Polyester fabric-based nano copper-polyhedral oligomeric silsesquioxanes sorbent for thin film extraction of non-steroidal anti-inflammatory drugs.

In this study, in-situ preparation of copper nanoparticles under sonoheating conditions followed by coating on commercial polyester fabric is reported. Through the self-assembly interaction of thiol groups and copper nanoparticles, the modified polyhedral oligomeric silsesquioxanes (POSS) was deposited on the fabric's surface. In the next step, radical thiol-ene click reactions were implemented to create more layers of POSSs. Subsequently, the modified fabric was applied for sorptive thin film extraction of non-steroidal anti-inflammatory drugs (NSAIDs) including naproxen, ibuprofen, diclofenac, and mefenamic acid from urine samples, followed by high-performance liquid chromatography equipped with a UV detector. The morphology of the prepared fabric phase was characterized by scanning electron microscopy, water angle contact, energy dispersive spectrometry mapping, analysis of nitrogen adsorption-desorption isotherms, and attenuated total reflectance Fourier transform infrared spectroscopy. The significant extraction parameters, including the acidity of the sample solution, desorption solvent and its volume, extraction time, and desorption time, were investigated using the one-variable-at-a-time approach. Under the optimal condition, NSAIDs' detection limit was 0.3-1 ng mL-1 with a wide linear range of 1-1000 ng mL-1. The recovery values were between 94.0% and 110.0%, with relative standard deviations of less than 6.3%. The prepared fabric phase exhibited acceptable repeatability, stability, and sorption property toward NSAIDs in urine samples.

Rate and causes of inappropriate stays and the resulting financial burden in a single specialty burns hospital.

BACKGROUND: One of the most important challenges facing hospitals is inappropriate admissions and stays the reduction of which can contribute to a decline in healthcare costs without reducing the quality of services. The aim of this study was to estimate the rate and causes of inappropriate stays and their financial burden in a single specialty burns hospital. METHODS: This is mixed methods study conducted in 2021. In the quantitative phase, all medical records of patients admitted to a burn hospital were reviewed and 260 cases were randomly selected. The records were evaluated based on the Appropriateness Evaluation Protocol to estimate the rate and preliminary causes of inappropriate stays and their direct costs. Frequencies and logistic regression were used for the rates and the influential factors in causing inappropriate stay, respectively. In the qualitative phase, 13 senior and middle managers of the hospital were interviewed for their interpretation of the quantitative data and the main causes of inappropriate stays. Qualitative data were analyzed by using Graneheim-Lundman method. RESULTS: About 28.5% of the patients had at least 1 day of inappropriate stay and about 6% of the total hospitalization days were inappropriate. Marital status, insurance status, and the length of stay were significantly associated with inappropriate admission (p < 0.05). In addition, the annual inappropriate admission days and the direct cost imposed on the patients were estimated at 1490 days and $ 66,848.17. The main causes of inappropriate stays are categorized under themes of healthcare providers, service recipients, financial issues, extra-organizational features, and equipment. CONCLUSION: A significant percentage of patients experience inappropriate admissions. The number of inappropriate stays, which imposes a high cost on patients, can be reduced by considering the standard criteria for appropriate admissions. In addition, hospital officials can prevent inappropriate stays as much as possible and reduce the costs and increase the productivity of hospitals through proper management and planning as well as a regular monitoring of physicians and patients.

Psychometric properties of the EQ-5D-5L compared with EQ-5D-3L in cancer patients in Iran.

Background and Objective: Psychometric evidence to support the validity and reliability of the EuroQol-5 Dimensions (EQ-5D) in cancer patients is limited. This study aimed to test the validity and reliability of the EQ-5D-5L (5L) in comparison with EQ-5D-3L (3L) in cancer patients. Methods: Data of 650 cancer patients were collected through consecutive sampling method from three largest governmental cancer centers in Iran between June 2021 and January 2022. The data were gathered using the 3L, 5L, and the European Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) instruments. The 3L and 5L were compared in terms of ceiling effect, discriminatory power, convergent and known-groups validity, relative efficiency, inconsistency, agreement, and reliability. Results: Compared with the 3L, ceiling effect decreased by 27.86%. Absolute and relative informativity of discriminatory power improved by 45.93% and 22.92% in the 5L, respectively. All convergent validity coefficients with 5L were stronger than with 3L. Both 3L and 5L demonstrated good known-groups validity, and the relative efficiency was higher for 5L in 4 out of 7 patients' characteristics. The two instruments showed low overall inconsistency (1.45%) and 92.57% of the differences of observations between the 3L and 5L were within the 95% limit of agreement. The interclass correlation coefficient (ICC) for 3L and 5L indexes were 0.88 and 0.85, respectively, and kappa coefficients in the 3L dimensions (range=0.66-0.92) were higher than the 5L(range=0.64-0.79). Conclusions: The 5L demonstrated to be better than the 3L in terms of ceiling effect, inconsistency, discriminatory power, convergent validity, relative efficiency.

Determination of a cost-effectiveness threshold for cancer interventions in Iran.

Background and objectives: The estimation of a cost- Effectiveness (CE) threshold from the perspective of those who have experienced a life-threatening disease can provide empirical evidence for health policy makers to make the best allocation decisions on limited resources. The aim of the current study was to empirically determine the CE threshold for cancer interventions from the perspective of cancer patients in Iran. Methods: A composite time trade-off (cTTO) task for deriving quality adjusted life-year (QALY) and a double-bounded dichotomous choice (DBDC) approach followed by open-ended question for examining patients' willingness-to-pay were performed. A nationally representative sample of 580 cancer patients was recruited from the largest governmental cancer centers in Iran between June 2021 and January 2022, and data were gathered using face-to-face interviews. The CE threshold was calculated using the nonparametric Turnbull model and parametric interval-censored Weibull regression model. Furthermore, the factors that affect the CE threshold were determined using the parametric model. Results: The estimated CE threshold using the nonparametric Turnbull model and parametric interval-censored Weibull regression model was IRR 440,410,000 (USD 10,485.95) and IRR 595,280,000 (USD 14,173.33) per QALY, respectively. Gender, age, education, income, type of cancer, and current treatment status were significantly associated with the estimated CE threshold. Conclusions: The value of parametric model-based threshold in this study was 1.98 times the Iranian GDP per capita, which was lower than the CE threshold value recommended by the WHO (i.e., 3 times the GDP per capita) for low-and middle-income countries.

Successful experiences of Hospital Services Quality Resilience during the COVID-19 Pandemic in Iran.

Background: Ensuring and maintaining people's health is one of the most important programs in every country. The aim of the present study was to identify successful experiences of hospital service quality resilience during the coronavirus pandemic. Methods: The present qualitative study was conducted using a content analysis method from September 2021 to April 2022. Seventeen senior and middle managers of Shiraz University of Medical Sciences and affiliated hospitals assigned as coronavirus centers were purposefully included. Data were analyzed using Graneheim and Lundman's method and MAXQDA 2020 software. The results of this study identified successful experiences that affected the quality of hospital services during the pandemic. Results: Five main themes were identified:" Supporting University of Medical Sciences, Improving the hospital process, human resource, Medical, and pharmaceutical equipment and Welfare Facilities" and 31 sub-themes. Conclusion: The resilience of hospital service quality was one of the governing indicators of the Ministry of Health during the coronavirus pandemic. Despite the many challenges in pandemic management and control, hospitals have made efforts in this field to create successful experiences that make it even more important to prepare hospitals for new epidemic conditions.

The Study of Cost-Effectiveness of Rivaroxaban versus Warfarin in Patients with Atrial Fibrillation Who Developed Ischemic Stroke.

INTRODUCTION: Rivaroxaban is a new anticoagulant providing benefits for the treatment of patients with atrial fibrillation (AF). This study is aimed at evaluating the cost-effectiveness of rivaroxaban compared to warfarin in patients with AF. METHOD: This economic evaluation study was conducted among 144 selected nonrandomly patients who were treated with rivaroxaban or warfarin and suffered from AF leading to stroke, in the stroke ward of Shiraz Nemazee Hospital in 2019. The final and clinical (intermediate) outcomes were QALYs and no bleeding and prevention of ischemic stroke, respectively. The study was performed from the social perspective, and a deterministic one-way sensitivity analysis was conducted to identify the effects of uncertainty. The analysis of the collected data was carried out using SPSS18 and TreeAge software. RESULTS: Patients who received rivaroxaban had lower costs ($ 25275 vs. $ 26554) and higher QALYs (0.5 vs. 0.33) compared to those taking warfarin. Bleeding and stroke occurred in (9 vs. 40) and (1 vs. 3) patients in the rivaroxaban and warfarin groups, respectively, and there was a significant decrease in the incidence of bleeding in the rivaroxaban group (81.9% vs 44.4%). Thus, rivaroxaban in all the outcomes was cheaper and more effective than warfarin. The one-way sensitivity analysis confirmed the robustness of the results. CONCLUSIONS: Considering the incremental cost-effectiveness ratio, rivaroxaban is more cost-effective and can be a dominant alternative. Therefore, it is suggested to use rivaroxaban as the first priority in AF patients because rivaroxaban reduces costs and increases clinical outcomes compared with warfarin.

Facile and ultra-sensitive voltammetric electrodetection of Hg2+ in aqueous media using electrodeposited AuPtNPs/ITO.

In this study, we have investigated the use of electrodeposited Au-Pt nanoparticles (AuPtNPs) on indium tin oxide (ITO) for the detection of Hg2+ heavy ions in water samples. The mechanism of AuPtNP electrocrystallization on ITO glass in an aqueous solution containing 0.5 mM HAuCl4 + 0.5 mM H2PtCl6 is described for the first time. The nucleation mechanism of monometallic AuNPs on ITO was found to be progressive; however, a transition from progressive to instantaneous was observed for bimetallic AuPtNPs at elevated overpotentials. The modified ITOs were then assessed for the electrodetection of Hg2+ in aqueous media. It was shown by differential pulse voltammetry (DPV) that the sensitivity of the constructed AuPtNPs/ITO electrode toward Hg2+ was about 2.08 µA nM-1. An approximate detection limit of 4.03 nM Hg2+ was achieved, which is below the permissible level of 30.00 nM Hg2+ in drinking water, according to the World Health Organization (WHO). Characterization of AuPt nanostructures was carried out by X-ray diffraction (XRD) patterns, scanning electron microscopy (SEM), and different electrochemical techniques (cyclic voltammetry (CV), chronoamperometry, and electrochemical impedance spectroscopy (EIS)). Our results indicate a good potential of a facile and robust electrochemical assembly for on-site detection of heavy metals in water samples.