Designing internet-enabled patient education for self-management of T2D diabetes-The case of the Razavi-Khorasan province in Iran.

BACKGROUND: The number of people with diabetes is estimated to increase to 642 million by 2040, with most having type 2 diabetes. Patients with diabetes require continuous monitoring and possible treatment changes. Patient education is the process of enabling individuals to make informed decisions about their personal health-related behaviours and internet-enabled interventions have the potential to provide support and information to patients with diabetes. OBJECTIVE: The aim of the study was to design a portal prototype based onto two models of care and a contextualised education programme to support the self-management of diabetes patients by involving stakeholders in the Iranian province of Razavi-Khorasan. METHODS: A Design-Based Research framework was adopted. A qualitative research method was used to analyse interviews with patients and care givers. Mock-ups were developed first and designed with features of user-driven and self-care models of care. The mock-ups also had adaptation features, such as for control of the disease, ability to cure self, and family support. The portal prototype was developed iteratively by building on the mock-ups and evaluated through interviews. The features and elements of the mock-ups and the portal prototype were evaluated in an outpatient diabetes clinic in Mashhad. RESULTS: Thirty-three participants were involved in the study. The evaluation of the mock-ups resulted in two themes and seven categories: 1) self-care improvement, including self-care requirements and self-management, and 2) educational usefulness, including medical information, information mode, mobility, interaction, and efficiency. The mock-up evaluation was used as a basis for designing a portal prototype. Next, the portal prototype was evaluated, and three categories emerged from the interview data: 1) user experience, 2) functionality, and 3) interactivity. Participants were not able to prioritise between the two care models. Some functionalities of the portal could benefit from the development within a cultural context to determine differences to the best way to present material. CONCLUSIONS: A portal prototype has been designed to include two care models to support self-management and functionalities that support aspects of culture-specific diabetes self-care. This study provides guidance on developing an internet-enabled educational portal, aimed at providing support for patients in their social context.

Remote Control in Formation of 3D Multicellular Assemblies Using Magnetic Forces.

Cell constructs have been utilized as building blocks in tissue engineering to closely mimic the natural tissue and also overcome some of the limitations caused by two-dimensional cultures or using scaffolds. External forces can be used to enhance the cells' adhesion and interaction and thus provide better control over production of these structures compared to methods like cell seeding and migration. In this paper, we demonstrate an efficient method to generate uniform, three-dimensional cell constructs using magnetic forces. This method produced spheroids with higher densities and more symmetrical structures than the commonly used centrifugation method for production of cell spheroids. It was also shown that shape of the cell constructs could be changed readily by using different patterns of magnetic field. The application of magnetic fields to impart forces on the cells enhanced the fusion of these spheroids, which could be used to produce larger and more complicated structures for future tissue engineering applications.

Essential managerial skills for financial and budgetary management in medical universities: The top managers' perspective.

Background: Achieving organizational objectives depends on the effectiveness of administrators. However, managerial efficacy largely depends on the knowledge and skills of managers. This study aimed at assessing the skills of financial and budget management of the Ministry of Health from the perspective of resource development assistants of universities of medical sciences nationwide. Methods: This cross- sectional study was conducted in 2012. Study participants were resource development assistants of universities of medical sciences in Iran. We adopted simple random sampling method in locating participants. Data were collected using pretested questionnaires and analyzed using descriptive statistics and Mann-Whitney test (as a non-parametric test) and Friedman test. Results: The highest mean recorded under financial management skills was technical skills (3.58±0.50), followed by human skills (3.50±.048), and perceptual skills (3.32±0.52). With regards to financial and budget management and performance monitoring, the means of technical skills, as prioritized by directors, was 3.72±0.71, followed by human skills (3.72±0.70), and perceptual skills (3.66±0.75). A significant association was found between perceptual skills of financial managers and budgeting and performance monitoring managers (p= 0.014). Conclusion: Operational level managers, such as financial and budgetary managers, need to acquire more technical skills. Therefore, we support activities that promote technical skills and awareness of managers within organizations, such as organizational training courses and distribution of educational materials like brochures.

Exploring educational needs and design aspects of internet-enabled patient education for persons with diabetes: a qualitative interview study.

OBJECTIVE: The objective of this article is to explore the educational needs and design aspects of personalised internet-enabled education for patients with diabetes in Iran. DESIGN: Data were collected using semistructured interviews and then qualitatively analysed using inductive content analysis. PARTICIPANTS: 9 patients with type 2 diabetes were included. Inclusion criteria were access to and knowledge on how to use the internet. The selection ensured representation based on gender, age, occupation and educational background. SETTING: The sample population was patients with diabetes who were admitted to an outpatient diabetes clinic in Mashhad, a large city of Iran with about 3 million inhabitants. RESULTS: 4 core categories emerged from the data: (1) seeking knowledge about diabetes, including specific knowledge acquisition, patient's interactions and learning requirements; (2) teaching and learning, including using different teaching methods and different ways to learn about the disease; (3) facilitators, including internet and mobile phone use to learn about the disease; and (4) barriers, including lack of internet access, uncertainty of access to the internet and lack of website in the local language and also perceived cultural barriers, such as patients' fears of the internet, lack of time and awareness. CONCLUSIONS: This study provides a better understanding of the patient's educational expectations and technical needs in relation to internet-enabled education. This knowledge will inform the development of functional mock-ups in the next research phase using a design-based research approach in order to design internet-enabled patient education for self-management of diabetes.

Electrospun chitosan-gelatin nanofiberous scaffold: fabrication and in vitro evaluation.

In this study, chitosan and gelatin solutions were blended at five different ratios. Samples were fed into electrospinning apparatus to produce non-woven nanofibrous mats. Scanning electron microscopy (SEM) showed that the low-viscosity sample with 30% chitosan and 70% gelatin (sample 30/70) formed the least amount of beads and droplets and yielded fibers with the highest morphological uniformity. To examine the effect of processing parameters on fibers morphology and nanofibers diameter, flow rate, voltage and distance between needle to the collector were changed in the sample 30/70. SEM revealed that high voltages (25 kV) and flow rates (1.5 ml·h⁻¹) decrease the uniformity of fibers and lead to bead and droplet formation. It has also shown that the distance between the tip and the collector have no significant effect on fibers' structure. The values of 15 kV (voltage), 0.2 ml·h⁻¹ (flow rate) and the fixed distance of 15 cm were identified as the optimal electrospinning conditions, which produce fibers with a mean diameter of 180±20 nm. Fourier transform infrared (FTIR) experiment revealed an increase in N-H bending and decrease in C-O stretching vibration in both chitosan and gelatin at 1060 and 1148 cm⁻¹. The in vitro biocompatibility tests performed with human skin fibroblasts showed excellent cell proliferation (MTT assay) and attachment (SEM) on these scaffolds confirming its highly acceptable biological properties.