Developing a quality and safety assessment framework for Iran's military hospitals.

BACKGROUND: The first crucial step towards military hospitals performance improvement is to develop a local and scientific tool to assess quality and safety based on the context and aims of military hospitals. This study introduces a Quality and Safety Assessment Framework (Q&SAF) for Iran's military hospitals. METHODS: This is a literature review which continued with a qualitative study. The Q&SAF for Iran's military hospitals was developed initially, through a review of the WHO's framework for hospital performance, literature review (other related framework), review of military hospital-related local documents, consultations with a national and sub-national expert. Finally, the Delphi technique used to finalize the framework. RESULTS: Based on the literature review results; 13 hospital Q&SAF were identified. After reviewing literature review results and expert opinions; Iran's military hospitals Q&SAF was developed with 58 indictors in five dimensions including clinical effectiveness, safety, efficiency, patient-centeredness, and Responsive Management (Command and Control). The efficiency dimension had the highest number of indictors (19 indictors), whereas the patient-centered dimension had the lowest number of indices (4 indictors). CONCLUSION: Regarding the comprehensiveness of the developed assessment framework due to its focus on the majority of quality dimensions and important components of the hospital's performance, it can be used as a useful tool for assessing and continuously improving the quality of hospitals, particularly military hospitals.

Comparison of RT-LAMP and RT-qPCR assays for detecting SARS-CoV-2 in the extracted RNA and direct swab samples.

Rapid detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in infected patients is critical for infection control. Loop-mediated isothermal amplification (LAMP) has been demonstrated to be a rapid, simple, reliable, cost-effective and sensitive method to detect SARS-CoV-2 in a variety of samples in considerably less time than Real-Time PCR. In this study, we developed and optimized a rapid detection method for SARS-CoV-2 based on RT-LAMP method utilizing a specific primer set targeting the ORF1a gene and then examined its sensitivity and efficiency using a serially diluted viral RNA sample with a known concentration. Furthermore, the sensitivity of the RT-LAMP to detect SARS-CoV-2 in direct swab samples with varying Ct values were compared to a commercial molecular RT-qPCR based detection kit. According to our findings the optimal incubation time for RT-LAMP assay was 45 min. There was a complete agreement between RT-LAMP and RT-qPCR in diagnosing the viral genome in the diluted extracted RNA sample. However, it had a lower sensitivity (71%) to detect the viral genome in direct swab samples compared to RT-qPCR. In conclusion, due to its simplicity, rapidness, sensitivity, and specificity, RT-LAMP has tremendous potential as a point-of-care tool; nevertheless, more research is needed to utilize it for detecting SARS-CoV-2, particularly in direct swab samples.

Experiences of operating room nurses in disaster preparedness of a great disaster in Iran: a qualitative study.

BACKGROUND: In recent years, Iran has encountered a growing frequency of earthquake disasters. Given that nurses constitute the largest group of healthcare providers, it is imperative that they possess adequate disaster preparedness skills, irrespective of the location or time. Despite the operating room nurses' roles in disasters, their experiences and challenges in disaster preparedness have been overlooked. Consequently, this study aimed to investigate the experiences, challenges, perspectives, and factors influencing the disaster preparedness of operating room nurses during the 2017 earthquake in Kermanshah, Iran. METHODS: The present qualitative research was carried out in Iran In 2022 utilizing conventional content analysis. The study involved conducting semi-structured interviews with 16 operating room nurses who had participated in disaster preparedness during the Kermanshah earthquake. The participants were selected using a purposive sampling approach that aimed to achieve maximum diversity. The interviews were continued until the point of data saturation was reached, and the verbatim transcripts were analyzed using conventional content analysis in MAXQDA software. To ensure the rigor of the research, Guba and Lincoln's criteria were employed. RESULTS: The study conducted data analysis to identify the main theme as "insufficient disaster preparedness due to a faded preparedness", along with six major categories and eighteen subcategories related to earthquake disaster preparedness. The major categories included: knowledge and perception of preparedness for disasters; educational and training programs for disaster preparedness; equipment preparedness for disasters; managerial-organizational preparedness for disasters; clinical skills for responding to disasters; and resilient ability in disaster response situations. CONCLUSION: The findings of the study provide valuable insights into the dimensions of disaster preparedness in earthquake disasters among operating room nurses. Nursing managers can utilize these findings to develop effective strategies and provide support in areas such as improving knowledge and educational level, equipment preparedness, strengthening plans and managerial structures, enhancing skills, and explaining resilience strategies to improve the disaster preparedness of operating room nurses and medical organizations' disaster response teams.

Lactobacillus casei condition medium downregulates miR-21 relative expression in HT-29 colorectal cancer cell line.

Previous research has demonstrated promising outcomes regarding the advantageous impact of probiotics in both cancer prevention and treatment. Nevertheless, the precise molecular mechanisms underpinning these effects remain elusive. Recent investigations have proposed a potential involvement of micro ribonucleic acids (miRNAs) in mediating the favorable influence of probiotics on cancerous cells. This study was designed to evaluate the effect of Lactobacillus casei condition medium on miR-21 relative expression in HT-29 colorectal cancer cells. Lactobacillus casei condition medium mixed with RPMI in different proportions (1:1, 1:3, and 1:7) and utilized to treat HT-29 cells for 24 and 48 h. Subsequently, percentage of early and late apoptotic cells were identified using a flow cytometry instrument. A real-time polymerase chain reaction was carried out to determine the relative expression of miR-21. Our findings revealed that L. casei condition medium induces apoptosis in a time- and dose-dependent manner in HT-29 cells. Furthermore, we found a significantly downregulated miR-21 after treatment with high doses of L. casei condition medium after 48 h. Overall, our results provide valuable insights into a potential mechanism through which L. casei condition medium mediates its apoptotic effect in colorectal cancer cells through downregulation of miR-21. However, further investigations are required to unravel its therapeutic, diagnostic, and treatment monitoring potential.

Development and Psychometric Properties of the Caring Behaviors of Operating Room Nurses Questionnaire during the COVID-19 Pandemic: A Mixed-Method Study.

Background: Considering the threats in the operating room during the COVID-19 pandemic, the optimal care and safety of the operating room nurses should be maintained when performing surgery on an acute respiratory patient. It seems necessary to design a tool to measure the caring behaviors of operating room nurses. Therefore, the present study was conducted with the aim to design a valid and reliable tool for measuring the caring behavior of operating room nurses during the COVID-19 pandemic. Materials and Methods: In this sequential, exploratory, mixed-method study, the designing and psychometric evaluation of the caring behaviors of operating room nurses questionnaire during the COVID-19 pandemic were performed in qualitative and quantitative phases from August 2021 to July 2022 in Aja University of Medical Sciences, Iran. In the qualitative phase, the concept of caring behaviors of operating room nurses was explored through interviews and a literature review based on online searches. In the quantitative phase, validity (face, content, and construct), and reliability of the questionnaire were evaluated. Results: The findings supported 21 items in the 5 factors of caring behaviors related to attitude toward patients, knowledge of surgical care, virus prevention principles, self-care knowledge, and self-care performance, which explained 35.92 of the total variance. Scale-Content Validity Index/Average and Cronbach's alpha were calculated to be 0.93 and 0.89, respectively. Conclusions: Given its desirable reliability and validity, simple scoring, and ease of use by operating room nurses, the Caring Behaviors of Operating Room Nurses Questionnaire is applicable and its use is recommended.

Long Non-Coding RNA Signatures in Lymphopoiesis and Lymphoid Malignancies.

Lymphoid cells play a critical role in the immune system, which includes three subgroups of T, B, and NK cells. Recognition of the complexity of the human genetics transcriptome in lymphopoiesis has revolutionized our understanding of the regulatory potential of RNA in normal lymphopoiesis and lymphoid malignancies. Long non-coding RNAs (lncRNAs) are a class of RNA molecules greater than 200 nucleotides in length. LncRNAs have recently attracted much attention due to their critical roles in various biological processes, including gene regulation, chromatin organization, and cell cycle control. LncRNAs can also be used for cell differentiation and cell fate, as their expression patterns are often specific to particular cell types or developmental stages. Additionally, lncRNAs have been implicated in lymphoid differentiation, such as regulating T-cell and B-cell development, and their expression has been linked to immune-associated diseases such as leukemia and lymphoma. In addition, lncRNAs have been investigated as potential biomarkers for diagnosis, prognosis, and therapeutic response to disease management. In this review, we provide an overview of the current knowledge about the regulatory role of lncRNAs in physiopathology processes during normal lymphopoiesis and lymphoid leukemia.

Inhibition of bacterial adhesion and anti-biofilm effects of Bacillus cereus and Serratia nematodiphila biosurfactants against Staphylococcus aureus and Pseudomonas aeruginosa.

Background and Objectives: Biosurfactants are amphiphilic surface-active agents that mainly produced by various microorganisms. In this study, the anti-biofilm and inhibition of bacterial adhesion activities of two bacterial biosurfactants were investigated. Materials and Methods: After extraction and evaluation of Bacillus cereus and Serratia nematodiphila biosurfctants, inhibition of bacterial adhesion and anti-biofilm effects of them on Staphylococcus aureus and Pseudomonas aeruginosa were determined. Results: On average, the synergistic effect of two bacterial biosurfactants, caused about 60% decrease in adhesion and about 80% decrease in biofilm formation of S. aureus and P. aeruginosa. Conclusion: The results of this study showed that combination of B. cereus and S. nematodiphila biosurfactants would increase the potential of attachment inhibition and biofilm eradication with very low toxicity.

Identifying the factors affecting on interaction of faculty member: A meta-synthesis.

BACKGROUND: The ability to interact and communicate effectively is one of the factors affecting the performance of faculty members, which is considered one of their basic competencies. The purpose of this study was to identify the factors affecting on interaction of faculty member with student and colleague, through the synthesis of literature. MATERIALS AND METHODS: The research method was qualitative with a meta-synthesis approach. Meta-synthesis was performed with Sandelowski and Barroso method. After the research of databases in the period 1995-2021, 259 studies were collected and finally 48 sources were selected and were included in the analysis phase. Coding method was used to analyze the data. RESULTS: Analyzing the findings of previous researchers and synthesizing the results, 155 codes, 18 subcategories, and 6 categories were identified and validated through kappa coefficient. The categories included "emotional-cognitive factor," "sociocultural factor," "communication factor," "professional factor," "educational factors," and "management factor." CONCLUSION: Based on the findings of this study and the importance of faculty members' interactions in medical universities, it is recommended that university officials and administrators use the results of this study to provide a suitable platform for creating and strengthening these interactions through holding workshops.

Isolation of nontuberculous mycobacteria species from different water sources: a study of six hospitals in Tehran, Iran.

PURPOSE: Nontuberculous mycobacteria (NTM) are ubiquitous bacteria that are naturally resistant to disinfectants and antibiotics and can colonize systems for supplying drinking water. Therefore, this study aimed to evaluate the prevalence of NTM in the drinking water of six hospitals in Tehran, Iran. METHODS: Totally, 198 water samples were collected. Each water sample was filtered via a membrane filter with a pore size of 0.45 µm and then decontaminated by 0.005% cetylpyridinium chloride. The membrane filters were incubated on two Lowenstein-Jensen media at 25 °C and 37 °C for 8 weeks. The positive cultures were identified with phenotypic tests, and then NTM species were detected according to the hsp65, rpoB, and 16S rDNA genes. Drug susceptibility testing (DST) was also carried out. RESULTS: Overall, 76 (40.4%) of the isolates were slowly growing mycobacteria (SGM) and 112 (59.6%) of the ones were rapidly growing mycobacteria (RGM). The most common NTM were Mycobacterium aurum, M. gordonae, M. phocaicum, M. mucogenicum, M. kansasii, M. simiae, M. gadium, M. lentiflavum, M. fortuitum, and M. porcinum. Among these 188 samples, NTM ranged from 1 to > 300 colony-forming unit (CFU) /500 mL, with a median of 182 CFU/500 mL. In the infectious department of all hospitals, the amount of CFU was higher than in other parts of the hospitals. The DST findings in this study indicated the diversity of resistance to different drugs. Among RGM, M. mucogenicum was the most susceptible isolate; however, M. fortuitum showed a different resistance pattern. Also, among SGM isolates, M. kansasii and M. simiae, the diversity of DST indicated. CONCLUSIONS: The current study showed NTM strains could be an important component of hospital water supplies and a possible source of nosocomial infections according to the CFU reported in this study. The obtained findings also help clarify the dynamics of NTM variety and distribution in the water systems of hospitals in the research area.

Exploring the components of student support system in blended learning for Iranian Universities of Medical Sciences: A thematic analysis.

BACKGROUND: Support services are a very important element for all educational institutions. The aims of this study were to explore the components of the student support system in blended learning for universities of medical sciences in Iran. MATERIALS AND METHODS: The present study was performed qualitative with exploratory approach. The tool used to collect data was a semi-structured interview, after conducting interviews with 17 e-learning experts and specialists of universities of medical sciences, we reached information saturation. The study was conducted at Aja University of Medical Sciences in Tehran in 2020. Data analysis was performed as Thematic Content Analysis by Attride-Stirling method. RESULTS: From the content analysis of the interviews, 6 main themes and 19 sub-themes were obtained. Main themes included "Scientific- cognitive Support", "Systematic Support", "Human Resource Support", "Emotional Support", "Technical Support" and "Financial- economic Support". CONCLUSION: Based on the results of this study, 6 basic components and its subcomponents of the student support system were obtained. It is suggested that the educational officials of medical universities with blended learning use the results of this study in setting up their student support system for academic success in e-learning and medical students.

Molecular detection of Propionibacterium acnes in biopsy samples of intervertebral disc with modic changes in patients undergoing herniated disc surgery.

BACKGROUND AND OBJECTIVES: Recent studies have hypothesized that sterile disc infection with the anaerobic Propionibacterium acnes, recently renamed Cutibacterium acnes, occurs in people with intervertebral disc (IVD) herniation. This study aimed to examine the presence of P. acnes in patients who have Low back pain (LBP) with Modic changes observed in their Magnetic Resonance Imaging (MRI). MATERIALS AND METHODS: Thirty-seven patients who were candidates for surgery due to disc herniation and demonstrated Modic changes in MRI were included in the study. Before the surgery, the level of pain in patients was assessed using the visual analog score (VAS). All patients were asked to fill in the Oswestry Low Back Pain Disability Questionnaire. Intervertebral disc changes observed in MRI were recorded for all patients. Then, during surgery, sterile intervertebral disc samples were taken. P. acnes detection was performed using PCR in the laboratory. Data analysis with Chi-squared test, independent samples t-test, and Mann-Whitney U test in SPSS 18.0. RESULTS: The mean age of 37 patients equaled 43.64 years and the mean duration of symptoms was 11.05 months. In molecular examination, of the 37 individuals, the genome of P. acnes was positive in 23 cases (62.2%) and negative in 14 (37.8%). The relationship between VAS, disability score, changes in MRI, and patients' age with the positivity of the intervertebral disc sample was also assessed. Of these variables, only age was significantly correlated with the positive molecular finding, such that with an increase in age, the probability of positive findings was increased (p = 0.022). CONCLUSION: Based on the results, lumbar disc infection with P. acnes may play a significant role in causing Modic changes and the progression of the disease in patients with LBP.

Identification of dimensions and indicators of spiritual health: A qualitative study.

INTRODUCTION: Spiritual health is considered one of the important dimensions of health and has been given serious attention by the scientific community, World Health Organization, health discourse, and medical education. However, despite these considerations, there is a controversy in defining the nature of this category and its dimensions and indicators. The purpose of this study is to identify the indicators and dimensions of spiritual health for medical students. MATERIALS AND METHODS: This qualitative study with exploratory approach utilized conventional content analysis and individual in-depth interviews with experts in the area of spiritual health and spirituality in medical sciences selected through purposeful sampling. The study was conducted at Aja University of Medical Sciences in Tehran in 2018. The semi-structured interview was a tool used to achieve data saturation, that interviewed with 19 experts. Member check, credibility, and reliability were measured to increase the validity and reliability of the results. Inductive content analysis was used for the analysis of data in three main phases: preparation, organization, and categories and creating categories. RESULTS: Based on the findings of the interviews, 52 indicators were identified.Then, the indicators of spiritual health were identified in the following four categories) relationship with God, relationship with himself, relationship with others, relation with the environment (and these categories were divided inthree dimentions (cognitive, attitudes and emotions, behavioral). CONCLUSION: The findings of the present study showed that in order to have spiritual health, it is important to pay attention to one's relationship with God and one's relationship with oneself, one's relationship with others, and one's relationship with the environment, and it is necessary to pay attention to it in medical science curricula.

A Study on Capabilities Required In Military Medicine to Develop Modular Training Courses: A Qualitative Study.

INTRODUCTION: The main mission of military medicine in the world is to support the health and treatment of the military in relation to issues, risks, injuries and diseases that arise due to the specific occupational conditions. The current study was carried out with the aim of determining the required skills of military physicians to define and determine the required training modules. METHODS: The study was a qualitative research. Semi-structured interviews were used to collect the data and qualitative content analysis was used to analyze the data. The study population included all the professors and experts in the field of military medicine and medical sciences at the medical universities of Tehran. Snowball sampling technique was used to sample the study participants. RESULTS: Based on the results, the required skills of military physicians in 5 categories and 29 sub- categories were identified; then based on the identified skills, 60 training modules at two introductory and advanced levels were determined including 39 introductory levels and 21 advanced levels. CONCLUSION: We can conclude that some of the important skills that military physicians need and can achieved through training have not been provided in any educational program and to achieve such skills and capabilities, other programs should be developed and modular training can be one of them.

Designing a model for critical thinking development in AJA University of Medical Sciences.

INTRODUCTION: In the new concept of medical education, creativity development is an important goal. The aim of this research was to identify a model for developing critical thinking among students with the special focus on learning environment and learning style. METHODS: This applied and cross-sectional study was conducted among all students studying in undergraduate and professional doctorate programs in Fall Semester 2013-2014 in AJA University of Medical Sciences (N=777). The sample consisted of 257 students selected based on the proportional stratified random sampling method. To collect data, three questionnaires including Critical Thinking, Perception of Learning Environment and Learning Style were employed. The data were analyzed using Pearson's correlation statistical test, and one-sample t-test. The Structural Equation Model (SEM) was used to test the research model. SPSS software, version 14 and the LISREL software were used for data analysis. RESULTS: The results showed that students had significantly assessed the teaching-learning environment and two components of "perception of teachers" and "perception of emotional-psychological climate" at the desirable level (p<0.05). Also learning style and two components of "the study method" and "motivation for studying" were considered significantly desirable (p<0.05). The level of critical thinking among students in terms of components of "commitment", "creativity" and "cognitive maturity" was at the relatively desirable level (p<0.05). In addition, perception of the learning environment can impact the critical thinking through learning style. CONCLUSION: One of the factors which can significantly impact the quality improvement of the teaching and learning process in AJA University of Medical Sciences is to develop critical thinking among learners. This issue requires providing the proper situation for teaching and learning critical thinking in the educational environment.