health care

Today, one of the major challenges of nursing education and practice is the demand for technological developments in health care. Undoubtedly, the management of technology in the health system requires training proficient human resources with knowledge and skills in the field of technology. Due to developments in new technologies and the application of such technologies in the field of health care, especially in nursing care, it is necessary to prepare nurses to effectively use these tools to improve health. Given the increasing need for electronic learning, it is necessary to develop electronic learning systems with appropriate technology. Some new technologies include virtual reality stimulation (VR), augmented reality (AR), Metaverse, blockchain technology, the Internet of Things (IoT), and artificial intelligence, which are used to provide opportunities to transfer information, improve learning, and reduce learning problems. Technology-based care can play a key role in developing remote nursing services. Since studies have indicated that there will be an increased shortage of nurses in the coming years, designing and implementing educational plans for nurses has been considered an effective and useful approach in this regard, which can improve nursing consequences in dealing with technological developments, and improve working interactions between health and treatment personnel, and increase the quality of care if effectively planned.

This study aimed to compare the effects of requirement-based and test-based formative assessment methods on pre-clinical endodontic competence and performance of dental students.

This interventional field study was conducted on dental students of Shahid Beheshti Dental School in the first and second semesters of 2021 academic year (third-year students), taking practical basic endodontics 1. After receiving theoretical instructions and practical demonstrations, the students in both groups were asked to perform root canal therapy for extracted maxillary anterior and mandibular/maxillary canine teeth as part of their requirement. Their errors were assessed and recorded by two calibratedinstructors. Next, group 1 students performed root canal therapy for mandibular incisors and premolars as their requirement and returned the treated teeth on a specific date every 3 weeks. Group 2 students did not have a specific requirement and only participated in an examination which included endodontic treatment of the same group of teeth treated by group 1 students at the same designated dates. The treated teeth were assessed by instructors for errors. A final examination was held at the end of the semester for both groups. The two groups were compared by independent t-test, ANCOVA, Pearson Chi-square, and Mann-Whitney tests (alpha=0.05).

No significant difference was found between the two groups in access cavity preparation, root canal instrumentation, or obturation (P>0.05).

Requirement-based and test-based formative assessment methods had similar effects on pre-clinical endodontic competence and performance of dental students

Knee arthroplasty procedures improve pain, function, stability, and appearance of the limb. Total knee arthroplasty (TKA) in severe, long-standing osteoarthritis (OA) with large medial tibial defects could be a challenge. This paper looks at TKA outcomes when large tibial defects are managed without metal wedges or stems.

TKA cases done for OA with tibial defects of 15-25 mm, without any metal wedge or stem from 2004 to 2017 by a single surgeon in Shiraz, Iran, were clinically and radiographically evaluated. The preoperative questionnaires of SF36, WOMAC, KSS, and radiographs were compared with the follow-up assessments of the same parameters. Data were analyzed by R programming language using student t test, ANOVA, and Kruskal-Wallis. P<0.05 was considered significant. 

91 knees in 72 patients at 65.99±8.66 years of age and 8.28±2.58 years follow-up were studied. The tibial defects were managed with extra tibial cuts and adjustment of tibial component position in all, and the addition of structural autograft in 14 knees. 89 (98%) knees survived with a knee society score (KSS) of 79.4±17.6 and were significantly functioning well (P<0.001). Two knees required revision surgery. Significant improvement in outcome measurements was seen in all cases (P<0.001). No radiographic loosening, alignment change, or clinical instability was detected. The tibial plateau reconstruction without bone grafting and the ones that had autologous bone grafting had similar functional results and radiographic outcomes.

TKA with tibial defects of 15-25 mm treated with a semi-constrained posterior-cruciate ligament (PCL) sacrificing condylar prosthesis without any metal wedges or stem extensions with or without additional autogenous bone graft obtained very good functional and radiographic outcome and 97% survival in 6-17 years follow-up.

The present study aimed to identify the dimensions and components of information therapy from the point of view of physicians and officials using fuzzy Delphi technique.

This applied research was conducted by a descriptive method (qualitative content analysis document study and fuzzy Delphi method) from 2019 to 2020. The thirty two valid document studies were used to examine the sources and extract the required components of the therapeutic information variable. The content analysis method was used to classify effective components. Participants in this study were 10 experts. Qualitative content analysis of the data obtained through software 2018 MAXQDA.

Two hundred and seventeen primary codes were extracted, reduced to 112 codes after continuous review, and finally these codes were divided in two main themes (categories), including: A- Information; health literacy (1- Information acquisition, 2- Information identification, 3- Information sharing, 4- Awareness-raising, 5- Information needs, and 6- Health knowledge), BTreatment; health services (7- Patient satisfaction, 8- Information-seeking behavior, 9- Treatment method and cost, 10- Participatory care and information use, 11- Health education, and 12- Disease prevention).

The results showed information therapy approach in medical centers of the country, as a dynamic platform to support clinical decisions of specific diseases (such as immunodeficiency diseases), requires long-term policy to improve research and educational activities. The services of the medical staff will be possible through the establishment of factors and effective elements in retrieving and accessing up-to-date information by the physician and the patient, and as a result, promoting health knowledge in this field.

Variability in medication reactions and illness susceptibility among individuals is often seen in clinical settings. Personalized medicine is now highly esteemed for its focus on prescribing the appropriate medication to each patient. Metabolomics is a developing field that thoroughly assesses all metabolite and low-molecular-weight compounds in a biological sample. Metabolic profiling offers a quick overview of a cell's physiology, making the technique a direct indicator of an organism's physiological condition. Quantifiable correlations exist between the metabolome and other cellular components such as the genome, transcriptome, proteome, and lipidome. These correlations can be utilized to forecast metabolite levels in biological samples based on mRNA levels. One of the key problems in systems biology is to incorporate metabolomics with other -omics data to enhance comprehension of cellular biology. Metabolomics is used to assess the effectiveness of clinical substances by analyzing the metabolic characteristics of patients before treatment to predict their responses (pharmacometabolomic) and to identify individuals at risk of developing diseases (patient stratification). The rapid progress in metabolomics technique highlights its significant potential for use in customized treatment. We reviewed the unique benefits of metabolomics, including instances in assessing medication treatment and individual stratification, and emphasized metabolomics' promise in personalized medicine.

Overcrowding in emergency departments (ED) is a global concern, emphasizing the need for effective resource allocation. Triage plays a crucial role in prioritizing patients based on medical needs. This study aimed to evaluate the accuracy of National Early Warning Score (NEWS) in predicting the ED patients’ outcomes.

A cross-sectional study was conducted in two tertiary hospitals in Tehran, Iran, from June to July 2023. Adult patients presenting to ED were included. Data for calculating the NEWs and emergency severity index (ESI), as well as outcomes were recorded by trained nurses, and then the accuracy of each score in predicting the outcomeswas evaluated.

A total of 2,085 patients were analyzed. The majority were male (57%) with a mean age of 54.4 years. The primary outcome, cardiopulmonary resuscitation (CPR) within 24 hours of admission, occurred in 1.9% of patients, while the need for intensive care unit (ICU) care and/or mechanical ventilation happened in 3.4%, and CPR or need for ICU care and/or mechanical ventilation was observed in 4.3% of studied cases. Each one-point increase in NEWS was associated with a 52% higher likelihood of CPR (95% confidence interval (CI): 1.41 to 1.65, p<0.001). Receiver operating characteristic curve analyses for the NEWS yielded the optimum cut-off value to be 6 for all three outcomes, with an overall area under the curve (AUC) of 0.856 (95% CI: 0.840 to 0.871), 0.834 (95% CI: 0.817 to 0.850), and 0.854 (95%CI: 0.838 to 0.869) for the primary, secondary, and tertiary outcomes, respectively.

NEWS 6 was associated with a higher incidence of adverse outcomes, including ICU admission and need for CPR. The good predictive validity of NEWS highlights its value in identifying patients at higher risk of adverse outcomes.

The quality of healthcare for pediatric asthma patients in the emergency department (ED) is of growing importance. This systematic review aimed to identify and describe existing quality indicators (QIs) designed for use in the ED for pediatric asthma care.

We systematically searched three main electronic databases in May 2023 for all English-language qualitative and quantitative publications that suggested or described at least one QI related to pediatric asthma care in the ED. Two reviewers independently selected the included studies and extracted data on study characteristics, all relevant QIs reported, and the rates of compliance with these indicators when available. The identified QIs were classified according to Donabedian healthcare quality framework and the Institute of Medicine (IOM) framework. When feasible, we aggregated the compliance rates for the QIs reported in observational studies using random effects models. The quality assessment of the included studies was performed using various Joanna Briggs Institute (JBI) tools.

We identified twenty studies, including six expert panels, 13 observational studies, and one trial. Together, these studies presented 129 QIs for use in EDs managing pediatric asthma. Among these QIs, 66 were pinpointed by expert panel studies, whereas 63 were derived from observational studies. Within the Donabedian framework, most indicators (86.8%) concentrated on the process of care. In contrast, within the Institute of Medicine (IOM) domain, the predominant focus was on indicators related to effectiveness and safety. Observational studies reported varying compliance rates for the 36 QIs identified in the expert studies. The included studies showed a wide range of bias risks, suggesting potential methodological variances.

A significant number of QIs in pediatric asthma care have been proposed or documented in literature. Although most of these indicators prioritize the process of care, there is a conspicuous absence of outcome and structure indicators. This meta-analysis uncovered significant disparities in compliance to the identified QIs, highlighting the urgent necessity for targeted interventions to enhance pediatric asthma care in ED.

 In-hospital cardiac arrest (IHCA) remains a substantial cause of morbidity and mortality for hospitalized patients worldwide. This study aimed to identify associated factors of return of spontaneous circulation (ROSC) and survival with favorable neurological outcomes of IHCA patients.

 A two-year retrospective cohort study was conducted at a university-based tertiary care hospital in Bangkok, Thailand, studying adult patients aged ≥ 18 years with IHCA from January 2021 to December 2022. The primary endpoint was sustained ROSC, and the secondary endpoint was survival with favorable neurological outcomes defined as Cerebral Performance Categories (CPC) Scale of 1 or 2 at discharge. Pre-arrest and intra-arrest variables were collected and analyzed using multivariable logistic regression to identify independent factors associated with the outcomes.

 During the study period, 156 patients were included in the study. 105 (67.3%) patients achieved sustained ROSC after the CPR, 28 patients (18.0%) were discharged alive, and 15 patients (9.6%) survived with a favorable neurological outcome at hospital discharge. Overall, sustained ROSC was higher in patients who had IHCA during the day shift (odds ratio (OR): 4.11; 95% confidence interval (CI): 1.05-16.06) and electrocardiogram (ECG) monitoring prior to arrest (OR: 6.38; 95% CI: 1.18-34.54). In contrast, higher adrenaline doses administrated, and increased CPR duration reduced the odds of sustained ROSC (OR: 0.72; 95% CI: 0.54-0.94 and OR: 0.92; 95% CI: 0.85-0.98, respectively). Arrest due to cardiac etiology was associated with increased discharged survival with favorable neurological outcomes (OR: 13.43; 95% CI: 2.00-89.80), while a higher Good Outcome Following Attempted Resuscitation (GO-FAR) score reduced the odds of the secondary outcome (OR: 0.89; 95% CI: 0.81-0.98).

The sustained ROSC was higher in IHCA during the daytime shift and under prior ECG monitoring. The administration of higher doses of adrenaline and prolonged CPR durations decreased the likelihood of achieving sustained ROSC. Furthermore, patients with cardiac-related causes of cardiac arrest exhibited a higher rate of survival to hospital discharge with favorable neurological outcomes.

Healthcare workers (HCWs) need to perform new preventive measures to protect themselves and patients against ongoing COVID-19 transmission, which can increase hand dermatitis (HD) among them. This study aims to investigate the prevalence of HD among HCWs and its possible risk factors in IRAN.

A survey of 159 HCWS working in university hospitals was performed from August to September 2020 in a cross-sectional study. Research data were collected via standardized self-administered questionnaire. The history of HD was determined via standardized Nordic Occupational Skin Questionnaire (NOSQ-2002).

The prevalence of HD in the study population was 51.6%. A significant association was found between the prevalence of HD among HCWs and sex, age, working hours per week, and wearing gloves (P<0.05).  Females had a 3.84 fold higher risk of HD than males (confidence interval (CI): 1.85-8). HCWs older than 40 and those who aged 30-39 had a 9.6 and 1.72 fold higher risk of HD than those aged 20-29 (CI: 2.6-35.7; CI: 0.87-3.4, respectively).

Possible risk factors for developing HD among HCWs are female gender, age, wearing gloves, and fewer working hours per week. Preventive measures for HD are needed for HCWs, especially during the COVID-19 pandemic.

The last criterion for behavioral abnormality occurs outside social and cultural norms. The present study aimed to design a model of behavioral abnormalities of human resources of the Ministry of Health and Medical Education.

The outcomes were identified through library studies, and the fuzzy Delphi technique was used with the opinion of experts until we reached a theoretical consensus. First, 13 factors were confirmed using the opinion of 50 experts. Then, a questionnaire was designed based on the results of the first stage of the study, and the experts were asked to specify the importance of each identified stage using verbal variables. Then, the verbal variables were converted into fuzzy triangular numbers, and the triangular fuzzy mean was de-fuzzified using the Minkowski formula by Excel and SPSS-21 software.

The members of the expert group reached a consensus on all components (dissatisfaction, drug abuse, alcoholconsumption, reduction of motivation, moral corruption, malice and revenge, suicide, absenteeism, earlyand excessive leaves, theft and destruction of property, procrastination, arguments and physical violence, sexual harassment, violation of laws and character assassination and humiliation of colleagues). The de-fuzzified mean difference of experts' opinions in the two stages was less than 0.1, indicating the intensity of experts' agreement with each of the components of the conceptual model of the study.

Behavioral abnormality is one of the problems of today's organizations, and the development of behavioral models in organizations is one way to guide employees' behavior and prevent the occurrence of abnormal behaviors.

The objective of this study was to identify the level of treatment adherence and also sought to explore several demographic, clinical, comorbidities, and self-care behavior factors that may affect adherence among patients with heart failure (HF).

This single-center cross-sectional, questionnaire-based study was conducted on 500 adult HF patients referred to the clinic of Rajaie Cardiovascular, Medical, and Research Center, in Tehran, Iran, from February to July 2022. The level of treatment adherence was assessment through Modanloo’s questionnaire. An unadjusted and adjusted binary logistic regression model was used to check the effect of different factors on the patients’ adherence level.

Among 474 responders, 51.7% had “good” adherence to treatment. According to the results, age >54 years (odds ratio [OR]: 0.967, 95% confidence interval [CI]: 0.946–0.988, P = 0.002), mitral valve regurgitation (OR: 0.597, 95% CI: 0.362–0.982, P = 0.042) and HF duration (OR: 0.486, 95% CI: 0.274–0.862, P = 0.014) were found as independent variables associated with “poor” treatment adherence. However, higher educational level (OR: 3.313, 95% CI: 2.632–4.067, P < 0.001), New York Heart Association class I (OR: 3.231, 95% CI: 1.587–4.661, P = 0.002), ejection fraction (EF) >40% (OR: 1.023, 95% CI: 1.005–1.041, P = 0.013), HF with preserved EF (OR: 2.728, 95% CI: 1.387–5.365, P = 0.004), familiar with social media (OR: 3.792, 95% CI: 1.777–4.268, P < 0.001) and high awareness of HF (OR: 2.385, 95% CI: 1.072–3.044, P = 0.006) were significant positive predictors for good adherence to treatment.

Adherence to the treatment regimen has improved compared to previous studies, but is still suboptimal, particularly with respect to awareness of HF. Therefore, improving the awareness of patients as well as encouraging and supporting them for self-care behaviors can have a positive effect on treatment adherence.