[A model for assessing hospital information systems]

Introduction: nowadays, all the areas of human knowledge are affected by informatics' knowledge and information technology. Health organizations and centers also need these technologies due to the vast variety of information. So the result of such a kind of knowledge is a tool named hospital information system [HIS]. This research attempts to fill this gap and present a complete conceptual framework to evaluate HIS by means of introducing indexes and their priority

Methods: based on literature review, initial model of evaluating main dimensions and indexes of each dimension were introduced. These indexes were classified into different questions and a related questionnaire was published between 100 staff [users, managers and authorities of HIS] of different departments of educational hospitals of Qazvin city. The data gathered were analyzed using first and second order of factor analysis

Results: the result of the two orders of analysis revealed that all indexes are acceptable according to loading factor and T value. All fit indices were suitable, too

Conclusion: the results indicate that organizational, humanity and technical dimensions are three main dimensions of evaluation, and organizational structure, goals and strategies, cost-benefit analysis and clinical effects are indexes of organizational dimension. User Satisfaction, User Acceptance, and being familiar with ICT are main indexes of humanity dimension. Finally, system quality, information quality and information security are main indexes of technical dimension

Tissue inhomogeneity in proton therapy and investigation of its effects on BRAGG peak by using MCNPX code

Hadron therapy for malignant tumor is becoming increasingly popular. There are many factors which effect on implementation of a proper treatment planning. The purpose of this work is to investigate the inhomogeneity effects as affecting factor on proton range, Full width at half maximum [FWHM] and 20% position of penumbra [P20] by MCNPX code. An inhomogeneous tissue [Bone or Adipose] with a variable thickness [0.1 cm, 0.5cm and 1.0 cm] was inserted into a phantom. Then this phantom was irradiated by 108.8 MeV proton beam located at 10 cm away from it. Particle energy deposition [PEDEP] in mesh tally card was used for simulation of Bragg curve and obtaining the proton range, FWHM and 20% position of penumbra [P20]. Finally, the MCNPX results were compared with GEANT4. The results of MCNPX for water phantom including 1cm adipose for range and P20 were 8.87 and 9.10 cm respectively, and for 1cm bone, range and P20 were 8.52 and 8.58 cm. By increasing the adipose thickness, range and P20 were reduced but it was vice versa for increasing the bone thickness. Also FWHM does not show a regular variation in both bone and adipose tissues. The results show that the location of the inhomogeneous tissues does not affect the variation of the whole shape of the Bragg curve, while it radically affects the dose in the Bragg curve. The comparison between MCNPX and GEANT4 results showed that the MCNPX results have the closer values than GEANT4 to references

Two-year experience of orthotopic liver transplantation in Afzalipoor Hospital, Kerman, Southeastern Iran

End-stage liver diseases are common in Iran. The only therapeutic option for these patients is liver transplantation. To present our 2-year experience of liver transplantations in Afzalipoor Hospital, Kerman, southeastern Iran. From November 2009 to September 2011, 12 patients underwent orthotopic liver transplantation in our center. Their data including demographics, indications for transplantation, MELD scores, post-operative complications and their management were collected. Patients [7 women and 5 men] aged between 14 and 55 years. Indications for the transplantation included HBV infection [n=5], cryptogenic cirrhosis [n=2], Wilson's disease, alcoholism [n=1], HCV infection [n=1], Budd-Chiari syndrome [n=1], and autoimmune hepatitis [n=1]. MELD score of patients ranged from 16 to 30. All patients received tacrolimus, mycophenolate mofetile and corticosteroid, post-operatively. 2 patients died of pulmonary and intra-abdominal infections with resultant to multiple organ failure. Nonfunctioning of transplanted liver and ongoing bleeding resulted in death in another patients. 9 patients are well doing and have excellent liver functions. We had relatively successful results in our experience of orthotopic liver transplantation. Vicinity of our center to Shiraz Transplant Center would be an important factor in this success

Prevention of mother to child HIV transmission

In Iran 8% of HIV- Mected cases are women. Since most of them are young and in childbearing ages, in case of becoming pregnant and not receiving preventive measures, they can infect their child. Without Preventive measures transmission rate is 15 to 45 percent. Several factors such as sever stage of HIV and AIDS, CD4 low count, high viral loud, acute retroviral phase, STDs, vaginal delivery, maternal age, maternal substance and alcohol abuse, chorioamnionitis, neonate low birth weight or prematurity, PROM and breast feeding increase the rate of mother to child transmission. This paper aims to present national strategies for Prevention of Mother to child Transmission [PMTCT] including consultation before pregnancy, counseling and testing during pregnancy, Anti Retro Viral [ARV] prophylaxis for HTV positive pregnant women, safe delivery, post partum evaluation and intervention, infant evaluation and monitoring and infant feeding by formula

Comparative study on energy usage status and its management in Farabi Eye Hospital

Background: Hospitals use most of the energy and besides, they also can save energy. Since energy costs are of the manageable costs in the hospitals, thus it is possible to wisely interfere in this area. This study is aimed to do a comparative study on energy usage and its management in Farabi Eye Hospital. Materials and methods: This is an applied, cross-sectional and descriptive study which carried out using three-year information of energy usage in studied hospital with consideration to reformative actions in order to reduce energy use through managing it. Data were compared using internal and external benchmarking methods. Results: Since studied hospital was implemented energy use management methods, therefore, results showed a descending trend in water and gas use [according to active bed day and occupied bed rate]. Both water and gas use was reduced to 31% and 28% in 2010 in comparison with 2008 [basic year]. Although, usage rate of electricity [considering bed indices] was also decreased to 10.5% in 2009 in comparison to 2008, it had an increase trend of 5% in 2010 due to applying development and growth strategies. Moreover, if taking "number of patients" index into account, electricity use was reduced to 7% in 2010 compare to 2008. On average, in 3-year period of study, water use was 1.63 times the standard value and electricity was 13.2 and 1.44 times the standard value per active bed day and square meter infrastructure, respectively. Conclusion: Actions related to energy use management played an important role in reducing usage rate in Farabi hospital. Considering hospitals high potentials in lessening energy savings for hospital in the future

Studying the total cost of services in Shahid Modarres Medical Center of Isfahan

One of the main concerns of the hospital managers is the financial affairs. The hospital services require costly equipment and skilled manpower which imposes financial burden on hospitals. Applying an accounting system to determine the total cost of such services leads to realization of the financial processes and the required controls to be operated. Proper steps could be taken by such realization to increase the efficiency and productivity of the hospitals. This study is aimed to calculate the total cost of the services in Shahid Modarres hospital. This is a retrospective study done descriptively and analytically. To collect data, face to face interviews and observations were employed and the calculations were done manually. Firstly, the cost centers and the cost factors were determined as the manpower costs, energy costs, overhead costs, and capital and depreciation costs. Secondly, cost factors were allocated to the related cost centers. In this step, the direct costs [the personnel, non-personnel, the consumables and non-consumables] and then the indirect costs [overhead costs] and capital costs and depreciation were calculated Finally, the obtained costs were added up and the total cost of the hospital services was estimated. The total cost of the hospital services in the fourth season of the year was estimated as 5, 250, 802, 340 million rials. The most costly center was the psychiatry [mental health services]. The highest costs [84%] which was estimated through the division of each cost by the cost price, was related to the hospital personnel costs. The total cost of the hospital wards fitted the heavy load of their work. The wards with heavier working load, have higher total cost

Production of 177Lu and formulation of Ethylene diamine tetramethylene phosphonate [EDTMP] kits as a bone-seeking radiopharmaceutical

Owing to its favourable decay characteristics 177Lu [T1/2= 6.71 d, Ebeta[max]= 497 keV] is an attractive radionuclide for various therapeutic applications. Ethylene diamine tatramethylene phosphonate [EDTMP] is one of the most widely used ligands which form stable complexes with various radionuclides and all the complexes. Enriched 176Lu2O3 was dissolved in 0.1 N HCl and evaporated several times and 176LuCl3 target was irradiated at 2.6x1013 n.Cm- 2.S-1 thermal neutron flux for 14 days.177LuCl3 was dissolved in 1N HCl. EDTMP was dissolved in double distilled water at pH=7.5-8.5 and freeze-dried kits was radiolabeled with 177LuCl3. Distribution studies were done in healthy mice. The yield of 177Lu was [220 TBq/g; 6000 Ci/g], the radionuclidic purity was 99%.The radiolabeling yield of EDTMP kits at 37°C after 30 min and 4 hours was 98 +/- 0.5% and after 72 hours was 90 +/- 2.1%, the in vitro stability in human serum at 37°C up to 72 hours post radiolabeling was 85 +/- 1.8%.The biodistribution studies of 177Lu-EDTMP and 177LuCl3 in normal mice showed skeleton uptake and low soft-tissue concentration. In this study, we produce 220 TBq/g [6000 Ci/g] of 177Lu by neutron activation of 176Lu in the Tehran Research Reactor. Our results showed 177Lu-EDTMP as a bone-seeking radiopharmaceutical. Due to its suitable nuclear characteristics 177Lu appears to be worthwhile for palliative therapy of bone metastasis

effect of combination of pseudomonas aeruginosa alginate and an immunomodulator protein of garlic on opsonophagocytosis in murine model

Chronic pulmonary infection in patients with cystic fibrosis is predominantly due to infection by mucoid strains of Pseudomonas aeruginosa. Mucoid P. aeriginosa is due to the production of exopolysaccharide called also alginate. Alginate in addition to interference with the clearance of lung has antiphagocytic property. Optimal killing activity of P. aeruginosa requires opsonic antibodies. Since immunomodulatory effects of garlic on enhancing phagocytic activity has been proved, in this study the effect of combination of alginate and an immunomodulator protein of garlic on production of opsonic antibodies against P. aeruginosa mucoid exopolysaccharide has been investigated. Alginate was extracted from a 72-hour culture of P. aeruginosa strain 8821M and then DNasel, RNaseA and Proteinase k were added. Subsequently, alginate was purified with gel filtration chromatography by sephacryl S-400. Female BALB/c mice aged 6-8 weeks were divided into five groups and injected subcutaneously on days 0, 7, 14 with either alginate, garlic, alginate- garlic, R10 or alginate-R10 and opsonophagocytic killing activity was calculated in each group. The purified alginate contained 34.6 micro g/ml uronic acid, 0.5 micro g/ml nucleic acid, 1.45 micro g/ml protein and 0.08 micro g/ml LPS. Opsonophagocytic killing activity after immunization with R10, alginate and their combination showed significant increases of respectively 69%, 67% and 82% comparing to the control group. Combination of P.aeruginosa alginate and immunomodulator fraction of garlic enhances immunogenicity to P.aeroginosa by the elicitation of opsonic antibodies in BALB/c mice

[Creutzfeldt-Jakob disease associated with non sterile phlebotomy [case report]]

Creutzfeldt-Jakob disease [C-JD] is a rare disorder characterized with rapidly progressive mental decline, myoclonic jerk and finally death. The transmissible pathogen for this disease is a proteinaceous infectious particle termed prion. The prion protein is encoded by a gene [designated as PRNP] on the short arm chromosome 20.This disorder is diagnosed based on clinical findings, course of disease, EEG, MRI and confirmed with brain biopsy. A 56- year- old woman presented with confusion, disorientation, hyper somnolence, psychiatric problems such as hallucination, progressive mental deterioration and myoclonic jerks. She had history of several times phlebotomy with traditional and non sterile methods in two past years. She had no past history of other disease. Her illness was diagnosed based on clinical findings, course of her illness, typical MRI, EEG and rule out other dementing disease. She died after one month. in any patients with psychiatric disorders, rapidly progressive mental deterioration and myoclonic jerks C-JD should be considered as an important diagnosis. Treatable dementing disease should be considered and ruled out at first. The significance of phlebotomy in C-JD has yet to be determined

[Production and quality control of technetium-99m radiolabeled monoclonal antibody against colon cancer cells]

Binding a monoclonal antibody to tumor associated antigens is an effective method for cancer therapy because these agents can specifically target malignant cells. In fact, monoclonal antibodies are effective agents for diagnosis, grading and treatment of different kinds of cancers. In this research, a new monoclonal antibody against colon cancer cells was prepared and radiolabeling with technetium-99m evaluated. This research was done in three parts: preparation of hybridoma cell against colon cancer cell line [HT29], production of monoclonal antibody, determination of its characterizations and radiolabeling with technetium-99m. mAb-D2 is an IgG1 with affinity constant of 7.2x10[9] M[-1] which can recognize CEA in tumor cells. Radiolabeling showed that [99m]Tc-HYNIC-mAb-D2 complex is stable, immunoradioactive, and has a desirable biodistribution. In this study, we gained a new radiopharmaceutical that may be a good candidate for radioimmunoscintigraphy

Study of noscapine effects on rat hind paw inflammation induced by bradykinin and histamine

Noscapine is an isoquline alkaloid from opium with antitussive effect. Our previous study indicated that noscapine is non-competitive inhibitor of bradykinin. Since bradykinin and histamine contribute in inflammatory processes, the effect of noscapine on rat hind paw inflammation induced by bradykinin and histamine was investigated. Paw edema induced by subplantar injection of 0.1 ml bradykinin solution [3nmol/paw] or 1% histamine solution. Noscapin [1, 5 and 10 mg/kg] and indomethacin [10mg/kg] as standard anti-inflammatory drug were administered intraperitoneally [i.p] one hour before injection of bradykinin or histamine. The thickness of hind paw was measured with a caliper and compared to control groups before and 15, 30, 60, 90, 120 minutes after injection of bradykinin and before and 60, 120, 180 minutes after injection of histamine. Administration of noscapine significantly suppressed the inflammation. The maximum anti-inflammatory effect of noscapin observed at dose of 5 mg/kg against bradykinin and at dose of 10mg/kg against histamine. So this activity of noscapine was similar to activity of indomethacin. Our results showed that noscapine has anti-inflammatory effect on inflammatory response of rat hind paw. This effect, was comparable to the anti-inflammatory effect of indomethacin

Synthesis, development and preclinical comparison of two new peptide based freeze-dried kit formulation 99mTc-EDDA-Tricine-HYNIC-TOC and 99mTc-EDDA-Trinice-HYNIC-TATE for somatostatin receptor positive tumor scintigraphy

Somatostatin receptor [sstr] scintigraphy with [111In diethylenetriaminepentaacetic acid]-octreotide [[111In-DTPA]-OC] has became a routine diagnostic procedure in oncology. However, it suffers from some drawbacks concerning the limited availability, suboptimal imaging properties and elevated radiation burden of 111In. In this study synthesis, conjugation and preclinical evaluation of two new freeze-dried kit formulation based on somatostatin analogues, Tyr3-Octreotide [TOC] and Tyr3-octreotate [TATE], designed for the labeling with 99mTc are described. After cleavage from the resin and preparation of the cyclized peptides, these compounds were conjugated with 6-hydrazinopyridine-3-carboxylic acid [HYNIC] in solution. Radiolabeling of HYNIC peptide conjugates was performed at high specific activity using one-step kits formulation based on tricine and ethylenediamine-N,N? -diacetic acid [EDDA] as co-ligands. Both, 6-hydrazinopyridine-3-carboxylic acid0-Tyr3-Octreotide [HYNIC-TOC] and 6-hydrazinopyridine-3-carboxylic acid0-Tyr3-Octreotate [HYNIC-TATE], showed a specific and high rate of internalization after 4 h in AR4-2J rat pancreatic tumor cells, [11.2 +/- 0.8 and 18.1 +/- 1.2 respectively]. Biodistribution studies in AR4-2J tumor-bearing rats showed rapid clearance of both analogues from all sstr-negative tissues except the kidneys. The specific uptake in tumor and sstr-positive tissues especially pituitary, pancreas and adrenals were observed. After 4 h the adrenals to pancreas uptake ratio for HYNIC-TOC was higher than that of HYNIC-TATE. Although both compounds had high kidney and low liver excretion, for HYNIC-TATE, it was lower. The results suggest these two new peptide based freeze-dried kits might be of great promise for clinical application in imaging of somatostatin receptor-positive tumors

Relationship between total and lipid-bound serum sialic acid and some tumor markers

Increased levels of total and lipid-associated sialic acid [TSA and LASA] have been reported in the sera of patients with benign or malignant tumors and also could be regarded as newly important clinical criteria for the diagnosis of cancer. This study has investigated the differences of TSA and LASA contents between cancer patients and healthy individuals and evaluated their correlations between TSA and LASA with some tumor markers in different types of cancer. 35 patients with histopathologically confirmed cancers and 32 healthy individuals participated in the study. Tumor markers in serum including CEA, CA15-3, CA19-9 and CA-125 were measured using ELISA. TSA and LASA were quantified using spectrophotometric methods of Erlich and Katopodis respectively and non-parametric tests were used for statistical analysis. The median [range] obtained for TSA in healthy and cancer patients were 83.6 [59.0-106.2] and 119.5 [84.7-205.8] mg/dl respectively and the difference was statistically significant [P<0.001]. The corresponding values for LASA content of serum in healthy and cancer patients were 16.9 [13.3-20.7], and 31.0 [15.0-50.3] mg/dl. Statistical analysis showed significant differences in LASA content between these two groups [P<0.001]. A positive correlation coefficient was obtained between TSA, LASA and different tumor markers. The significant correlation between TSA, LASA and different tumor markers in cancer patients indicated that they could be used as diagnostic criteria. However, due to their lack of specificity, they may support the presence of tumor markers in different malignancies and be helpful in relation to therapy and monitoring of patients