Is critical care service relevant to Iran’s hospital care?

The numbers of acutely ill patients (AIP) are admitted in general hospital wards increased. The failing to identify, manage and deliver timely and optimal care to AIPs may lead to catastrophic outcomes. A qualitative study aimed to define the current state of AIPs in Iranian hospitals showed the flaws and shortcomings in the current services for identifying and managing AIPs. An evaluation study was designed to explore the potential impact of Critical Care Service (CCS) in an Iranian University Hospital. The study design was a Stepped-Wedge Cluster Randomized Controlled Trial. The study included, for each ward, an unexposed to the intervention, training, and an exposed to the intervention phase. The data was analyzed using three methods: all patients, matched randomized and before-after. The null-hypothesis was tested using the mixed effect logistic regression, linear mixed and the mixed effects models. The results showed that there are no significant differences in mortality, CPR, ICU admission and length of stay. A second qualitative to find the views of staffs toward the CCS indicated that the CCS had several favorable effects, however; overcoming contextual problems in the hospital, prior to implementation of CCS, may facilitate its implementation

Characterization and optimization of the pharmaceutical supply chain under uncertainty and regulatory conditions

190 páginasSupply chain management costs account for 25% to 30% of total costs in hospital expenses [Gebicki 2014]. Additionally, the costs associated with moving and handling medicines can account for 35% to 40% of the total logistics costs [McKone-Sweet 2005]. The pharmaceutical industry is one of the most challenging industries in the world, and it is estimated that medicines account for approximately 10% to 30% (sometimes as high as 60%) of global health spending [Xu 2018]. Given the inherent di erences between medicines and traditional industrial products, compared to the analysis of traditional supply chains, the analysis of pharmaceutical supply chains requires special considerations. For example, some medicines and surgical supplies must be available for use at all times [James Little 2008], and medicines have strict regulatory requirements related to the length of manufacturing time, distribution, product shelf life, and the reimbursement values that can be obtained by the government or the insurer [Almarsdóttir 2005]. In some countries, health expenses can range from 7% to 10% of the total gross domestic product, and the pharmaceutical costs take up a large portion of this total, reaching approximately 10% [Priyan 2014]. According to World Health Organization (WHO) the supply of medicines is a distribution and dispensation system to the hospitalized patient. In this system medicines are prepared in pharmaceutical services in order to guarantee the quantities correspond to the required dose in a single administration and it is labeled with the name of the patient for being administrated without any subsequent preparation. Hospitals and clinics face several problems, such as the high and variable prices of medicines, physical and monetary constraints and the medicines' expiration due to their perishability

WEHST: Wearable Engine for Human-Mediated Telepresence

This dissertation reports on the industrial design of a wearable computational device created to enable better emergency medical intervention for situations where electronic remote assistance is necessary. The design created for this doctoral project, which assists practices by paramedics with mandates for search-and-rescue (SAR) in hazardous environments, contributes to the field of human-mediated teleparamedicine (HMTPM). Ethnographic and industrial design aspects of this research considered the intricate relationships at play in search-and-rescue operations, which lead to the design of the system created for this project known as WEHST: Wearable Engine for Human-Mediated Telepresence. Three case studies of different teams were carried out, each focusing on making improvements to the practices of teams of paramedics and search-and-rescue technicians who use combinations of ambulance, airplane, and helicopter transport in specific chemical, biological, radioactive, nuclear and explosive (CBRNE) scenarios. The three paramedicine groups included are the Canadian Air Force 442 Rescue Squadron, Nelson Search and Rescue, and the British Columbia Ambulance Service Infant Transport Team. Data was gathered over a seven-year period through a variety of methods including observation, interviews, examination of documents, and industrial design. The data collected included physiological, social, technical, and ecological information about the rescuers. Actor-network theory guided the research design, data analysis, and design synthesis. All of this leads to the creation of the WEHST system. As identified, the WEHST design created in this dissertation project addresses the difficulty case-study participants found in using their radios in hazardous settings. As the research identified, a means of controlling these radios without depending on hands, voice, or speech would greatly improve communication, as would wearing sensors and other computing resources better linking operators, radios, and environments. WEHST responds to this need. WEHST is an instance of industrial design for a wearable “engine” for human-situated telepresence that includes eight interoperable families of wearable electronic modules and accompanying textiles. These make up a platform technology for modular, scalable and adaptable toolsets for field practice, pedagogy, or research. This document details the considerations that went into the creation of the WEHST design