Hospital Performance Evaluation Checklist in Context of COVID-19 Pandemic: Design and Validation.

OBJECTIVE: Around the world, pandemics have been considered among the main hazards in the last 2 decades. Hospitals are 1 of the most important organizations responding to pandemics. The aim of this study was to design and develop a valid checklist for evaluating the hospitals' performance in response to COVID-19 pandemic, for the first time. METHODS: This study is a mixed method research design that began in February, 2020 and was conducted in 3 phases: Designing a conceptual model, designing a primary checklist structure, and checklist psychometric evaluation. Known-groups method has been used to evaluate construct validity. Two groups of hospitals were compared: group A (COVID-19 Hospitals) and group B (the other hospitals). RESULTS: The checklist's main structure was designed with 6 main domains, 23 sub-domains, and 152 items. The content validity ratio and index were 0.94 and 0.79 respectively. Eleven items were added, 106 items were removed, and 40 items were edited. Independent t-test showed a significant difference between the scores of the 2 groups of hospitals (P < 0.0001). Pearson correlation coefficient test also showed a high correlation between our checklist and the other. The internal consistency of the checklist was 0.98 according to Cronbach's alpha test. CONCLUSIONS: Evaluating the hospitals' performance and identifying their strengths and weaknesses, can help health system policymakers and hospital managers, and leads to improved performance in response to COVID-19.

The Current State of Infectious Disasters Preparedness Around the World: A Qualitative Systematic Review (2007-2019).

Infectious disasters have specific features which require special approaches and facilities. The main challenge is the rate of spread, and their ability to traverse the Earth in a short time. The preparedness of hospitals to face these events is therefore of the utmost importance. This study was designed to assess the preparedness of countries facing biological events worldwide. A qualitative systematic review was done from PubMed (National Library of Medicine, Bethesda, MD), Scopus (Elsevier, Amsterdam, Netherlands), Web of Science (Thomson Reuters, New York, NY), ProQuest (Ann Arbor, MI), and Google Scholar (Google Inc, Mountain View, CA). Two journals were searched as key journals. The search period was from January 1, 2007 to December 30, 2018. Twenty-one (21) documents were selected including 7 (33%) from Asia, 7 (33%) from Europe, 4 (19%) from USA, 2 (10%) from Africa, and 1 (5%) multi-continental. Forty-six (46) common sub-themes were obtained and categorized into 13 themes (infection prevention control, risk perception, planning, essential support services, surveillance, laboratory, vulnerable groups, education and exercise and evaluation, human resource, clinical management of patients, risk communication, budget, and coordination). Not all articles discussed all the identified categories. There is an extended process required to reach complete preparedness for confronting biological events, including adequate and well-managed budget. Medical centers may have trouble dealing with such events, at least in some respects, but most developed countries seem to be more prepared in this regard.

Designing and Validation of the Nurses' Preparedness to Response to COVID-19 Questionnaire in Iran.

OBJECTIVE: Nurses are considered key members to respond to incidents and disasters. As many patients are hospitalized during the coronavirus disease (COVID-19) pandemic, and nurses are directly in contact with these patients; their preparedness enables them to respond to this situation more effectively and protects their health. Therefore, the present study aimed to design and validate a questionnaire to measure the nurses' preparedness in response to COVID-19 in Iran in 2020. METHODS: This study was a mixed research aiming to develop and validate a psychometric research instrument in 2020. Based on the review of the literature regarding COVID-19 and other viral respiratory infections, the items were extracted, rewritten, and validated. In the quantitative phase, the validity of the questionnaire was evaluated in terms of face, content, and construct validity, and its reliability was evaluated based on internal consistency and stability (Cronbach's alpha and Intra-class Correlation Coefficient [ICC]). To fill out the questionnaire, the nurses were selected by random sampling. Data analysis was done by the SPSS software, version 23 (IBM Corp, Armonk, NY). RESULTS: The designed questionnaire included 9 dimensions and 50 items. The dimensions included (1) Incident Command System (ICS); (2) risk assessment and management; (3) information and communication management; (4) psychological approaches; (5) personal protective equipment; (6) prevention of contamination, isolation, and quarantine; (7) education and training; (8) patient management; and (9) features of the new coronavirus. The content and face validity of the questionnaire were approved by the specialists and experts of nursing and health in disasters and emergencies. The content validity ratio was > 0.7 for all items. The content validity index was also approved for all items. The Cronbach's alpha coefficient and ICC were respectively 0.71 and 0.72 for the total questionnaire. The total score was determined based on 5 ranges, including 50-89 (very low preparedness), 90-129 (low preparedness), 130-170 (medium-level preparedness), 171-210 (high preparedness), and 211-250 (very high preparedness). CONCLUSION: Nurses' preparedness to respond to this pandemic requires multilateral measures. Measuring the nurses' preparedness can clarify the challenges in hospital measures taken to respond to this crisis. Evaluating the nurses, determining the challenges and priorities, and finding solutions to resolve them can improve the nurses' performance in providing health care services. Preparation of nurses during pandemics can reduce the damages to this group and maximize their efforts to protect the patients. Thus, health planners and policy-makers should try to promote the nurses' awareness and preparedness.

Management Challenges of Informal Volunteers: The Case of Kermanshah Earthquake in Iran (2017).

OBJECTIVES: Two of the 5 great earthquakes have occurred in Iran between 1990 and 2005. Informal volunteers' management is a determinant factor in disaster management. This research was conducted to investigate the management challenges of informal volunteers after the Kermanshah earthquake. METHODS: The study is qualitative, done by content analysis. Data were gathered by observation and semi-structured interview. RESULTS: Analysis of 12 interviews resulted in 4 main categories (inappropriate dispatch, volunteers' inefficiency, decrease in volunteers' incentive, deficiency of welfare services) and 11 subcategories. DISCUSSION: To avoid mistrust and decrease in motivation, proposed actions are: standardize information collection, apply effective communication, create registration networks and accreditation of certificates and expertise, and perform periodic drills. CONCLUSION: We recommend the start of extracurricular programs and applying potential volunteers within the preparedness phase, and follow-up at the beginning of the response phase. Decrease of motivation to participate in future events needs to be studied more comprehensively.

Factors affecting hospital response in biological disasters: A qualitative study.

Background: The fatal pandemics of infectious diseases and the possibility of using microorganisms as biological weapons are both rising worldwide. Hospitals are vital organizations in response to biological disasters and have a crucial role in the treatment of patients. Despite the advances in studies about hospital planning and performance during crises, there are no internationally accepted standards for hospital preparedness and disaster response. Thus, this study was designed to explain the effective factors in hospital performance during biological disasters. Methods: Qualitative content analysis with conventional approach was used in the present study. The setting was Ministry of Health and related hospitals, and other relevant ministries responsible at the time of biologic events in Islamic Republic of Iran (IR of Iran) in 2018. Participants were experts, experienced individuals providing service in the field of biological disaster planning and response, policymakers in the Ministry of Health, and other related organizations and authorities responsible for the accreditation of hospitals in IR of Iran. Data were collected using 12 semi-structured interviews in Persian language. Analysis was performed according to Graneheim method. Results: After analyzing 12 interviews, extraction resulted in 76 common codes, 28 subcategories, and 8 categories, which are as follow: detection; treatment and infection control; coordination, Resources; training and exercises; communication and information system; construction; and planning and assessment. Conclusion: Hospital management in outbreaks of infectious diseases (intentional or unintentional) is complex and requires different actions than during natural disasters. In such disasters, readiness to respond and appropriate action is a multifaceted operation. In IR of Iran, there have been few researches in the field of hospital preparation in biologic events, and the possibility of standardized assessment has be reduced due to lack of key skills in confronting biological events. It is hoped that the aggregated factors in the 8 groups of this study can evaluate hospital performance more coherently.

Effect of calcitriol supplementation and tail suspension on serum biomarkers of bone formation in rats.

BACKGROUND: Calcitriol is documented to cause significant increase in bone mass densitometry counteracting osteoporosis. Promising results of calcitriol supplementation in studies aiming space flight induced osteoporosis is little and the effect of this hormone on biomarkers of bone metabolism is not examined yet in space flight models of osteoporosis in rats. METHODS: This was an interventional animal study being performed in a 1-month period. We included 21 Sprague Dawley strain rats (>200 gr, >6 week) who were randomly assigned to receive daily supplementation of oral 0.03µgr calcitriol and to be submitted to tail suspension model. Rats were followed for 1 month and were tested for serum osteocalcin (OC), alkaline phosphatase (ALP) and serum calcium at the beginning and the end of the study period. The results were analyzed and compared between groups. RESULTS: Although serum levels of osteocalcin and alkaline phosphatase biomarkers and total serum calcium were not significantly different within and between study groups, their levels were increased in tail suspension model compared to control group. The levels of these biomarkers were lower in those who were submitted to tail suspension model and received calcitriol supplementation compared to those who were only submitted to tail suspension (60.14 ± 11.73 ng/mL vs. 58.29 ± 2.69 ng/mL; p = 0.696 for osteocalcin and 381.86 ± 99.16 mU/mL vs. 362.57 ± 27.41 ng/mL; p = 0.635 for alkaline phosphatase). CONCLUSION: Supplementation of daily diet with calcitriol in rats under weightlessness conditions may results in lower values for bone metabolic biomarkers of alkaline phosphatase and osteocalcin and serum calcium. This pattern of change in biomarkers of bone formation, may point to the capacity of calcitriol supplementation in preventing cellular process of osteoporosis. Thus calcitriol supplementation could be an available, economic and effective strategy for preventing bone metabolic changes related to weightlessness commonly encountered in space flight. The outcome of this study needs to be further studied in future trying to find more definite results.

Histological and biomechanical analysis of the effects of streptozotocin-induced type one diabetes mellitus on healing of tenotomised Achilles tendons in rats.

BACKGROUND: Tendon healing is impaired in patient with diabetes mellitus. The effects of streptozotocin-induced type 1 diabetes (STZ-D) on the healing of the transected Achilles tendon in rats was studied. METHODS: In the experimental group, type one diabetes was induced via administration of STZ. The right Achilles tendon of all the rats was transected 30 days after the STZ administration. The Achilles tendons were examined for biomechanical and histological examinations. RESULTS: The statistical analysis showed that Young's modulus of elasticity and stress tensile load of the control group were significantly higher than those of the experimental group, and inflammation in the experimental group was significantly higher than that in the control group. At the same time, fibrosis in the experimental group was significantly lower than that of the control group. CONCLUSION: Induction of type 1 diabetes by STZ significantly delayed the healing of the transected Achilles tendon in rats.

Effects of Vitamin D and Calcium Supplementation on Micro-architectural and Densitometric Changes of Rat Femur in a Microgravity Simulator Model.

BACKGROUND: Revealing data on the role of vitamin D and calcium supplementation in bone health has led some to suggest that vitamin D and calcium treatment could also play a role in protecting bone against microgravity-induced mineral loss. OBJECTIVES: The aim of the present study was to investigate the effects of vitamin D and calcium administration on microscopic and densitometric changes of rat femur in a Microgravity Simulator Model. MATERIALS AND METHODS: After designing a Microgravity Simulator Model, 14 rats were placed in the cages as follows: seven rats as osteoporosis group and seven rats received oral supplement of calcium/vitamin D as the treatment group. Animals were sacrificed after eight weeks and then both femurs were removed. Bone mineral density was measured for one femur from each animal, and morphologic studies were evaluated for the contralateral femur. RESULTS: Bone mineral density of the whole femur in the treatment group was significantly higher than the osteoporosis group (0.168 ± 0.005 vs. 0.153 ± 0.006, P = 0.003). Also, bone mineral content of the whole femur was significantly higher in treatment group (0.415 ± 0.016 vs. 0.372 ± 0.019, P = 0.003). However, resorption eroded surface percentage was higher in the osteoporosis group (18.86 ± 3.71% vs. 9.71 ± 1.61%, P = 0.002). CONCLUSIONS: According to the results of this study, vitamin D and calcium administration might have protective effects against microgravity-induced mineral loss in a Rat Microgravity Simulator Model.

Evaluating the effect of low-level laser therapy on healing of tentomized Achilles tendon in streptozotocin-induced diabetic rats by light microscopical and gene expression examinations.

Tendon healing is impaired in individuals diagnosed with diabetes mellitus (DM). According to research, there is considerable improvement in the healing of surgically tenotomized Achilles tendons following low-level laser therapy (LLLT) in non-diabetic, healthy animals. This study uses light microscopic (LM) and semi-quantitative reverse transcription PCR (RT-PCR) analyses to evaluate the ability of LLLT in healing Achilles tendons from streptozotocin-induced diabetic (STZ-D) rats. A total of 88 rats were randomly divided into two groups, non-diabetic and diabetic. DM was induced in the rats by injections of STZ. The right Achilles tendons of all rats were tenotomized 1 month after administration of STZ. Laser-treated rats were treated with a helium-neon (He-Ne) laser that had a 632.8-nm wavelength and 7.2-mW average power. Experimental group rats received a daily dose of 0.014 J (energy density, 2.9 J/cm(2)). Control rats did not receive LLLT. Animals were sacrificed on days 5, 10, and 15 post-operatively for semi-quantitative LM and semi-quantitative RT-PCR examinations of transforming growth factor-beta1 (TGF-ß1) gene expression. The chi-square test showed that LLLT significantly reduced inflammation in non-diabetic rats compared with their non-diabetic controls (p = 0.02). LLLT significantly decreased inflammation in diabetic rats on days 5 (p = 0.03) and 10 (p = 0.02) compared to the corresponding control diabetic rats. According to the student's t test, LLLT significantly increased TGF-ß1 gene expression in healthy (p = 0.000) and diabetic (p = 0.000) rats compared to their relevant controls. The He-Ne laser was effective in altering the inflammatory reaction and increasing TGF-ß1 gene production.

Effect of low-level treatment with an 80-Hz pulsed infrared diode laser on mast-cell numbers and degranulation in a rat model of third-degree burn.

BACKGROUND DATA: Low-level laser therapy (LLLT) has been reported to be capable of changing mast cell numbers and degranulation in experimental burns in rats. OBJECTIVE: We conducted a study of the influence of LLLT on mast cells in a rat model of third-degree burn. METHODS: In this study we divided 48 rats equally into two groups of 24 rats each. Third-degree burns were inflicted at three different locations on each rat in each group. The first burn site on rats in group I was treated with 890-nm pulsed laser, 75W peak, 80 Hz, 180 ns, average power 1mW, illuminated area 1 cm(2), 1 mW/cm(2), 856 sec, 0.924 J/cm(2). The second burn site on both groups of rats was treated with 0.2% nitrofurazone cream. Mast cell numbers and degranulation at each burn site on each group of rats were then assessed at 4, 8, 13, and 20 days after the infliction of burns. RESULTS: Analysis of variance on day 4 showed that the total numbers of mast cells were significantly lower at the laser-treated burn sites than at other burn sites on both groups of rats. On day 8 the total numbers of mast cells were again significantly lower at the laser-treated burn sites than at other burn sites, and on day 13, the numbers of both types 1 and 2 mast cells were significantly lower at the laser-treated burn sites than at other burn sites. CONCLUSIONS: We conclude that LLLT can significantly decrease total numbers of mast cells during the proliferation and remodeling phases of healing in a rat model of third-degree burn.

Low-level laser therapy with a pulsed infrared laser accelerates second-degree burn healing in rat: a clinical and microbiologic study.

OBJECTIVE: This study was carried out to investigate the influence of pulsed-wave low-level laser therapy (LLLT) on the healing of a deep second-degree burn model in rat. BACKGROUND DATA: Review of literature indicates that LLLT has a biostimulatory effect on wound healing; however, no clear recommendation can yet be made. METHODS: Two deep second-degree burns were made in the skin of 67 rats. Rats were divided into four groups. In the first group (control), the proximal burn were received LLLT with shot down laser; in the second and third groups, proximal burns were treated with a 3,000-Hz pulsed infrared diode laser with 2.3 and 11.7 J/cm(2) energy densities, respectively. In the fourth group, the proximal burns were treated topically with 0.2% nitrofurazone. The distal burn of all groups was considered the control burn. The response to treatment was assessed both microbiologically and macroscopically. RESULTS: The incidence of Staphylococcus aureus decreased significantly in group 3 in comparison with group 1 on day 28 (χ(2) test, p = 0.05). Analysis of variance showed that LLLT with 11.7 J/cm (2) significantly increased the wound-closure rate at 2 weeks (0.915 ± 0.310) and 3 weeks (0.677 ± 0.397) after burning compared with placebo burns (1.413 ± 0.319; 1.116 ± 0.436, respectively) ANOVA-LSD test, p = 0.045 and p = 0.046 respectively. Independent sample t tests showed that LLLT with 11.7 J/cm (2) significantly increased the wound-closure rate at 4 weeks after burning (0.211 ± 0.146) compared with the control burns (0.707 ± 0.480) p = 0.039. CONCLUSIONS: Pulsed LLLT with 11.7 J/cm(2)/890 nm of a deep second-degree burn model in rat significantly increased the rate of wound closure compared with control burns.