Natural Based Anticancer Drugs and Their Worthiness

With the prevalence of every type of cancer increasing globally, the inability to treat and the severe side effects caused by chemotherapy and radiotherapy are some of the biggest problems facing cancer patients and their physicians.1 Many herbal medicines have replaced their chemical rivals; for example, emetine lost its ground to metronidazole as an amoebicidal agent, and digoxin has given its place to ACE inhibitors for treating congestive heart failure. Their use has particular importance in some areas due to the widespread side effects of synthetic drugs, especially in the treatment of incurable diseases such as cancer.2 It is noteworthy that several natural anticancer agents are provided by lower organisms. For example, the anti-hyperlipidemic agent lovastatin comes from Aspergillus terreus, the immunosuppressant cyclosporin A is derived from Beauveria nivea, and some antibiotics (bleomycin, dactinomycin, daunorubicin, doxorubicin, mitomycin, plicamycin, streptozocin) also fall into this category; however, other higher plants have produced more complicated contributions as secondary metabolites. Among those, the antileukaemic alkaloids vinblastine and vincristine which are obtained from Catharanthus roseus are noted as earlier instances. Other popular and important plant components for use as anticancer agents are etoposide and teniposide which are isolated from Podophyllum peltatum and are effective against many types of tumors, and taxoids that are obtained from crude extracts of the bark of the Taxus brevifolia and are significantly active against ovarian cancer, advanced breast cancer, small and non-small cell lung cancer. Furthermore, these cases should be noted: Shikonin (from Lithospermum erythrorhizon), curcuminoid (from Curcuma longa), camptothecin (from Camptotheca acuminate), and ingenol mebutate (from Euphobia peplus), Trastuzumab emtansine (Kadcyla) which is an antibody conjugated to a synthetic derivative of the cytotoxic principle of the Ethiopian plant Maytenus ovatus and used to treat breast cancer.3 Although more than half of the anticancer compounds used to treat cancer are obtained from plant sources or marine and microorganisms, it seems that there is still little knowledge about the power of natural resources in the face of incurable diseases such as cancer.4 Finally, the fewer side effects, availability, and lower cost of drugs obtained from plants compared to synthetic samples, especially for cancer patients who have weakened immune systems, make alternative medicine a very important issue. Expanding man’s knowledge on the discovery and use of these natural compounds requires a greater investment by related companies and more attention from the academic community and researchers

International Hospitals’ Performance Variables: A Comparative Study

Background: To define a series of variable that separates international hospitals from other ones is the main aim of this study.Materials and Methods: After choosing some countries in the worldwide, two hospitals, which were the leaders on international patients’ admissions, were selected for investigating their main indicators according to world health organization framework for demonstrating performance assessment to attract patients from the universe.Results: Under the first performance assessment dimension clinical effectiveness and safety, in chosen hospitals of Australia as Malaysia found (4), New Zealand (9), India (7) and Iran (1) indicator (s). The production efficiency and staff orientation dimensions concluded no difference in terms of quantity and type of indicators via countries. Next aspect as patient centeredness was consisted of 4 indicators in Australia, New Zealand (2), India (6) and Iran (5). Eventually, eight indicators asset from Australia, New Zealand (2), India (6) and Iran (6) for responsive governance.Conclusion: Although the variables of international hospital’s performance assessment were the same with others, these should be more highlighted for attracting worldwide patients and strongly recommends the international authority for quality assurance

International Hospital Performance Assessment: Developing a Questionnaire

Background: As there is no valid questionnaire for assessing international hospital performance from providers’ perspective, this study aimed to develop a reliable as well as valid questionnaire for Iranian hospitals.Materials and Methods: To develop the International Hospital Performance Assessment (IHPA) questionnaire, literature review did and comparative study conducted for extracting relevant items from twenty leader hospitals in all over the world. After that, to design the questionnaire and estimate its content validity index and ratio (CVI, CVR), 20 medical tourism experts selected. Then, questionnaire‘s construct validity (CVI & CVR) determined by using SPSS version 21 as well as exploratory factor analysis. Finally, reliability assessed by calculating Cronbach’s alpha coefficient.Results: The content validity of the questionnaire determined as (CVI= 0.85, CVR= 0.60). According to expert opinion 5 dimensions of the questionnaire selected from World Health Organization hospital performance framework, which were clinical effectiveness and patient safety, efficiency, patient centeredness, governance responsiveness and even staff orientation. Furthermore, results of exploratory factor analysis showed that the questionnaire contained 45 items and Cronbach’s alpha coefficient was 0.687.Conclusion: Results indicated that standard IHPA questionnaire with 45 items in 5 dimensions developed as a tool for measuring hospitals’ quality of care in Iran

Comparing performance of Tabriz obstetrics and gynaecology hospitals managed as autonomous and budgetary units using Pabon Lasso method

BackgroundConsidering governmental scrutiny and financial constraints in medicine, the need for improved performance, which can provide acceptable care for medical consumers, leads to the conduct of new managerial methods to improve effectiveness.AimsThis study aimed to compare performance indicators of obstetrics and gynaecology teaching hospitals in Tabriz.MethodA longitudinal, retrospective study was conducted to compare performance indexes of Tabriz obstetrics and gynaecology teaching hospitals during 2010-2012. Al-Zahra is Tabriz’s central teaching hospital in obstetrics and gynaecology that is authorised under a board of trustees as an autonomous hospital and Taleghani hospital is managed under centralised administration. Study variables included: Average Length of Stay (ALOS), Bed Occupancy Rate (BOR), and Bed Turnover Ratio (BTR). The data was extracted via the Hospital Information Systems (HIS) within the hospitals' admission and discharge units. Pabon Lasso model was used to assess hospital performance. Data was analysed and graphs were plotted using the SPSS-17 software package.ResultsAccording to study findings, overall ALOS in Al-Zahra hospital is 3.15 (2.15) days (1.88 (0.97) days for prenatal wards and 6.13 (0.97) days for neonatal wards) and ALOS in Taleghani Hospital is 3.37 (3.09) days (1.74 (0.14) days for perinatal wards and 5.96 (3.55) days for neonatal wards). In this regard, Al-Zahra hospital holds the maximum BOR with 86.92 per cent and the minimum BOR was attributed to Taleghani hospital at 68.44 per cent (

Factors Affecting on Development of Age_Friendly Hospital in Iran: Factor Analysis

Background & Aim: Developing countries such as Iran experience a growing phenomenon of aging, and the elderlies are at a risk of longer hospital stay. The increasing number of elderly patients necessitates the establishment of age-friendly hospitals. This study aimed to determine the factors affecting the development of age-friendly hospitals in Iran using factor analysis. Materials and Methods: This descriptive, analytic and cross-sectional study was performed during three months in 2018. The statistical population included physicians, nurses, and paramedical staff  of hospitals from across the country. In total, 408 subject were selected by cluster sampling. Data were collected using a demographic characteristics questionnaire (seven items) and the researcher-made age-friendly hospital questionnaire (57 items). In addition, data analysis was performed in SPSS version 22, and the exploratory factor analysis was confirmed by AMOS. Results: The exploratory analysis identified seven main components, including ethics in care (eight variables and variance 8.84%), physical environment (nine variables and variance 7.75%), care process (six variables and variance 7.69%), emotional and behavioral environment (six variables and variance 7.38%), organizational support (six variables and variance 7.33%), healthcare systems (six variables and variance 5.99), and policy-making (six variables and variance 5.56%). All the seven factors explained 50.56% of total variance. Conclusion: According to the results of the study, attention to factors including ethics in care, physical environment, care process, emotional and behavioral environment, organizational support, healthcare systems, and policy-making factors can lead to the development of age-friendly hospitals in Iran

Designing A Model of Medical Equipment Purchase Management in Hospitals of Tehran University of Medical Sciences

Objective: Medical equipment plays an effective and vital role in the diagnosis and treatment of diseases. Each society dedicates a plethora of health resources to these facilities. Since prioritizing and resource allocation are crucial in low-income countries with limited health resources, understanding and improving the purchase management of medical equipment in hospitals is a primary key for preparing high-quality health services. The aim of this study was to design a model for medical equipment purchase management at hospitals affiliated with the Tehran University of Medical Sciences. Methods: The statistical population for the present applied study, consisted of 623 people and the research sample was comprised of 420 people, which was selected using the stratified random sampling method. Data was collected using a researcher-made questionnaire whose variables were extracted from comparative studies and whose validity was measured by the relative content validity coefficient, content validity index and Cronbach's alpha coefficient. The SPSS 18 and AMOS were employed for analyses. Results: The most and the least effective aspects of medical equipment purchase management in the studied hospitals were found to be decision-making (path coefficient of 1.244) and organization respectively (path coefficient of 0. 845). Conclusion: It is crucial to take factors into consideration when using the facilities and capacities available in health and treatment centres. The proposed model can best guide buyer institutions to move towards efficient purchase mentioned in upstream policy documents

Critical success factors of lean management: An investigation of factors affecting lean management in public hospitals in Kohgiluyeh and Boyerahmad and Bushehr provinces

Aim: Lean is a set of operating philosophies and methods that help create maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer's needs, employee involvement, and continuous improvement. The aim of this study was of factors affecting lean management in public hospitals in Kohgiluyeh and Boyerahmad and Bushehr provinces. Materials and Methods: This research was descriptive correlation study. The questionnaire was used to collect the data. Factor analysis and multiple regression analysis were conducted to understand the relationship between these factors and lean implementation success. With using 60 questions questionnaire, the content validity of the method developed by the researchers and expert judgment and Cronbach's alpha and test–retest reliability of the method was investigated, and the opinions of 500 primary health-care practitioners were collected. Then, a two-stage exploratory and confirmatory factor analysis and structural equation modeling with the use of statistical software SPSS for Window 17.0 software (SPSS Inc., lllinois, USA) (Leland Stanford Junior University) and AMOS 20 carried out to review and modify the conceptual model. Results: Exploratory factor analysis identified five factors of human, technology, management, processes, and relational that explains 58.5% of the total variance. Confirmatory factor analysis also showed that among identified factors, technology factor with 0.953 coefficient has greatest impact and management factor with 0.615 coefficient has the lowest impact on the pattern of lean management in public hospitals to improve the quality of services. Conclusions: The factors affecting the deployment of lean management in public hospitals and appropriate strategy for using the lean management to improve the delivery of primary health care and reduce waste. The results represent guidelines for using effective implementation of lean management to increase efficiency and ability to compete in the global market offers

Active Aging Management in Iran: Designing a model

Objective: Active ageing constitutes one of the guiding perspectives on policies, but the factors influencing ageing have not received considerable attention. The present study aimed to identify the factors affecting active ageing management in Iran. Design: Drawing on quantitative data gathered through a questionnaire filled out by 287 participants and an interview with 20 experts. Main outcome measures: The instrument was a questionnaire based on the five-point Likert scale. Questions with CVR>0.49 and with CVI>0.7 were accepted. To assess the reliability of the questionnaire, Cronbach's alpha coefficient was (0.92) used. The adequacy of the sample size was estimated at 0.952, based on the Kaiser-Meyer-Olkin (KMO) index. The collected data were analyzed by SPSS Ver 22. An exploratory factor analysis was used to explore and evaluate the dimensions of the model through a mathematical approach. Also, confirmatory factor analysis was utilized to verify the model, using AMOS 24 software. Results: Eight factors were identified as effective factors in active ageing management in Iran, which include: Organizational structure (0/83), services (0/80), control (0/74), financing (0/72), government grants (0/71), policy making (0/68), selected area to focus (0/65), members (0/63). Organizational structure and member components had the most and least significant effects. Conclusions: Establishing a High Council with the presence of the President's representative, allocating a specific budget for the elderly, determining the responsibilities of the government and the related organizations, determining the responsibility and providing suitable services can lead to the effective management of active ageing