General practitioner\u27s knowledge regarding the diagnosis and drug therapy for acute myocardial infarction

OBJECTIVE: To assess the general practitioners (GP) knowledge regarding the diagnosis and initial drug therapy for acute myocardial infarction (AMI). METHODS: A questionnaire-based survey was conducted in randomly selected GPs of Karachi. Doctors working in community as GPs who were registered medical practitioners having a Bachelor of Medicine & Bachelor of Surgery degree were included in the study. Doctors working at tertiary care facilities or having a post graduate degree or post graduate training in a specialty other than family medicine were excluded from the study. RESULTS: A total of 186 GPs participated in our study. GPs who studied research journals were 2.33 times more likely to investigate serum cardiac troponins levels for the diagnosis of AMI compared to those who did not study research journals (P = 0.02). Twenty six percent of the GPs said that they would refer a patient with suspected AMI without treatment, while 76% said that they would consider some treatment prior to referral. Fifty eight percent of the GPs identified ST segment elevation myocardial infarction (STEMI) of \u3c 12 hours duration as an indication of thrombolysis while 28% identified posterior wall AMI as a thrombolytic indication. CONCLUSION: GPs, although adequately aware of the presenting features of AMI, were lacking in knowledge regarding the means for confirmation of diagnosis, initial drug therapy and were less likely to carry management steps in their practice

An extended framework for implementing of enterprise resource planning for small and medium enterprises

Enterprise Resource Planning (ERP) has been used in developed countries to integrate the information and to support decision making in business improvement and competition globally. Many frameworks, models and methods were proposed and applied clearly intended for large companies. Many Small and Medium Enterprises (SMEs) have difficulties when implementing and adopting the ERP systems that resulted in failures. The objective of this research is to formulate a new framework for SMEs implementing the ERP project with a view of highlighting the enterprise architecture and Critical Success Factors (CSFs) as the foundation for ERP systems for substantial improvement in success rate of projects. The CSFs of ERP projects were derived using literature and questionnaire survey and were classified by Exploratory Factor Analysis (EFA). Furthermore, the relevance of CSFs and life cycle of implementation were obtained from the expert panel. The requirements of SMEs' framework were also determined by the expert panel prior to the development of the ERP implementation framework. The proposed framework was evaluated in five case studies from SMEs in Iran. Feedback from the case studies was used to revise the framework which addressed the requirements of the ERP system implementation. The implementation cycle would consist of four phases, namely, planning, selection and design, implementation and control, and evaluation and improvement. The framework consists of relevant elements to guide the managers and implementers in attaining the success rate of ERP projects in SMEs. The future work of the current study may be directed towards testing the applicability and validity of the proposed framework in various sectors, improving the CSFs instruments, refining the relevance factors, and the stages of the implementation process

A comparative study on critical success factors (CSFS) of ERP systems implementation among SMEs and large firms in developing countries

The main goal of this research is to explore the difference between the critical success factors (CSFs) of enterprise resource planning (ERP) system implementation in large firms with small and medium-sized enterprises (SMEs) in developing countries. Understanding this subject can help the implementers and users of ERP systems to notice the CSFs of their particular enterprises and to improve the success rate of these systems. The number of seventeen resources of studies evaluating the CSFs of ERP in SMEs and equal numbers of resources were used for the large enterprises. Following an evaluation of each category was conducted to elicit similarities and diversities in CSFs of these two groups. This research shows that there are some significant differences among the CSFs of ERP implementation in SMEs and large firm of developing countries. There was lacking of studies that have been focused on large firm and SMEs separately. The study explored the need for more research that is focused on CSFs studies with regard of distinct separated size of enterprises. By recognizing the differences of CSFs for large organization with SMEs, stakeholders can better develop and use suitable and useful implementation models / frameworks to improve the successful of ERP implementations in enterprises with any sizes. This paper appears to be one of the first studies to focus on comparing of CSFs in implementation of ERP in SMEs with large enterprise in developing countries

Effects of synbiotic food consumption on serum minerals, liver enzymes, and blood pressure in patients with type 2 diabetes: A double-blind randomized cross-over controlled clinical trial

Background: This research was to examine the effects of synbiotic intake on minerals, liver enzymes, and blood pressure in patients with type 2 diabetes (T2D). Methods: This randomized, cross-over clinical trial was performed among 62 diabetic patients. Persons were randomly assigned to intake either a synbiotic (n = 62) or a control food (n = 62) for 6 weeks. A 3-week washout period was applied following which persons were crossed over to the alternate intervention arm for an additional 6 weeks. The synbiotic was consisted of Lactobacillus sporogenes (1 × 107 CFU), 0.04 g inulin (HPX) as prebiotic. Persons were asked to consume the synbiotic and control foods 27 g a day. Blood pressure was measured, and blood samples were taken at baseline and after 6-week intervention to assess calcium, magnesium, iron, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, and total bilirubin. Results: The consumption of a synbiotic food, compared to the control food, resulted in a significant rise of calcium (0.66 vs. −0.14 mg/dL,P= 0.03) and iron (5.06 vs. −9.98 mg/dL,P= 0.03). The decrease of total bilirubin (0.08 vs. −0.04 mg/dL;P = 0.009) was also seen in the synbiotic group compared with the control group. Conclusions: Overall, synbiotic in T2D patients had beneficial effects on calcium, iron, and total bilirubin concentrations