Applying Electronic Medical Records in health care Physicians’ perspective

Summary Background: In order to fulfill comprehensive interoperability and recognize the electronic medical records (EMRs’) benefits, physicians’ attitudes toward using and applying EMR must be recognized. Objectives: The purpose of this study was to present an integrated model of applying EMRs by physicians. Methods: This was a cross sectional study in which a sample of 330 physicians working in hospitals affiliated to the Tehran University of medical sciences (TUMS) was selected. Physicians’ attitudes toward using and accepting EMR in health care have been analyzed by an integrated model of two classical theories i.e. technology acceptance model (TAM) and diffusion of innovation (DOI). The model was tested using an empirical survey. The final model was tested by structural equation modeling (SEM) and represented by Analysis of Moment Structures (AMOS). Results: The results suggest that the hybrid model explains about 43 percent of the variance of using and accepting of EMRs (R2=0.43). The findings also evidenced that Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Relative Advantage, Compatibility, Complicatedness and Trainability have direct and significant effect on physicians’ attitudes toward using and accepting EMRs. But concerning observe ability, significant path coefficient was not reported. Conclusions: The integrated model supplies purposeful intuition for elucidates and anticipates of physicians’ behaviors in EMRs adoption. The study identified six relevant factors that affect using and applying EMRs that should be subsequently the major concern of health organizations and health policy makers

Laser in Situ Keratomileusis Outcomes among Myopic and Myopic Astigmatism Patients with Thin Cornea

Purpose:To evaluate refractive results after laser in situ keratomileusis among patients with thin corneas.Patients and Methods: Three hundred and two eyes from 168 patients with thin corneas undergoing laser in situ keratomileusis in Basir Eye Clinic, Tehran, Iran, were retrospectively studied. We included patients with best corrected visual acuity of better than 6/12, age of more than 18 years, and corneal thickness of less than 499 μm.Results: The mean age of patients was 30.7 ± 8.6 years and the mean preoperative spherical equivalent was - 4.61 ± 2.37 D. The results after at least one year of follow-up were as follow: 86.6 % of patients with low myopia, 71.8 % of patients with mild myopia, 50.0 % of patients with moderate myopia and 51.8 % of patients with high myopia achieved a ± 0.5 D spherical equivalent postoperatively. General linear model indicated a significant effect for the remaining stromal bed on final uncorrected visual acuity after adjustment for age, sex, and degree of myopia. No important complication occurred.Conclusion: No important complications occurred after laser in situ keratomileusis among myopic patients with corneal thickness of less than 499 μm, and most of the patients achieved satisfactory refractive results.Keywords: Laser in Situ Keratomileusis; outcome; myopia; thin cornea; Iran

Missense mutation outside the forkhead domain of FOXL2 causes a severe form of BPES type II

Purpose: Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a developmental disease characterized by a complex eyelid malformation associated or not with premature ovarian failure (POF). BPES is essentially an autosomal dominant disease, due to mutations in the forkhead box L2 (FOXL2) gene, encoding a forkhead transcription factor. More than one hundred unique FOXL2 mutations have been described in BPES in different populations, many of which are missense mutations in the forkhead domain. Here, we report on a very severe form of BPES resulting from a missense mutation outside the forkhead domain. Methods: A clinical and molecular genetic investigation was performed in affected and unaffected members of an Iranian family with BPES. The FOXL2 coding region was sequenced in an index case. Targeted mutation testing was performed in 8 family members. Results: We have identified a heterozygous FOXL2 missense mutation c.650C -> G (p.Ser217Cys) co-segregating with disease in members of a three-generation family with BPES type II. Only few missense mutations have been reported outside the forkhead domain so far. They were all found in mild BPES, in line with in vitro studies demonstrating mostly normal localization and normal or increased transactivation properties of the mutant proteins. Unlike previous studies, affected members of the family studied here showed a severe BPES phenotype, with bilateral amblyopia due to uncorrected ptosis. Conclusions: This is the first study demonstrating a severe BPES phenotype resulting from a FOXL2 missense mutation outside the forkhead domain, expanding our knowledge about the phenotypic consequences of missense mutations outside the forkhead domain in BPES

Optimization of Water-Energy-Food Nexus considering CO2 emissions from cropland: A case study in northwest Iran

Water-Energy-Food (WEF) Nexus and CO2 emissions for a farm in northwest Iran were analyzed to provide data support for decision-makers formulating national strategies in response to climate change. In the analysis, input–output energy in the production of seven crop species (alfalfa, barley, silage corn, potato, rapeseed, sugar beet, and wheat) was determined using six indicators, water, and energy consumption, mass productivity, and economic productivity. WEF Nexus index (WEFNI), calculated based on these indicators, showed the highest (best) value for silage corn and the lowest for potato. Nitrogen fertilizer and diesel fuel with an average of 36.8% and 30.6% of total input energy were the greatest contributors to energy demand. Because of the direct relationship between energy consumption and CO2 emissions, potato cropping, with the highest energy consumption, had the highest CO2 emissions with a value of 5166 kg CO2eq ha−1. A comparison of energy inputs and CO2 emissions revealed a direct relationship between input energy and global warming potential. A 1 MJ increase in input energy increased CO2 emissions by 0.047, 0.049, 0.047, 0.054, 0.046, 0.046, and 0.047 kg ha−1 for alfalfa, barley, silage corn, potato, rapeseed, sugar beet, and wheat, respectively. Optimization assessments to identify the optimal cultivation pattern, with emphasis on maximized WEFNI and minimized CO2 emissions, showed that barley, rapeseed, silage corn, and wheat performed best under the conditions studied.publishedVersio

The Evaluation of Web-based Software for Sending Medication Adherence Reminders in Infectious Disease Patients

Background: Incomplete drug adherence can cause problems for patients as well as physicians and cost billions of dollars each year throughout the globe. One of the tools that can help patients and physicians is short text messaging (SMS). This research aims to design and implement the first web-based software specified for medicine use in Iran and test its feasibility to send short message reminders to infectious disease patients and also patient acceptance, and satisfaction. Methods: In this qualitative action research, initially a software was designed for sending text messages to patients and then 30 patients were chosen purposefully in four weeks and were sent short text messages exactly based on clinicians’ prescribed order. After completing a treatment course, each patient was interviewed and questions were asked to assess patient’s satisfaction. Results: The result showed that all of the patients who received the text messages, believed that this method in comparison to their previous experience has helped them to use their medicine on time and correctly and they were keen to use this service in the future. Conclusion: Short text messaging can be used as an effective tool to remind patients to take their medicine correctly, and increase their satisfaction and compliance. Keywords: Reminder system, Drug utilization, Text messaging, Cellular phone, Infectious disease

Efficacy of High Dose Vitamin C, Melatonin and Zinc in Iranian Patients with Acute Respiratory Syndrome due to Coronavirus Infection: A Pilot Randomized Trial

INTRODUCTION: Our aim was to investigate the efficacy of vitamin C, melatonin, and zinc in patients with severe Covid-19. METHODS:  Twenty-one adult patients were randomized 1:1 to standard care alone or standard care plus IV vitamin C (2 g, q6hr), oral melatonin (6 mg, q6hr), and oral zinc sulfate (50 mg, q6hr) for 10 days. Patients were monitored for changes in hypoxemia and inflammatory markers. RESULTS: Both treatment modalities were effective to improve PaO2/FiO2 and oxygen saturation. However, there were no significant differences between 2 groups (P > 0.05). There were reductions in CRP, ESR, and LDH levels in both study groups, although not significant. No significant difference was noted in length of ICU stay between 2 groups (P = 0.3). CONCLUSION: Our study suggests that addition of vitamin C, melatonin, and zinc to standard care is not associated with considerable improvement in patients with severe Covid-19.&nbsp

Phantom Tumor of the Lung

Background: Localized interlobar effusions in congestive heart failure (phantom or vanishing lung tumor/s) are uncommon but well-known entities.Case Report: The patient is a 60-year-old male with a history of dyspnea and surgical removal of kidney stonein 1 year ago.Results: In chest-X-ray prior to the surgery an olive-shaped homogenous density, with a size of 30 mm × 20 mm in the right lung have been detected. Computed tomography (CT) scan has been performed, and a homogenous mass with a well-delineated border in major fissure of the right lung and mediastinal lymphadenopathy had been detected. Serial CT scans revealed mass enlargement. In Ct guided, Transthoracic biopsy fluid collection along the major fissure of the right lung had been detected. Biopsy of mediastinal lymph node silicoanthracotic changes with focal hyaline fibrosis had been shown.Conclusions: The diagnosis of the phantom tumor must be considered in any patient with congestive heart failure and lung mass. In this patient, there was no history of congestive heart failure which shows that phantom tumor could happen in non-chronic heart failure patients. Although the accurate diagnosis of the phantom tumor with imaging modalities in patients without congestive heart failure is very difficult but at least this diagnosis must be considered in a patient with a lung mass in the major fissure of the lungs

A framework for exploration and cleaning of environmental data : Tehran air quality data experience

Management and cleaning of large environmental monitored data sets is a specific challenge. In this article, the authors present a novel framework for exploring and cleaning large datasets. As a case study, we applied the method on air quality data of Tehran, Iran from 1996 to 2013. ; The framework consists of data acquisition [here, data of particulate matter with aerodynamic diameter ≤10 µm (PM10)], development of databases, initial descriptive analyses, removing inconsistent data with plausibility range, and detection of missing pattern. Additionally, we developed a novel tool entitled spatiotemporal screening tool (SST), which considers both spatial and temporal nature of data in process of outlier detection. We also evaluated the effect of dust storm in outlier detection phase.; The raw mean concentration of PM10 before implementation of algorithms was 88.96 µg/m3 for 1996-2013 in Tehran. After implementing the algorithms, in total, 5.7% of data points were recognized as unacceptable outliers, from which 69% data points were detected by SST and 1% data points were detected via dust storm algorithm. In addition, 29% of unacceptable outlier values were not in the PR.  The mean concentration of PM10 after implementation of algorithms was 88.41 µg/m3. However, the standard deviation was significantly decreased from 90.86 µg/m3 to 61.64 µg/m3 after implementation of the algorithms. There was no distinguishable significant pattern according to hour, day, month, and year in missing data.; We developed a novel framework for cleaning of large environmental monitored data, which can identify hidden patterns. We also presented a complete picture of PM10 from 1996 to 2013 in Tehran. Finally, we propose implementation of our framework on large spatiotemporal databases, especially in developing countries