. One hundred A. baumannii were isolated from one of the largest governmental hospitals in Kuwait. Following the identification of the isolates by molecular methods, the amplified bla OXA-51-like gene product of one isolate (KO-12) recovered from blood showed the insertion of the ISAba19 at position 379 in bla OXA-78. Of the 33 MDR isolates, 28 (85%) contained bla OXA-23, 2 (6%) bla OXA-24 and 6 (18%) bla PER-1 gene. We did not detect bla OXA-58, bla VIM, bla IMP, bla GES, bla VEB, and bla NDM genes in any of the tested isolates. In three bla PER-1 positive isolates the genetic environment of bla PER-1 consisted of two copies of ISPa12 (tnpiA1) surrounding the bla PER-1 gene on a highly stable plasmid of ca. 140-kb. Multilocus-sequence typing (MLST) analysis of the 33 A. baumannii isolates identified 20 different STs, of which six (ST-607, ST-608, ST-609, ST-610, ST-611, and ST-612) were novel. Emerging STs such as ST15 (identified for the first time in the Middle East), ST78 and ST25 were also detected. The predominant clonal complex was CC2. Pulsed-field gel electrophoresis and MLST defined the MDR isolates as multi-clonal with diverse lineages. Our results lead us to believe that A. baumannii is diverse in clonal origins and/or is undergoing clonal expansion continuously while multiple lineages of MDR A. baumannii circulate in hospital ward simultaneously.

19.
Daru ; 23: 34, 2015 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-26122674

RESUMO

BACKGROUND: Klebsiella pneumoniae is one of the most important opportunistic pathogens causing serious complications in patients in hospitals and community. The clinical significance of K. pneumoniae is mainly due to its ability to acquire multiple antibiotic resistance genes. In this study we report the findings of a survey of plasmid mediated quinolone resistance in Extended-Spectrum ß-lactamase (ESBL)-producing K. pneumoniae in Kuwait. METHODS: Clinical samples were collected from the microbiology laboratories of three major hospitals. Isolates were confirmed as ESBL-producers by disc diffusion method and PCR for the presence of bla genes. Antimicrobial susceptibility testing and genetic analysis were performed to detect the presence of a number of genes conferring resistance to ß-lactam and fluoroquinolone antimicrobial agents including bla SHV, bla TEM, aac (6')-Ib-cr, qnrA, qnrB and qnrS. Pulsed-field gel electrophoresis (PFGE) was used for typing the isolates. RESULTS: In total 173 ESBL-producing K. pneumoniae were detected. qnr genes were identified in 27 (15.6 %) isolates and aac(6')-Ib Ib-cr gene in 26 (96 %). One (3.7 %) contained qnrA2, 21 harbored qnrB1 (78 %) and 5 (18.5 %) contained qnrS. Twenty one (78 %) isolates contained all three bla genes. PFGE showed diverse profiles. CONCLUSION: We identified for the first time the emergence of the mobile fluoroquinolone resistance qnrA2 in a clinical isolate in the middle east and also showed the dissemination of aac (6')-Ib-cr, qnrB, and qnrS genes among ESBL-producing K. pneumoniae in Kuwait. The abundance of plasmid mediated resistance to fluoroquinolones among ESBL-producing K. pneumoniae is alarming as it facilitates therapy failure. Preventing the spread of these isolates is crucial if we are to sustain the effectiveness of the limited choices we have left in antimicrobial therapy.


Assuntos
Proteínas de Bactérias/genética , Farmacorresistência Bacteriana Múltipla/genética , Klebsiella pneumoniae , beta-Lactamases/genética , Antibacterianos/farmacologia , Genes Bacterianos/genética , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Kuweit , Testes de Sensibilidade Microbiana , Plasmídeos , Quinolonas/farmacologia
20.
Int J Infect Dis ; 34: 112-6, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25835102

RESUMO

In most hospitals, chlorhexidine is used as skin antiseptic prior to clinical procedures, in dressings and when bathing patients. We hereby report, for the first time, the isolation of a clinical Klebsiella oxytoca isolate with reduced sensitivity to chlorhexidine from a foot ulcer of a diabetic patient, which is a common and serious complication associated with diabetes. The Minimum Inhibitory Concentration of the K. oxytoca isolate to chlorhexidine was found to be 30 mg/L and the Minimum Bactericidal Concentration was 60 mg/L. An increased resistance to ethidium bromide (MIC 200 mg/ L) was also observed. Molecular tests revealed that the isolate contained blaCTXM15, blaT(EM-1) and bla(SHV). The other resistant genes detected were qnrB1 and aac(6')-Ib-cr. The resistant determinants were located on a class I integron integrase (intI1) containing qacE gene. DNA sequencing showed homology to K. oxytoca plasmid pACM1. Identification of K. oxytoca with reduced sensitivity to chlorhexidine raises concern regarding dilution standards in hospitals. Adherence to the hospitals' infection control policies should be strictly monitored to avoid continuous low level exposure of bacteria to biocides, specifically in developing countries.


Assuntos
Anti-Infecciosos Locais/farmacologia , Anti-Infecciosos/farmacologia , Clorexidina/farmacologia , Pé Diabético/microbiologia , Farmacorresistência Bacteriana/genética , Klebsiella oxytoca/efeitos dos fármacos , Feminino , Humanos , Integrases/genética , Klebsiella oxytoca/genética , Klebsiella oxytoca/isolamento & purificação , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Plasmídeos/genética , beta-Lactamases/metabolismo
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