Designing two models for comprehensive center of excellence and center of excellence in the field of medical sciences in Iran

Background: Despite exist several centers of excellence in the various medical field in the country, most of them lack a single procedure and organizational structures in their functioning, organizing, targeting, etc. So the study aimed to design an organizational model that meets the goals and mission of them in the field of medical sciences. Methods: This qualitative and applied research was conducted in two comparative and analytical stages from May 2016 to February 2017 in Iran. The location of the study includes a university, research institute, health center, or research center known as a center of excellence. In the analytical stage, 10 experts and managers of the top centers were selected through a targeted sampling method as a study sample. In the comparative section, all 50 centers of excellence and similar specimens in the world were selected. The data collection tool was a semi-structured interview in the analytical section and the ministry of health's documents. In comparative section data, bases and official sites of the centers were analyzed. Results: The term "center of excellence" for units that play a role in one or two of the three dimensions of education, research, and treatment, and the term "comprehensive center of excellence" for a unit that plays a role in all three dimensions, in addition to knowledge management have been agreed upon. Seven missions (national and international) for the comprehensive center of excellence and five different missions for center of excellence were formulated. The role of the ministry of health in the guidance of these centers was agreed in the seven items. Ultimately, the macro model of organizing "comprehensive centers of excellence" and "centers of excellence" at the university level and ministry of health level was designed and presented. Conclusion: Correcting the governance structure of these centers in ministry, unit command at the highest level of management by reorganizing of duties, the authority of High Council for the Center of Excellences and the establishment of a systematic relationship between ministry and vices are the part of the requirements for fulfilling the roles and mission of center of excellence. © 2020 Tehran University of Medical Sciences. All rights reserved

Multi-Drug-Resistant Tuberculosis

Tuberculosis (TB) is one of the most important health issues in developing countries. Understanding the epidemiology of TB is essential for effective control of the disease. Drug-resistant TB is a danger that threatens the world and should be taken seriously; the highest incidence of TB in Iran is in the provinces of Sistan, Baluchestan and Golestan because of Afghan refugees. The incidence of TB in the country is 13.5 per thousand. This figure is 7 to 9 per thousand in developed countries; and in Africa it is 150 per thousand. The cost of treatment and hospitalization of patients with TB approximates 60 USD. In patients with resistant TB (MDR) admission is about 4333 USD. Ultra-resistant tuberculosis or XDR TB treatment is several times that. Although the prevalence of TB in our country has decreased due to free medical care for these patients, rapid two-hour TB diagnosis centers, vaccination, chemoprophylaxis, education, system of recording and reporting patients etc., multidrug resistant TB however, has increase

Causes and Severity of Fatal Injuries in Autopsies of Victims of Fatal Traffic Accidents

Introduction: In this retrospective study, we decided to determine the death causes and severity of injuries in traffic accidents according to reports of the forensic medical center of Yazd. Methods: A total of 251 fatalities due to traffic accidents that had undergone autopsy examinations at the Yazd forensic medicine center from2006 till 2008 were included in the study by census method. Data regarding gender, road user type, type of vehicle (car, motorcycle, autobus or minibus), consciousness level, and intensive care unit (ICU) admission was gathered. For evaluation of injury severity, we used Injury Severity Score (ISS). Results: The population under study consisted of 202 men (80.5%) and 49 women (19.5%) with an average age of 34.1 years (range: 1-89 years). Motorcycle-pedestrian accidents were the most common type of injury (100, 39.8%). Head (220, 87.6%) and face (169, 67.3%) were the two most common sites of injuries. Mean (±SD) of ISS was 23.2 (±10.4). According to autopsy records, the main cause of death was head trauma (146, 58.1%). Conclusion: Public awareness in terms of primary prevention of road accidents should be considered important. Also, regarding the high prevalence of brain injuries and complications associated with skull fractures, accessibility to neurosurgeons and availability of imaging devices have an important role in decreasing the mortality rate of traffic accidents

Incidence of chronic groin pain following open mesh inguinal hernia repair, and effect of elective division of the ilioinguinal nerve: meta-analysis of randomized controlled trials

Chronic post-operative groin pain is a substantial complication following open mesh inguinal hernia repair. The exact cause of this pain is still unclear, but entrapment or trauma of the ilioinguinal nerve may have a role to play. Elective division of this nerve during hernia repair has been proposed in an attempt to reduce the incidence of chronic groin pain. We performed a meta-analysis of nine randomized controlled trials comparing preservation versus elective division of the ilioinguinal nerve during this operation. A substantial proportion of patients having open mesh inguinal hernia repair experience chronic groin pain when the ilioinguinal nerve is preserved (estimated rate of 9.4% at 6 months and 4.8% at 1 year). Elective division of the nerve resulted in a significant reduction of groin pain at 6-months post-surgery (RR 0.47, p = 0.02), including moderate/severe pain (RR 0.57, p = 0.01). However, division of the nerve also resulted in an increase of subjective groin numbness at this time point (RR 1.55, p = 0.06). At 12-month post-surgery, the beneficial effect of nerve division on chronic pain was reduced, with no significant difference in the rates of overall groin pain (RR 0.69, p = 0.38), or of moderate-to-severe groin pain (RR 0.99, p = 0.98) between the two groups. The prevalence of groin numbness was also similar between the two groups at 12-month post-surgery (RR 0.79, p = 0.48). Routine elective division of the ilioinguinal nerve during open mesh inguinal hernia repair does not significantly reduce chronic groin pain beyond 6 months, and may result in increased rates of groin numbness, especially in the first 6-months post-surgery