Indomethacin electrospun nanofibers for colonic drug delivery: in vitro dissolution studies

Generally, although the conventional drug delivery systems, such as using only pHdependent polymers or time-dependent release systems are popular, the individuals’ variations of physiological conditions usually lead to premature or imperfect drug release from each of these systems. Therefore, a combination of pH- and time-dependent polymers could be more reliable for delivering drugs to the lower GI tract such as colon. To this end, electrospinning method was used as a fabrication approach for preparing electrospun nanofibers of indomethacin aimed for colon delivery. Formulations were prepared based on a 3 2 full factorial design. Independent variables were the drug:polymer ratio (with the levels of 3:5, 4.5:5 and 6:5 w/w) and Eudragit S:Eudragit RS w/w ratio (20:80, 60:40 and 100:0). The evaluated responses were drug release at pH 1.2, 6.4, 6.8 and 7.4. Combinations of Eudragit S (ES), Eudragit RS (ERS) and drug based on factorial design were loaded in 10 ml syringes. 3 Electrospinning method was used to prepare electrospun nanofibers from electrospinning solutions. Conductivity and the viscosity of the solutions were analyzed prior to electrospinning. After collection, the nanofibers were evaluated in terms of morphology and drug release. It was shown that the ratio of drug:polymer and polymer:polymer were pivotal factors to control the drug release from nanofibers. A formulation containing Eudragit S:Eudragit RS (60:40) and drug:polymer ratio of 3:5 exhibited the most appropriate drug release as a colon delivery system with a minor release at pH 1.2, 6.4 and 6.8 and major release at pH 7.4. Nanofibers resulted from this formulation were also more uniform and contained fewer amounts of beads. It was demonstrated that the electrospinning could be regarded as a modern approach for the preparation of colon drug delivery systems leading to marketable products

Concordance of Continuing Education Programs with the Principles of Adult Learning and their Effectiveness: Perspectives of Nurses in Mashhad University of Medical Sciences

Introduction: Continuing education is an essential component of the professionalization of nursing and could be viewed as a catalyst for the development of nursing practice. This study aimed to determine the concordance of the continuing education programs with the principles of adult learning and the effectiveness of these programs from the perspective of nurses. Methods: In this cross-sectional descriptive study, 150 nurses working in teaching hospitals affiliated to Mashhad University of Medical Sciences in 2011 were selected using quota sampling. Data were collected using a researcher-made questionnaire which proved to be valid and reliable. The questionnaire had 3 sections, focusing on “Concordance rate of in-service training programs with the adult learning principles”, “Effectiveness rate of these programs”, and “the preferred educational methods”. Data were analyzed using descriptive statistics, and Pearson correlation coefficient. Results: 68% of participants were women and 89% had a BS degree in nursing. The mean score of compliance of continuing education program with principals of adult learning was 35.2±4.6 out of 65.The mean score for the effectiveness was 28.6±6.2 out of 55. As for adult learning principles, 46.9% of the participants rated the program weak. Conclusion: It is suggested that the continuing education program be revised in term of planning and implementing, based on the principles of adult learning in order to increase the effectiveness of this program

A Critical Review on Communication Paradigms Beteween Academic and Clinical Service Institutions in Nursing

Introduction: Clinical education is the duty of academic and clinical organizations and its effectiveness is influenced by the interaction of both organizations. Since the commencement of nursing profession, this interaction has experienced different paradigms. This paper is an endeavor for identification and critical analysis of these paradigms as well as the current trends of the interactions between educational and clinical institutions. Exploration of these patterns and their advantages and disadvantages could help the administrators of educational and clinical institutions in designation and choice of appropriate relationship paradigms. Methods: For this narrative review, an electronic search within three phases was performed in January 2008 to retrieve studies published from 1990 to 2008 through these databases: ISI Web of Science, Medline, CINAHL, ERIC, and BNI. The key terms were clinical education, clinical practice models, clinical education model, models of shared learning in clinical practice, and partnership between university and clinical institutions. These articles were studied several times to identify and derive the type of communicational paradigm, significant characteristics, manners of communication, advantages, and disadvantages. Results: Four paradigms of communication between educational and clinical institutions in nursing profession were identified. These included service-orientation, organizational independence, shared models of clinical education, and intra-organizational partnership paradigm. Conclusion: A developing trend can be identified which is influenced by factors such as professional progress in nursing and changes in community expectations. The need for professionalism and expanding the body of knowledge in nursing makes it necessary to maintain nursing schools. The trend of communication paradigms is toward the establishment of partnership between these two independent organizations

‍Clinical Supervision System: A Method for Improving Educational Performance of Nursing Personnel

Introduction: Employing supervision methods which focuses on educational aspects may increase the effectiveness of nursing personnel's educational activities, especially patient education. The aim of this study was to investigate the effect of clinical supervision on the effectiveness of nurses' educational performance. Methods: This quasi-experimental study was conducted using static groups' comparison in which the control and experiment groups were compared by a post-test. Study samples included 72 patients who were matched and assigned into two distinct groups. Clinical supervision system was implemented through three steps in 3 wards of Samen-al-Aemme hospital in Mashhad for 6 months. The data gathering tool included patient information sheet, patient satisfaction from nurses' educational practice and rating scale of self-care knowledge and practice of patients. Data was gathered through interview and observation methods and analyzed by SPSS software. Results: The mean scores of self-care knowledge and practice of the patients were 30.6 and 57.1 out of 100, in the control and experiment groups, respectively. The mean score of patients' satisfaction from nurses' educational practice was 19.6 in the control group and 20.9 in the experiment group, out of 24. So that, independent t-test showed a significant difference between these two groups. Conclusion: Implementing clinical supervision system through observation, feedback, discussion, and investigation, may develop nurses' knowledge and professional skills in patient education. Therefore, this supervision method could be regarded as an effective model for in-service education. More studies are required in order to investigate the effect of this model on other aspects of nurses' practice

The Mechanisms to Attract Nurses’ Parthnership in Clinical Education: Perspective of Managers, Nursing Educators, and Staff Nurses

Introduction: Parthnership in clinical education is a duty for all those involved in providing health care. Nurses’ involvement in clinical education can reduce the gap between theory and practice. This study aimed to identify the mechanisms used by nursing educators to attract staff nurses’ parthnership in the delivery of clinical education. Methods: This is a qualitative content analysis study performed in year 2009. Fifteen nursing clinical educators, staff nurses, educational managers, and nurse managers of Mashhad University of Medical Sciences and Tehran University of Medical Sciences participated in this study. Data was collected through semi-structured interviews. Primarily, purposeful sampling was performed and continued using snowballing method and continued until data saturation. All interviews were recorded and subsequently transcribed. The analysis was carried out by qualitative content analysis method. Results: Six themes were discovered through rich and deep descriptions by participants. These include acquiring skillfulness supremacy, being realistic, commitment and responsibility, modesty, using other nurses’ experiences, and assertiveness. Conclusion: Nursing educators use their special approaches to make effective and appropriate personal and professional relationships with clinical nurses and transfer their experiences to the students. These personal mechanisms should be systematically supported through incorporation within organizational programs shared by academic and clinical institutes. This will enhance the efficacy of nursing educators in accomplishing their clinical rol

Customers' typology in medical tourism

This research is performed to identify the effective solutions for attracting medical tourists and making them loyal. Hence, after studying theoretical background and reviewing literature, the effective factors on choosing destination were gathered regarding supply and demand model of medical tourism. Then, the medical tourists divided into four groups including Platinum, Gold, Iron and the Lead and the questionnaires distributed among them. Next, regarding the results, which means the priorities of medical tourists' demands, authors put medical tourists in two new categories termed Diamond and Silver, based on the similarities on their needs. Afterward, these needs classified into two categories named hygiene needs and motivational needs, regarding Herzberg two-factor theory. In the Diamond type, the lack of motivational needs lead to dissatisfaction, but in the Silver type, it will not lead to dissatisfaction

Comparing Professional Confidence in Midwifery Students and Clinical Midwives

Introduction: Professional confidence is a desirable characteristic of health professionals and midwives as the first persons in contact with the clients. As a result they should have enough knowledge and skills to offer clinical services. This study aimed to determine the level of professional confidence among midwifery students and clinical midwives in year 2013 in Mashhad University of Medical Sciences. Methods: In this descriptive cross-sectional study, we assessed the professional confidence of all midwifery students and a proportionate sample of clinical midwives in Mashhad University of Medical Sciences using Professional confidence questionnaire. The validity of the questionnaire was confirmed using content validity index and factor analysis and its reliability was confirmed using Cronbach's alpha coefficient. Data was analyzed using descriptive and inferential statistics. Results: 101 (63.9%) midwifery students and 57 (36.1%) clinical midwives took part in this study. The mean score of professional confidence was 135.77±25.27 for second-year students, 149±26.36 for third-year students, 141.03±27.53 for fourth-year students and 158/94±27/53 for clinical midwives out of a total of 210 points. The result of one-way Anova test showed a significant difference between these four groups (P=0.001). Conclusion: Educational programs were successful in creating professional confidence in second and third-year students at a desirable level but the professional confidence in fourth-year students didn’t have an appropriate level. Professional confidence score among clinical midwives was higher compared to students as expected. Along with increase in students’ capabilities in senior years, a supportive clinical environment should be created which nurtures students’ professional confidence development. Assessing and exploring, factors reducing professional confidence is suggested for further research

Comparison of Nursing Students’ Professional Behavior to Nurses Employed in Mashhad University of Medical Sciences

Introduction: An important part of nurse’s professional behavior forms during academic education and develops throughout professional career. Therefore comparing professional behavior of freshmen and seniors at graduation with that of nurses can illustrate the formation and development of professional behavior at the time of formal and informal nursing education. This study was conducted to compare professional behavior of nursing students to that of nurses employed in Mashhad University of Medical Sciences. Methods: In this descriptive cross-sectional study of trend type, study population included all freshmen and senior nursing students of school of nursing and midwifery in Mashhad University of Medical Sciences as well as nurses employed in hospitals affiliated to this university in year 2011 (n=322). Professional behavior of these students and nurses was assessed using modified “nursing student professional behavior” questionnaire of Goze. The validity of the questionnaire was confirmed using content validity index and its reliability was confirmed using Cronbach's alpha coefficient. Data was analyzed using descriptive statistics, Kruscall-Wallis, and Spearman correlation coefficient. Results: 72 freshman students of clinical nursing (64%), 40 senior nursing students (35%), and 322 nurses formed the sample. The mean score of professional behavior of freshman students was 110/3±17.3 out of total score of 135 and this mean score was 107±12/8 for senior nursing students and 109±12/6 for clinical nurses. The result of Kruscall-Wallis test showed no significant difference among these three groups (p=0.2). Conclusion: Although basic nursing educations prior to clinical education has lead to development of a desirable level of professional behavior in junior nursing students, development of these behaviors did not have an appropriate trend among senior students and employed nurses. Further studies using other ways of assessment are needed to assess nursing students and clinical nurses' professional behavior considering factors promoting professional behavior