12014 research outputs found
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A systematic mapping review of factors associated with willingness to work under emergency condition
Full text linkIntroduction: An effective response to an emergency situation relies on health care workers� preparedness. The main purpose of this study was to provide a comprehensive overview of relevant studies regarding the willingness to work in emergency and disaster situations, describe and classify the most important challenges and solutions, identifying knowledge gaps in the literature which could inform future research. Methods: In this Systematic Mapping Review required information was searched from PubMed, Scopus, the web of science, Embase databases, and Google scholar search engine in the period 2000�2020. Data were analyzed using a content framework analysis. Results: From 2902 article search results, 26 articles met the inclusion criteria. The studies varied in terms of aim, study design, and detail of reporting. The results showed that nearly three-quarters of studies were conducted in high and middle-income countries. Most of the studies were published in 2020 due to the COVID-19 pandemic. Also, the most common types of crises reported in the included studies were emerging and re-emerging infectious diseases. The results show that most of the problems were in the dimension of mental and psychological issues, personnel health concerns, and management relationship with personnel. Conclusion: This mapping review illustrated a big picture of health workers' resilience in disaster conditions. This review presents an overview of different kinds of strategies that address the challenges. One of the most important challenges in health workforce retention is poor communication between managers and staff. Being away from family, which leads to mental fatigue, puts staff in moral dilemmas. Attracting adequate health professionals, especially volunteers and regulating the shifts of health personnel in crisis time will largely prevent burnout. © 2021, The Author(s)
Visualization of clinical teaching citations using social network analysis
Full text linkBackground: Analyzing the previous research literature in the field of clinical teaching has potential to show the trend and future direction of this field. This study aimed to visualize the co-authorship networks and scientific map of research outputs of clinical teaching and medical education by Social Network Analysis (SNA). Methods: We Identified 1229 publications on clinical teaching through a systematic search strategy in the Scopus (Elsevier), Web of Science (Clarivate Analytics) and Medline (NCBI/NLM) through PubMed from the year 1980 to 2018.The Ravar PreMap, Netdraw, UCINet and VOSviewer software were used for data visualization and analysis. Results: Based on the findings of study the network of clinical teaching was weak in term of cohesion and the density in the co-authorship networks of authors (clustering coefficient (CC): 0.749, density: 0.0238) and collaboration of countries (CC: 0.655, density: 0.176). In regard to centrality measures; the most influential authors in the co-authorship network was Rosenbaum ME, from the USA (0.048). More, the USA, the UK, Canada, Australia and the Netherlands have central role in collaboration countries network and has the vertex co-authorship with other that participated in publishing articles in clinical teaching. Analysis of background and affiliation of authors showed that co-authorship between clinical researchers in medicine filed is weak. Nineteen subject clusters were identified in the clinical teaching research network, seven of which were related to the expected competencies of clinical teaching and three related to clinical teaching skills. Conclusions: In order to improve the cohesion of the authorship network of clinical teaching, it is essential to improve research collaboration and co-authorship between new researchers and those who have better closeness or geodisk path with others, especially those with the clinical background. To reach to a dense and powerful topology in the knowledge network of this field encouraging policies to be made for international and national collaboration between clinicians and clinical teaching specialists. In addition, humanitarian and clinical reasoning need to be considered in clinical teaching as of new direction in the field from thematic aspects. © 2021, The Author(s)
Cost-effectiveness of a population-based AAA screening program for men over 65 years old in Iran
Full text linkBackground: Screening program tend to recognized patients in their early stage and consequently improve health outcomes. Cost-effectiveness of the abdominal aortic aneurysm (AAA) screening program has been scarcely studied in developing countries. We sought to evaluate the cost-effectiveness of a screening program for the abdominal aortic aneurysm (AAA) in men aged over 65 years in Iran. Methods: A Markov cohort model with 11 mutually exclusive health statuses was used to evaluate the cost-effectiveness of a population-based AAA screening program compared with a no-screening strategy. Transitions between the health statuses were simulated by using 3-month cycles. Data for disease transition probabilities and quality of life outcomes were obtained from published literature, and costs were calculated based on the price of medical services in Iran and the examination of the patients� medical records. The outcomes were life-years gained, the quality-adjusted life-year (QALY), costs, and the incremental cost-effectiveness ratio (ICER). The analysis was conducted for a lifetime horizon from the payer�s perspective. Costs and effects were discounted at an annual rate of 3. Uncertainty surrounding the model inputs was tested with deterministic and probabilistic sensitivity analyses. Results: The mean incremental cost of the AAA screening strategy compared with the no-screening strategy was 140 and the mean incremental QALY gain was 0.025 QALY, resulting in an ICER of 5566 (14,656 PPP) per QALY gained. At a willingness-to-pay of 1 gross domestic product (GDP) per capita (5628) per QALY gained, the probability of the cost-effectiveness of AAA screening was about 50. However, at a willingness-to-pay of twice the GDP per capita per QALY gained, there was about a 95 probability for the AAA screening program to be cost-effective in Iran. Conclusions: The results of this study showed that at a willingness-to-pay of 1 GDP per capita per QALY gained, a 1-time AAA screening program for men aged over 65 years could not be cost-effective. Nevertheless, at a willingness-to-pay of twice the GDP per capita per QALY gained, the AAA screening program could be cost-effective in Iran. Further, AAA screening in high-risk groups could be cost-effective at a willingness-to-pay of 1 GDP per capita per QALY gained. © 2021, The Author(s)
A systematic review of case reports of hepatic actinomycosis
Full text linkBackground: Hepatic Actinomycosis (HA) is one of the infections that causes disorders in patients when diagnosed untimely and inappropriately. Methods: Case reports on HA in patients published between 2000 and April 2020 were gathered by carrying out a structured search through PubMed/Medline. Results: Through a survey of the Medline database, 130 studies were identified and then, 64 cases with HA were included in the final analysis. Asia had the largest share of cases with 37.5 (24 reports), followed by Europe and the Americas. Affected patients were predominantly males (64) and the overall mortality rate was 1 with only one male patient in his 50 s dying. Nearly all patients (92) were immunocompetent. However, in four patients, the use of immunosuppressive medication led to depression of the immune system. Most of the patients (80) experienced complications. In terms of the complications, the most frequent ones were previous history of abdominal surgery (32) and foreign bodies in the abdominopelvic region (20). Actinomyces israelii was the most common pathogen isolated from patients. Abdominal pain (66), fever (62), weight loss (48), night sweat, malaise, and anorexia (14) over about 3.1 months were the most frequently reported clinical symptoms. Extension to one or more surrounding organs was evident in 18 patients (28). Histopathologic examination confirmed infection in 67 of the patients and samples obtained from liver puncture biopsy (32) were most frequently used in diagnosis. Surgery or puncture drainage + anti-infection was the most common method to treat patients and penicillin, Amoxicillin, Doxycycline, and ampicillin were the most frequently used drugs to control infection. Conclusion: HA should be considered in patients with a subacute or chronic inflammatory process of the liver. With accurate and timely diagnosis of infection, extensive surgery can be prevented. © 2021, The Author(s)
The national rate of intensive care units-acquired infections, one-year retrospective study in Iran
Full text linkBackground: Hospital-acquired infections (HAIs) in intensive care units (ICUs) are among the avoidable morbidity and mortality causes. This study aimed at investigating the rate of ICU-acquired infections (ICU-AIs) in Iran. Methods: For the purpose of this multi-center study, the rate of ICU-AIs calculated based on the data collected through Iranian nosocomial infections surveillance system and hospital information system. The data expanded based on 12 months of the year (13,632 records in terms of �hospital-ward-month�), and then, the last observation carried forward method was used to replace the missing data. Results: The mean (standard deviation) age of 52,276 patients with HAIs in the ICUs was 47.37 (30.78) years. The overall rate of ICU-AIs was 96.61 per 1000 patients and 16.82 per 1000 patient-days in Iran�s hospitals. The three main HAIs in the general ICUs were ventilator-associated events (VAE), urinary tract infection (UTI), and pneumonia events & lower respiratory tract infection (PNEU & LRI) infections. The three main HAIs in the internal and surgical ICUs were VAE, UTI, and bloodstream infections/surgical site infections (BSI/SSI). The most prevalent HAIs were BSI, PNEU & LRI and eye, ear, nose, throat, or mouth (EENT) infections in the neonatal ICU and PNEU & LRI, VAE, and BSI in the PICU. Device, catheter, and ventilator-associated infections accounted for 60.96, 18.56, and 39.83 of ICU-AIs, respectively. The ventilator-associated infection rate was 26.29 per 1000 ventilator-days. Based on the Pabon Lasso model, the lowest rates of ICU-AIs (66.95 per 1000 patients and 15.19 patient-days) observed in zone III, the efficient area. Conclusions: HAIs are common in the internal ICU wards. In fact, VAE and ventilator-related infections are more prevalent in Iran. HAIs in the ICUs leads to an increased risk of ICU-related mortality. Therefore, to reduce ICU-AIs, the specific and trained personnel must be responsible for the use of the devices (catheter use and ventilators), avoid over use of catheterization when possible, and remove catheters earlier. © 2021, The Author(s)
The role of viral and bacterial infections in the pathogenesis of IPF: a systematic review and meta-analysis
Full text linkBackground: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease. Several risk factors such as smoking, air pollution, inhaled toxins, high body mass index and infectious agents are involved in the pathogenesis of IPF. In the present study, this meta-analysis study investigates the prevalence of viral and bacterial infections in the IPF patients and any possible association between these infections with pathogenesis of IPF. Methods: The authors carried out this systematic literature review from different reliable databases such as PubMed, ISI Web of Science, Scopus and Google Scholar to December 2020.Keywords used were the following �Idiopathic pulmonary fibrosis�, �Infection�, �Bacterial Infection� and �Viral Infection�, alone or combined together with the Boolean operators "OR�, �AND� and �NOT� in the Title/Abstract/Keywords field. Pooled proportion and its 95 CI were used to assess the prevalence of viral and bacterial infections in the IPF patients. Results: In this systematic review and meta-analyses, 32 studies were selected based on the exclusion/inclusion criteria. Geographical distribution of included studies was: eight studies in American people, 8; in European people, 15 in Asians, and one in Africans. The pooled prevalence for viral and bacterial infections w ere 53.72 (95 CI 38.1�69.1) and 31.21 (95 CI 19.9�43.7), respectively. The highest and lowest prevalence of viral infections was HSV (77.7 95 CI 38.48�99.32), EBV (72.02, 95 CI 44.65�90.79) and Influenza A (7.3, 95 CI 2.66�42.45), respectively. Whereas the highest and lowest prevalence in bacterial infections were related to Streptococcus sp. (99.49, 95 CI 96.44�99.9) and Raoultella (1.2, 95 CI 0.2�3.08), respectively. Conclusions: The results of this review were confirmed that the presence of viral and bacterial infections are the risk factors in the pathogenesis of IPF. In further analyses, which have never been shown in the previous studies, we revealed the geographic variations in the association strengths and emphasized other methodological parameters (e.g., detection method). Also, our study supports the hypothesis that respiratory infection could play a key role in the pathogenesis of IP. © 2021, The Author(s)
The association between zinc and endothelial adhesion molecules ICAMs and VCAM-1 and nuclear receptors PPAR-� and PPAR-γ: A systematic review on cell culture, animal and human studies
No full textBackground: Cardiovascular health is strongly influenced by diet. The levels of inflammatory factors like ICAM-1 and VCAM-1 are high in patients with atherosclerosis or predisposing factor for heart disease. Antioxidant and anti-inflammatory functions are attributed to zinc. We systematically reviewed cell culture, human or animal studies for determining the relationship between zinc status and ICAMs or VCAM-1 levels. Methods: PubMed, Google Scholar, Scopus, and Cochrane databases from database inception till 30th August 2020 were systematically searched to obtain any possible article for inclusion. Results: After screening and removing unrelated or duplicate articles by the title and abstract by two independent reviewers, 15 articles were included. Results indicating an inverse relationship between zinc status with ICAM-1 or VCAM-1 levels and the development of endothelial inflammation, plaque formation, or atherosclerosis. A direct relationship between zinc status and PPAR-α or γ levels was also observed. Zinc oxide (ZnO), zinc nanoparticles, or ions can cause endothelial activation and increased levels of ICAM-1 and VCAM-1. Conclusion: Normal function of the endothelium is linked with zinc level. Zinc deficiency causes atherosclerosis, most probably via increased production of ICAM-1 and VCAM-1; and decreased expression of PPAR-� and PPAR-γ receptors. Contrarily, endothelial activation and increased ICAM-1 and VCAM-1 levels can be caused by ZnO, zinc nanoparticles, or zinc ions. © 2021 Elsevier Inc
Non-surgical management of spinal epidural hematoma after kyphoplasty: A case report
Full text linkKyphoplasty and Vertebroplasty (VP) are accepted therapeutic approaches to treat pain associated with vertebral compression fractures. Major complications such as cord or root compression, subdural and epidural hematomas (EDH), as well as pulmonary emboli, have been reported in less than 1 of patients. Spinal EDH is an extremely rare complication that usually happens a few hours after the procedure. We report a case of spinal EDH that developed four days after a successful kyphoplasty. © 2021 The Author(s
Transcranial photobiomodulation in the management of brain disorders
No full textTranscranial photobiomodulation (tPBM) is the process of delivering light photons through the skull to benefit from its modifying effect. Brain disorders are important health problems. The aim of this review was to determine the existing evidence of effectiveness, useful parameters, and safety of tPBM in the management of traumatic brain injury, stroke, Parkinson, and Alzheimer's disease as the common brain disorders. Four online databases, including Cochrane, Pub Med, Embase, and Google scholar were searched according to the Preferred Reporting Items for Systematic Reviews and meta-analyses (PRISMA) guidelines. 4728 articles were obtained in the initial search. Only those articles that were published until September 2020 and designed as randomized clinical trials (RCTs) or animal-controlled studies were included. 6 RCTs, 2 related supplementary articles, and 38 controlled animal studies met the inclusion criteria of this study. No RCTs were performed in the fields of Alzheimer's and Parkinson's diseases. The human RCTs and animal studies reported no adverse events resulted from the use of tPBM. Useful parameters of tPBM were identified according to the controlled animal studies. Since the investigated RCTs had no homogenous results, making an evidence-based decision for definite therapeutic application of tPBM is still unattainable. Altogether, these data support the need for large confirmatory well-designed RCTs for using tPBM as a novel, safe, and easy-to-administer treatment of brain disorders. Evidence before this study: High prevalence and complications of brain disorders and also side effects of neuropsychiatric medications have encouraged researchers to find alternative therapeutic techniques which tPBM can be one of them. In present review we tried to determine the existing evidence of effectiveness, useful parameters, and safety of tPBM in the management of traumatic brain injury, stroke, Alzheimer, and Parkinson's disease as common brain disorders. Four online databases, including �Cochrane�, �Pub Med�, �Embase�, and �Google scholar� were searched. Only those articles that were published until September 2020 and designed as RCTs or animal-controlled studies were included. Search keywords were the followings: transcranial photobiomodulation� OR �transcranial low-level laser therapy� AND �stroke� OR �traumatic brain injury� OR �Alzheimer� OR �Parkinson�. Several studies have confirmed effectiveness of tPBM in treatment of different brain disorders but the level of evidence of its effectiveness remain to be determined. Added value of this study: In this study we systematically reviewed human RCTs to determine the existing evidence of tPBM effectiveness in management of four mentioned brain disorders. Since the outcomes of the reviewed RCTs were not homogeneous, further well-designed RCTs are required to decide more definitively on the evidence of this noninvasive and probably safe therapeutic intervention. We hypothesized that non-homogeneous outcomes could be due to inefficiency of PBM parameters. Controlled animal studies have the advantage of using objective tests to evaluate the results and compare them with the control group. We determined useful tPBM parameters based on these studies. Implications of all the available evidence: This research is part of our main project of tinnitus treatment using photobiomodulation (PBM). Evidence of central nervous system involvement in tinnitus led us to believe that treatment protocol of tinnitus should also include transcranial PBM. The determined useful parameters can be helpful in designing more efficient tPBM protocols in the management of brain disorders and tinnitus as a common debilitating symptom that can be associated with these disorders. © 202