Senior managersâ viewpoints toward challenges of implementing clinical governance: a national study in Iran

Background: Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and governmentâs intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. Methods: A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Results: Analysis revealed that a number of items were important in the successful implementation of CG from the senior managersâ�� viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Conclusion: Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managersâ attitude toward CG and ultimately affected the success of quality improvement activities. © 2016, Kerman University of Medical Sciences. All rights reserved

Effects of intravenous Semelil (ANGIPARS�) on diabetic foot ulcers healing: A multicenter clinical trial

Some diabetic foot ulcers, which are notoriously difficult to cure, are one of the most common health problems in diabetic patients .There are several surgical and medical options which already have been introduced for treatment of diabetic foot ulcers, so some patient will require amputation. The purpose of this study was to evaluate the efficacy of intravenous Semelil (ANGIPARS�), a naive herbal extract to accelerate healing of diabetic foot ulcers. A multi-centric randomized controlled trial was conducted to evaluate intravenous Semelil for healing of diabetic foot ulcers. Sixteen diabetic patients were treated with intravenous Semelil, and nine other patients were treated with placebo as control group. Both groups were otherwise treated by wound debridement and irrigation with normal saline solution, systemic antibiotic therapy and daily wound dressing. Before and after intervention, the foot ulcer surface area was measured, by digital photography, mapping and planimetry. After 4 weeks, the mean foot ulcer surface area decreased from 479.93±379.75 mm2 to 198.93±143.75 mm2 in the intervention group (p = 0.000) and from 766.22±960.50 mm2 to 689.11±846.74 mm2 in the control group (p = 0.076). Average wound closure in the treatment group was significantly greater than placebo group (64 vs. 25, p= 0.015). This herbal extract by intravenous rout in combination with conventional therapy is more effective than conventional therapy by itself probably without side effect. However, further studies are required in the future to confirm these results in larger population

Relationship between maximum clot firmness in ROTEM® and postoperative bleeding after coronary artery bypass graft surgery in patients using clopidogrel

Background: The aim of the present study was to investigate the relationship between maximum clot firmness (MCF) in rotational thromboelastometry (ROTEM®) and postoperative bleeding in patients on clopidogrel after emergency coronary artery bypass graft surgery (CABG). Methods: This observational study recruited 60 patients posted for emergency CABG following unsuccessful primary percutaneous coronary intervention (PCI) while on 600 mg of clopidogrel. The study population was divided into 2 groups on the basis of their MCF in the extrinsically activated thromboelastometric (EXTEM) component of the (preoperative) ROTEM® test: patients with MCF <50 mm (n = 16) and those with MCF �50 mm (n = 44). Postoperative chest tube drainage amount, need for blood product transfusion, postoperative complications, and duration of mechanical ventilation after CABG were recorded. Results: No significant differences were observed between the two groups regarding duration of surgery, cardiopulmonary bypass, and aortic cross-clamp time. Chest tube drainage at 6, 12, and 24 h after Intensive Care Unit admission were significantly higher in the patients with MCF below 50 mm. The need for blood product transfusion was higher in the group with MCF <50 mm. In patients who experienced postoperative bleeding of 1000 mL or more, the ROTEM® parameters of INTEM (Intrinsically activated thromboelastomery) and MCF, EXTEM and MCF, and HEPTEM (INTEM assay performed in the presence of heparinase) MCF (but not FIBTEM (Thromboelastometric assay for the fibrin part of the clot) values) were significantly lower than those with postoperative bleeding <1000 mL (P � 0.05). Conclusions: When platelet aggregometry is not available, the ROTEM® test could be useful for the prediction of increased risk bleeding after emergency CABG in patients who have received a loading dose of clopidogrel. © 2018 Annals of Cardiac Anaesthesia | Published by Wolters Kluwer - Medknow

Nano silver-coated polypropylene water filter : II. evaluation of antimicrobial efficiency

This research will improve our understanding of the microorganism removal effectiveness of the nano silver-coated polypropylene filter used in water purification. Silver nanoparticles were deposited on cylindrical polypropylene water filter by physical vapor deposition method using a modified Balzers machine. The enumeration of bacteria was done by membrane filter method. At a flow rate of 3L/hr and after 5h filtration all of the Escherichia coli cells were killed when the input water had a bacterial load of 103 colony-forming units (CFU) per mL. The inductively coupled plasma/mass spectrometry (ICP/MS) was used to determine any trace amount of the silver nano particles left in the water sample after filtration. Results showed that nano particles are stable on the water filter and are not washed away by water flow after 5h filtration. The nano silver-coated filter reported here has the potential to be used as an efficient water treatment technique

New trends in microbiological water treatment

Clean water is essential to human life as well as the rest of the ecosystem. Nowadays, we are experiencing difficulties in responding to the increasing demand for reliable water sources. There are many approaches available for the disinfection of water. Each method has some practical difficulties and disadvantages. Nanotechnology is an emerging advanced technology with significant potential in various fields including solving water purification problems. Using nanotechnology methods it is possible to convert metal ions into nanoparticles for medical and non-medical [1] applications. The major property that makes nanoparticles attractive is that they are extremely small in size (1-100nm), which provides them with a higher surface area per unit mass. Nanomaterials often show unique and considerably enhanced physical, chemical and biological properties compared to their macro-scaled counterpart