Comparison of two new educational techniques on knowledge of nurses about cerebrovascular accident nursing care in emergency department.

BACKGROUND: One of the important challenges faced by health-care system is to raise the level of knowledge of nurses about cerebrovascular accident (CVA) nursing care in the emergency department. Therefore, the aim of this study was comparison of two new educational techniques (noninteractive multimedia learning and workshop) on knowledge of nurses about CVA nursing care in the emergency department. MATERIALS AND METHODS: This experimental study was conducted with a two-group design. Sixty-four eligible nurses working in the emergency department in selected hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, were selected as the study participants. Nurses were randomly assigned into two groups of noninteractive multimedia (n = 32) and workshop (n = 32) using random number table. The data-gathering tools including a demographic questionnaire (6 items) and knowledge questionnaire (24 items) were completed before and 2 weeks after the intervention in both the groups. Data were analyzed using SPSS 18 and descriptive (mean and standard deviation) and analytical statistics (ANOVA, independent t-test, and paired t-test). The level of statistical significance was P ≤ 0.05. RESULTS: The result shows that independent t-test showed that there was not a significant difference between the mean total scores of nurses' knowledge before intervention in the two groups (P > 0/05). Furthermore, the results of paired t-test showed a significant difference in the knowledge score 2 weeks after compared to before the education in both the groups (P < 0.005). In addition, the results of independent t-test showed a significant difference in the knowledge score 2 weeks after the intervention in the two groups (P < 0.005). The average knowledge score in the workshop group was significantly higher than in noninteractive multimedia learning group. CONCLUSION: According to the result, new educational techniques such as noninteractive multimedia learning and workshop could improve knowledge of nurses about CVA nursing care in the emergency department.

Challenge of Politico-Economic Sanctions on Pharmaceutical Procurement in Iran: A Qualitative Study.

Background: Politico-economic sanctions over the recent years have led to significant challenges in the pharmaceutical supply chain (PSC) in Iran. Given the importance of the chain's resilience for the health system and its impact on accessibility, equity, and public health, this study was conducted to determine the major challenges facing pharmaceutical procurement in Iran after the imposition of these sanctions. Methods: This study was a qualitative research with a content analysis approach conducted in 2019. Eighteen policymakers and administrative managers in food and drug administration of two Iranian Medical Universities and Iran's Ministry of Health were included in the present study via snowball sampling and semi-structured interview. The data were analyzed using the framework analysis of MAX QDA10. Results: Five main themes and 15 sub-themes were identified, which addressed pharmaceutical supply chain challenges under politico-economic sanctions. These included the challenges in financing, purchasing, importing, and manufacturing domestic products in addition to storing and distributing medicines, along with challenges facing the general public, particularly patients. Conclusion: The results revealed that pharmaceuticals are not immune to politico-economic sanctions, although they are not directly subjected to them. Sanctions, similar to any economic crisis, can affect public health and limit their access to healthcare. Identifying supply chain challenges and planning to address them could help policymakers find solutions to enhance PSC resilience in the future.

Strategies to improve pharmaceutical supply chain resilience under politico-economic sanctions: the case of Iran.

BACKGROUND: Given the impact of politico-economic sanctions on the pharmaceutical supply chain, this study aims to identify practical strategies to improve the resilience of the Iranian supply chain in pharmaceutical procurement under politico-economic sanctions. METHODS: This is a qualitative content analysis study conducted in 2018. Semi-structured interviews were conducted using snowball sampling, and saturation was achieved after 18 interviews. Guba and Lincoln's criteria, namely credibility, confirmability, transferability, and dependability, were considered to ensure the validity and transparency of the study. A five-step framework analysis was applied to analyze the data using MAX QDA10. RESULTS: The results led to the identification of nine main themes and 26 subthemes as strategies to improve the resilience of the pharmaceutical chain. According to the thematic map, some of these strategies have an extra-sectoral character: 'insurance organizations', 'strengthening relations with other countries', 'mechanization of the distribution system', and 'suppliers and manufacturers'. At the same time, some inter-sectoral strategies can help the pharmaceutical chain maintain its resilience: 'healthcare management and policy', 'exploiting local potential', 'pricing', and 'integrated health information systems.' As a strategy, 'Medical community and consumers' also plays a crucial role in this regard. According to the subthemes, revisions of health management, more supervision, privatization, clinical policies, strategic purchasing, improvement of the referral system, inter-sectoral cooperation, support of indigenous medicines, rational pricing, insurance system, improvement of medical coverage, and development of electronic prescription should be considered by health systems. Sufficient support for indigenous medication and supervision of the distribution system should be considered by the pharmaceutical industry, taking into account the cooperation between consumers and patients. CONCLUSIONS: Integration of the pharmaceutical supply chain and modern technologies, more attention to business complexity, economic development, intense competition, rapid changes in customer needs, and appropriate relationship between manufacturers, distributors, prescribers, and insurance organizations as purchasers should be considered by policymakers to improve supply chain resilience.

Corrected QT Interval Prolongations in Patients with Non-ST-Elevation Acute Coronary Syndrome.

Background: The presence of different risk groups among patients with the non-ST-elevation acute coronary syndrome indicates the need for new tools to establish early diagnoses and prognostic stratifications. The role of prolonged corrected QT (QTc) intervals in myocardial ischemia has yet to be thoroughly assessed. The purpose of our study was to assess the significance of QTc prolongations during acute non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina. Methods: The QTc interval was measured in 205 patients admitted with NSTEMI or unstable angina to the Coronary Care Unit of Fatemeh Zahra Hospital between 2014 and 2015. On that basis, the patients were divided into those with normal (<440 ms) and the ones with prolonged (≥440 ms) QTc intervals. Echocardiography and coronary angiography were performed within 48 to 72 hours after hospitalization. A logistic regression model was applied to assess the predictors of left ventricular systolic dysfunction. Results: The mean age of the patients was 58.21±10.72 years, and men comprised 51% of the participants. Overall, a QTc interval prolongation of ≥440 ms was present in 45 subjects (21.95% of the patients), which was significantly associated with a previous myocardial infarction (MI) (P=0.024), a minimum ST depression of 1 mm in the inferior leads (P=0.006), and a maximum left ventricular ejection fraction of 35% (P=0.018). Furthermore, among the different electrocardiographic variables, only a prolonged QTc interval (OR=0.275, 95% CI=0.078-0.976; and P=0.046) was inversely associated with the left ventricular systolic function. Conclusion: Our study showed that prolonged QTc intervals can be used as a useful risk marker for identifying high-risk patients with the acute coronary syndrome.

ESR1 single nucleotide polymorphism rs1062577 (c.*3804T>A) alters the susceptibility of breast cancer risk in Iranian population.

OBJECTIVES: Albeit single nucleotide polymorphisms related to ESR1 gene have been studied, only a number of them have been reported to be associated with breast cancer risk. rs1062577 is one of the most recent microRNA-related ESR1 SNPs; however, no study has been conducted to investigate the significance this polymorphism in Iranian population. In this study, we aimed to investigate the frequency and also the association between rs1062577 and breast cancer. MATERIALS AND METHODS: rs1062577 position was genotyped by Tetra-primer ARMS-PCR in totally 182 blood specimens obtained from breast cancer patients (n=86), and healthy blood donors (n=96). The distribution of different genotypes was statistically analyzed in terms of the potential association between rs1062577 different alleles, breast cancer risk and clinicopathological criteria of breast cancer patients. RESULTS: The statistical analyses confidently indicated that rs1062577 A allele is associated with the increased breast cancer risk in both univariate and multivariate regression models (Odds Ratio=8.403 and 32.602 respectively). rs1062577 T allele was statistically associated with stage I of breast cancer patients (p-value=0.025). In silico studies implied that rs1062577 A allele can alter the binding capacity of ESR1 mRNA and miRNAs via either breakage or formation of hydrogen bonds. CONCLUSION: rs1062577 A allele is significantly and dramatically associated with the elevated risk and greater stages of breast cancer.

The use of information sources by faculty members of babol university of medical sciences: a case study from iran.

INTRODUCTION: This study seeks to determine the expertise, use, and satisfaction of faculty members of Babol University of Medical Sciences, using the provided online information services by the university. METHODS: This study is descriptive and analytical survey and the information gathering was through the questionnaireand the samples, based on the random of Kerjesi and Morgan Table sample size determination that was selected through stratified sampling proportionately to the size of the departments which summed up to 155 of which 113 responded to the mailed questionnaire. RESULTS: The results of the study show that among the various data sources such as books, journals and internet, faculty members have more undemandingand convenient access to the Internet compared to other resources use, however, half of the information needs of faculty members, 57 (50.4 percent) are provided by the printed books;and the databases available to the University and used by faculty members are PubMed with 76.1% and Science direct with 53.1% and Iranmedex with 46.9%.Only 17% of faculty members have the absolute contentment of the Internet information services,and more than half of the respondents (58.4%) expressed the low speed of Internet service as their major reason for their dissatisfaction of the provided services. PRACTICAL IMPLICATIONS: Use and Satisfaction of Internet-Based Information Services of Faculty Members. DISCUSSION: Using the Internet to provide the needed information with an index of 46%is a significant issue. The results of the study show that among the various data sources such as books, journals and internet, faculty members have more undemandingand convenient access to the Internet and their access to printed books was really hard and limited, although the internet was more convenient to acquire information, most of the information needs of faculty members are provided by the printed books based on what they expressed. The study showed that the use and acquaintance of the sample of the information databases is very lowand only a few of them have the full satisfaction of the provided Internet information services and the main foremost reason for this major dissatisfaction is the low-speed Internet services at the University.