An etiologic evaluation of children with short stature in Gorgan (Northeast Iran), 2005

Growth is an important biological process during childhood. Short stature is the most common cause of a child to be examined by an endocrinologist. This cross-sectional study was performed to determine the short stature causes in children aged 6-14 years old in 2005 who were referred to Talghani Medical-Educational Center. Demographic characteristics, history of any serious problem (prematurity), clinical feature, biochemical and endocrinological test results and radiological findings were evaluated. Standard Deviation Score (SDS) was calculated and written down in an information recording form. From 100 children under study (66%) were girls with the average age of 10.84 year. Their average of bone age was 8.4 year. Most common causes for short stature were constitutional (57%), growth hormone deficiency (30%) and familial (8%). There was not significant difference between two sexes in this view. According to the findings, after ruling out of Constitutional and familial causes, we strongly recommended the provocative growth hormone test for early detection and timely prevention of permanent short stature

Knowledge implementation in health care management: A qualitative study

Background: The gap between knowledge and practice is a global issue, which increases wasteful spending in healthcare. There are several models and frameworks to address this gap and try to solve the challenge. Promoting Action on Research Implementation in Health Services (PARIHS) framework highlights the interaction of three main elements: evidence, context and facilitation, to implement research into practice, successfully. This framework can use as a tool to evaluate the situation and guide the changing. This study conducted to explain the status of knowledge implementation in Iran's healthcare management system. Methods: This qualitative study was done by using a directive content analysis approach through conducting in-depth, structured interviews with 15 health managers based on the PARIHS framework. Guiding questions were based on the three main elements of the framework: evidence, context and facilitation. The content of the interviews entered into the Qualitative Data Analysis software (MAXQDA version 10) and, then, analyzed. Results: The most common source of evidence used by managers for decision-making was local information and previous experience. Evaluation more emphasized compared to other sub-elements of context, i.e. culture and leadership. In terms of facilitation, performing tasks by others was the dominant opinion. Conclusion: Our results showed that managers in the healthcare system of Iran use their own and other manager's experience and the local information for decision-making and have no ideas about facilitation. © 2020 The Author(s)

Surface wrinkling of the twinning induced plasticity steel during the tensile and torsion tests

\u27Heterogeneous twinning\u27 is defined as plastic deformation due to the formation and progress of twins resulting in surface wrinkles on the deforming part when the initial grain size is relatively large compared to the typical size of the part. In the case of a Twinning Induced Plasticity (TWIP) steel with an initial grain size of ~160. m, the heterogeneous twinning generated visible wrinkles, an orange peel effect, under medium uni-axial strains. The heterogeneous twinning did not occur in the material subjected to high shear strains. The complications resulting from this phenomenon on strain hardening characterization of the TWIP steels using two commonly used mechanical tests, tensile and torsion are discussed along with some experimental aspects of heterogeneous twinning. © 2014

Prevalence of malnutrition among elderly people in Iran: Protocol for a systematic review and meta-analysis

Background: Malnutrition occurs following a decrease or an imbalance in the absorption of energy, protein, vitamins, and minerals because of numerous factors. Thus, it has serious and life-threatening consequences. To plan for this issue, we need information on the burden of this problem. Objective: The aim of this study is to determine the prevalence of malnutrition among elderly people in Iran. Methods: For the purpose of this study, papers, including original articles, theses, and conference proceedings on the prevalence of malnutrition among people aged 60 years and above, and have been published in national and international journals until September 2018 will be included without any language limitation. The following keywords along with their synonyms in Persian will be used in the literature search: malnutrition, elderly, and Iran. At first, the screening process will be conducted based on our inclusion and exclusion criteria. Then, the full text of the remaining articles will be read carefully, and eligible articles will be selected according to the objectives of the study. Next, the methodological quality of the selected papers will be reviewed, and the required information will be extracted from those with acceptable quality. Finally, a meta-analysis will be performed using the Stata software (version 14) when optimum criteria are met. It should be noted that all stages of screening, selection, quality assessment of primary studies, and data extraction will be performed by 2 reviewers independently. Results: This review is ongoing and will be completed at the end of 2019. Conclusions: This review aims to provide comprehensive evidence about the prevalence of malnutrition among elderly people in Iran. This can help Iranian health managers and policy makers make informed decisions for preventing malnutrition and promoting the health status of elderly people. © Homeira Khoddam, Sepideh Eshkevarlaji, Mahin Nomali, Mahnaz Modanloo, Abbas Ali Keshtkar

Studying the power of the integrative weaning index in predicting the success rate of the spontaneous breathing trial in patients under mechanical ventilation

Background and Aims: The use of weaning predictive indicators can avoid early extubation and wrongful prolonged mechanical ventilation. This study aimed to determine the power of the integrative weaning index (IWI) in predicting the success rate of the spontaneous breathing trial (SBT) in patients under mechanical ventilation. Materials and Methods: In this prospective study, 105 patients undergoing mechanical ventilation for over 48 h were enrolled. Before weaning initiation, the IWI was calculated and based on the defined cutoff point (≥25), the success rate of the SBT was predicted. In case of weaning from the device, 2-h SBT was performed and the physiologic and respiratory indices were continuously studied while being intubated. If they were in the normal range besides the patient's tolerance, the test was considered as a success. The result was then compared with the IWI and further analyzed. Results: The SBT was successful in 90 (85.7%) and unsuccessful in 15 (14.3%) cases. The difference between the true patient outcome after SBT, and the IWI prediction was 0.143 according to the Kappa agreement coefficient (P < 0.001). Moreover, regarding the predictive power, IWI had high sensitivity (95.6%), specificity (40%), positive and negative predictive values (90.5% and 60), positive and negative likelihood ratios (1.59 and 0.11), and accuracy (86.7%). Conclusion: The IWI as a more objective indicator has acceptable accuracy and power for predicting the 2-h SBT result. Therefore, in addition to the reliable prediction of the final weaning outcome, it has favorable power to predict if the patient is ready to breathe spontaneously as the first step to weaning

Researchable clinical problems from the viewpoint of healthcare providers: A qualitative study

Background and purpose: There is lack of concordance between researchers' interests and clinical problems. This study aimed at explaining researchable clinical problems from the perspective of healthcare providers to provide a better understanding of the issues that could be solved by the health system. Materials and methods: This qualitative study was carried out in 27 healthcare providers in selected hospitals affiliated to Golestan University of Medical Sciences, 2017. The participants were selected by purposive sampling. Focused Group Discussion (FGD) was used to collect the data. The participants explained their experiences through three FGDs which began with a broad open-ended question and further probing questions were used. Interviews were recorded and transcribed verbatim. Data were analyzed using qualitative content analysis. Results: The participants aged 25-53 years old with 2-26 years of clinical experience, among whom 59 were males. The analysis of data led to the development of four main themes. The researchable clinical problems included clinical problems associated with health system structure, the status of healthcare providers, the status of service delivery in the health system and needs assessment, and problems associated with clinical processes. Conclusion: Current study suggests that after determining the priority of researchable problems regional issues should be addressed in designing and performing clinical researches. © 2019, Mazandaran University of Medical Sciences. All rights reserved

Psychometric Properties of the 'Patients' Perspective of the Quality of Palliative Care Scale'

Objectives: Palliative care is a basic human right for all patients suffering from progressive and excruciating pain, limitations in daily activities as well as requiring constant care. The development of palliative care is always associated with the physical, psychological, social and spiritual care quality level and requires continuous evaluation by the care-receiving patients. This study aimed to determine the psychometric properties of the patients' perspective of the quality of palliative care scale. Materials and Methods: This methodological study was conducted on 500 patients with chronic diseases admitted to the hospitals affiliated in Golestan University of Medical Sciences, between 2019 and 2020. Participants were selected through stratified sampling through proportional allocation as well as considering the bed occupancy rate in the two referral hospitals of the university. According to Wild approach, we translated the original version of the scale the patients' perspectives of the quality of the palliative care scale with 35 items and eight subscales. Using exploratory and confirmatory factor analysis, the psychometric properties of the scale (i.e., initial reliability and face, content, convergent and construct validities) were assessed. The reliability of the scale was calculated by applying Cronbach's alpha coefficient, McDonald's omega coefficient and the Intraclass correlation coefficient (ICC). SPSS- 16 and AMOS-24 software programs were used to analyse the data. Results: Three items were omitted after assessing the initial reliability of the translated version of the perspectives of the quality of the palliative care scale using adjusted Cronbach's alpha. The qualitative face validity and impact score of the remaining items of the scale were confirmed by the target group. Meanwhile, a panel of experts confirmed the content validity ratio and content validity index. Convergent validity was approved by calculating the average variance extracted >0.5. Performing EFA led to the extraction of 7 subscales with 32 items. CFA and goodness of fit indices such as GFI = 0.98, CFI = 0.91, RMSEA = 0.048 and GFI = 0.97 confirmed the construct model by omitting three items. Hence, the Persian version of the patient's perspective of the quality of palliative care scale was finalised, including seven subscales with 29 items. ICC of >0.7 represented good reliability. Moreover, Cronbach's alpha and McDonald's omega coefficient confirmed the internal consistency of the scale. Conclusion: Based on the findings of this study, the Persian version of the patients' perspective of the quality of palliative care scale is introduced as a valid and reliable scale. It can accurately indicate and predict the meticulous quality of such care in hospitalised patients and can be used in the cure and care assessments in the health system. © 2022 Wolters Kluwer Medknow Publications. All rights reserved