Re-designing and evaluation of Tele-dermatology software for skin diseases

Introduction: The continuous increase in the demand for specialized skin care services, together with the unbalanced geographical distribution of these specialists, has limited the access of patients to these services. Teledermatology is one of the innovative approaches that can be considered as a solution to improve the access to specialized skin care services with minimal material resources in developing countries such as Iran

Methods: The present study is an applied and aimed to re-designing and evaluating tele-dermatology software. In this research, redesign of the software was done through obtaining the users feedback after being used in clinical setting, then final version of the software designed and usability evaluation test was conducted

Results:The usability testing result, show dermatologist and GP were very satisfied with the system and overall average scores obtained were 8 out of a total of 9 achievable scores. The scores earned was respectively: 7.8for overall reaction to the system, 8.5 for screen feature, 7.9 for terminology and system information, 8.3 for Learning and 7.5 for system capability

Conclusion: The experience gained from this research shows that for the successful development and use of telehealth tools, need engage and collaboration with main stakeholder, identify, understand and modeled work flows and processes related to the provision of patient services and treatment. Also in order to increase the usability and user satisfaction, the design and development of systems should be based on the principle of user-centered design and engagement of system stakeholders at all stages of system design and development

Third study on WHO MPOWER tobacco control scores in eastern mediterranean countries 2011-2015

This study was conducted to quantify the implementation of the MPOWER policies and to assess any possible changes across Eastern Mediterranean Region [EMR] countries. In this comparative cross-sectional study based on 10 categories mentioned in MPOWER report 2015 a checklist was designed. Seven questions were scored from 0-4 and three from 0-3. The 22 EMR countries were ranked and compared by their total score on a scale of 0-37. The highest scores were achieved by Egypt and the Islamic Republic of Iran. Pakistan, Sudan and Yemen showed progress, while Bahrain, Jordan, Kuwait, Oman, and the Syrian Arab Republic had decreased scores. The total score of the EMR countries had decreased compared to 2013. Thus, there remains a need for greater focus on tobacco taxation and smoke-free policies to address this retrograde step

comparative study on tobacco cessation a quantitative systematic review

During recent years, there have been many advances in different types of pharmacological and non-pharmacological tobacco control treatments. In this study, we aimed to identify the most effective smoking cessation methods used in quit based upon a review of the literature. We did a search of PubMed, limited to English publications from 2000 to 2012. Two trained reviewers independently assessed titles, abstracts and full texts of articles after a pilot inter-rater reliability assessment which was conducted by the author [GH]. The total number of papers and their conclusions including recommendation of that method [positive] or not supporting [negative] was computed for each method. The number of negative papers was subtracted from the number of positive ones for each method. In cases of inconsistency between the two reviewers, these were adjudicated by author. Of the 932 articles that were critically assessed, 780 studies supported quit smoking methods. In 90 studies, the methods were not supported or rejected and in 62 cases the methods were not supported. Nicotine replacement therapy [NRT], Champix and Zyban with 352, 117 and 71 studies respectively were the most supported methods and e-cigarettes and non-Nicotine medications with one case were the least supported methods. Finally, NRT with 39 and Champix and education with 36 scores were the most supported methods. Results of this review indicate that the scientific papers in the most recent decade recommend the use of NRT and Champix in combination with educational interventions. Additional research is needed to compare qualitative and quantitative studies for smoking cessation

Primary experience of telemedicine at shahid beheshti university of medical sciences

Telemedicine plays an important role in providing medical services over long distances, particularly in developing countries. For better management and planning, periodic assessment of this system seems necessary. This study was aimed to evaluate the first phase of teleconsultation project so as to use the findings for addressing the current practical problems and improving the system for future projects. After installing the equipment in Imam Khomeini Hospital of Firuzkuh and Zaeem Hospital of Pakdasht as the remote sites, teleconsultation project was started and patients at these hospitals requiring specialist opinion were enrolled in the study and consultation via teleconference by specialists at Masih Daneshvari Hospital as the central site was performed for them. A total of 22 patients [13 male] with mean age of 54.13 years [14 in Imam Khomeini Hospital] entered the study. Pulmonary medicine was the most frequently requested consultation [36.4%], followed by cardiology [27.3%]. Teleconsultation was resulted in recovery and discharge of 8 patients, yet 4 patients required emergency referral to a more equipped hospital. This study demonstrated that inadequate knowledge and unacceptability of telemedicine among physicians and medical staff and unavailability of necessary instrumentation in remote centers, and also lack of all the required specialties in central site, were setbacks in the uptake of teleconsultation system. Therefore, future projects should be conducted with enough funding and using the experience of this study to improve the quality and quantity of the consultations in order to perform a more meticulous assessment

Comparison of sedative and hemodynamic effects of remifentanil and propofol in patients with pulmonary disease requiring mechanical ventilation in intensive care unit

ICU hospitalized patients usually need sedation. Common sedatives include benzodiazepines, opioids, barbiturates and etc. This study was conducted to compare the sedative, hemodynamic and respiratory effects of propofol and remifentanil in pulmonary disease patients requiring intubation and mechanical ventilation in intensive care unit of Masih Daneshvari Hospital during the years 2005-2007. This study was conducted as a randomized controlled clinical trial. All patients with pulmonary disease requiring mechanical ventilation in the ICU were randomly divided into two groups. The first group was given an initial 10 micro g /kg/min infusion of propofol and the second group received an infusion of remifentanil starting with 0.05 micro g /kg and the doses sequentially increased to reach a sedation state of 3-4 according to Ramsay sedation scale. The regimen was continued for 48 hours, during which blood pressure, heart rate, and respiratory rate were monitored every 3 hours. Data was analyzed using SPSS version 11 software. A total of 40 patients with a mean age of 58.67 +/- 18.57yrs [range 21-85 yrs] including 27 [67.5%] males and 13 [32.5%] females entered the study. The mean time to optimal sedation was 17.9 +/- 13.9 min and 20.16 +/- 16.11 min for remifentanil and propofol groups, respectively [p=0.09]. The mean systolic and diastolic blood pressures of each group showed a small decrease after initiation of infusion but this decrease was not statistically significant [p=0.26 for remifentanil and p=0.12 for propofol group]. The heart rate and respiratory rate showed no dramatic change during the infusion period. Both remifentanil and propofol are suitable drugs for sedating patients with pulmonary disease and neither of them induces dramatic hemodynamic changes. Therefore, using each of them is effective for optimal sedation of patients

Prevalence and severity of asthma symptoms in students of Tehran and Rasht: phase III ISAAC study

This study is a part of the third phase of the "International Study of Asthma and Allergy in Childhood" [ISAAC] aiming to study the prevalence and severity of asthma symptoms among children of Rasht and Tehran. Materials and This analytical cross-sectional study assessed Rasht and Tehran students in two age groups [6-7 and 13-14 years] during 2001-2002. After performing statistical analysis, prevalence of asthma symptoms was compared between the students form the two cities and was evaluated in both sexes and age groups by using the Chi-square test. Result: A total of 12,214 students from both Rasht and Tehran participated in this study. History of wheezing and asthma were significantly higher among Rasht students. Prevalence of wheezing, speech limitation due to wheezing, wheezing during exercise and dry nocturnal cough were higher among 13-14 year olds in both cities. History of wheezing and exercise wheezing were higher in 6-7 year-old girls living in Tehran. However, prevalence of the aforementioned symptoms and prevalence of asthma were higher in total boys residing in Rasht. Also, prevalence of asthma, wheezing during exercise and dry nocturnal cough were higher in 13-14 year old boys in Rasht. No significant difference was found in this regard between Tehran girls and boys in this age group. Prevalence of asthma and some of its symptoms was significantly higher among Rasht students compared to those residing in Tehran

Prevalence and severity of asthmatic symptoms in Rasht students: a report from ISAAC study

This study is a part of the third phase of "International Study of Asthma and Allergy in Childhood" [ISAAC] which was aimed to study the prevalence and severity of asthma symptoms among children and to compare the result with those of the first phase in Rasht city. A descriptive study was performed on 0-7 and 13-14 years old students of Rasht city during 2001-2002. After performing statistical analysis, prevalence of asthma symptoms was evaluated in both sexes and the two age groups by using chi-square test. A total of 6074 students participated in this study. History of wheezing during their life-time and history of recent wheezing were present in 23.3% and 15.4% of students, respectively. Prevalence of this symptom in both situations was significantly higher in male students compared to females. Three hundred forty-nine students [5.7%] were known cases of asthma. Number of asthmatic cases among 6-7 years old students was 1.5 times higher than the other group. Also, prevalence of asthma in boys was 1.6 times higher than girls. Over all, 522 students [8.6%] mentioned a history of wheezing during or after exercise in the past 12 months. This was 3 times higher among 13-14 years old students and 1.9 times higher in boys. Eight hundred thirty-five [13.7%] students had a history of dry cough during the last 12 months and its prevalence was higher in students in the 13-14 years old group and in boys as well. Compared to the results of phase I of this study, the prevalence of known cases of asthma has considerably increased in both age groups. Prevalence of asthma was higher in 6-7 years old boys. There is a wide range of risk factors for development of asthma and its exacerbation in children which requires further investigations to find factors responsible for increased prevalence of this disease in Rasht city

Comparison of propofol and remifentanil administration on lipid profile

This study aimed to investigate the serum level of triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, and very low density lipoprotein during administration of propofol and comparing it with infusion of remifentanil in patients undergoing sedation in ICU of Masih Daneshvari Hospital during 2005-2007. All patients with pulmonary disease, undergoing intubation and mechanical ventilation were enrolled in our study. The patients were randomly divided into two groups, first receiving propofol and second receiving remifentanil as the sedative agent. Lipid profile [triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, and very low density lipoprotein] was checked before, immediately after, and the day after drug administration. A total of 40 patients were enrolled in this study, 20 of which took propofol and the remaining took remifentanil. The mean age of the patients was 58.67 +/- 18.57 yrs. Triglyceride and very low density lipoprotein[VLDL] were the two factors with statistically significant rise after infusion of propofol [p < 0.002]. Such a change was not detected in the remifentanil group. The other understudy factors did not show similar changes. Propofol infusion can induce dramatic rises in triglyceride and VLDL concentration even after low dose infusions and therefore special attention must be paid to patients prone to hyper-triglyceridemia and pancreatitis

Comparison of hemodynamic effects of morphine and remifentanil in traumatized patients requiring mechanical ventilation

This study was conducted to compare the sedative and hemodynamic effects of morphine and remifentanil in traumatized patients requiring intubation and mechanical ventilation in intensive care unit of Rasool Akram Hospital, Iran University of Medical science during the years 2003-4. This was a randomized controlled clinical trial study in which all traumatized patients requiring mechanical ventilation in ICU were randomly enrolled into two groups. The first group was given a 5 mg bolus dose of morphine and the second group received an infusion of remifentanil starting with 0.05 microgr/kg and the doses were sequentially increased to reach a sedation state of 3-4 according to Ramsey scale. The regimen was continued for 24 hours, during which blood pressure, heart rate, and respiratory rate was monitored. Data were analyzed using SPSS software version 11.5. A total of 60 patients aged 18-80 yrs with mean age of 42.53 +/- 18.5 yrs, consisting of 37 [61.7%] males and 23 [38.3%] females entered the study. The mean blood pressure was 109.12 +/- 1.68 mmHg in the morphine group and 90.01 +/- 6.66 mmHg in the remifentanil group [p < 0.00]. The mean heart rate of the aforementioned groups were 101.89 +/- 2.31 and 95.06 +/- 10.15 [p < 0.00] respectively. Remifentanil causes an initial decline in blood pressure but it maintains the pressure in a rather steady state during the period of infusion. This result was quite similar to that of morphine with the additional fact that there was no profound decline of blood pressure with morphine

Prevalence and severity of Asthma symptoms in children of Tehran international study of asthma and allergies in childhood [ISAAC]

This descreptive study was conducted to determine the prevalence of asthma and related symptoms among 6-7 and 13-14 year old school children in Tehran as a part of International study of Asthma and Allergies in childhood [ISAAC] phase Ill. The ISAAC written questionnaire was given to a total of 6127 students of 72 schools in urban area of Tehran. Simple random sampling was performed with a uniform distribution throughout 12 clusters of 2 divisions of the municipality. All 6-7 and 13-14 year old students were enrolled in this study. Results showed that 15% of the 6-7 year olds and 17% of the 13-14 year olds had positive history of wheezing among which 8.6% and 10.6% respectively had had recent attacks. Physician confirmed asthma was reported in 2.1% of the 6-7 year olds and 2.6% of the 13-14 age group. Severity of asthma assessed by frequency of speech limitation due to wheeze was positive in 1.5% of 6-7 aged group and 3% of 13-14 year olds. Exercise induced wheeze was detected in 2.3% of the 6- 7year old group compared to 15.3% of the 13-14 year olds. Nocturnal cough was more prevalent among 13-14 year olds [18.4%] compared to only 7.2% in the 6-7 year olds. Overall, no significant change in prevalence of asthma symptoms has occurred since 1997 [the last phase of ISAAC] among children of Tehran. The results of our study suggest higher rates of confirmed asthma among 6-7 years old girls compared to boys. However, more extensive and precisely designed studies are needed to further confirm these findings

Thoracic CT-guided needle biopsy: a report of 150 cases

The purpose of this study is how to use CT-guided needle biopsy for the diagnosis of pulmonary, pleural, and mediastinal mass lesions. Meanwhile, the complications of the procedure were evaluated. The pathology results of 150 biopsy specimens, which were obtained from 145 patients aged from 9 to 87 years old [55.3 +/- 17.6] referred during a one-year period were reviewed, and the frequency of pneumothorax and hemoptysis were analyzed. Lesion size ranged 1-18 cm [mean [ +/- SD] 6.5 +/- 3.4 cm. 95 lesions were contacted to the chest wall. Pathological studies showed that 22 specimens were benign, 61 malignant, 28 nonspecifics, 17 suspicious for malignancy, and 22 insufficient for diagnosis. Risk for pneumothorax and hemoptysis was 6 and 2 percent respectively, which were much better results than previous reports. Although our low complication rate may be attributed to the large size of the lesions and their small distance from the chest wall, we still recommend CT-guided needle biopsy as a useful diagnostic method for thoracic mass lesions