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

The Prevalence of Trauma Injuries From Neighboring Countries Transferred to Iran

Introduction: In recent years, the prevalence of attacks perpetrated by humans against other humans has increased worldwide. The injuries suffered by attack victims are severe and multi-organ. Iran’s neighboring countries have been the scenes of attacks in the recent past. This study assessed the type and severity of injuries sustained by victims transferred to Iran during the time period 2005-2007. Methods: This study was conducted on injured civilians transferred to hospitals in Iran. Data regarding cause of injury, type and severity of injuries, diagnostic-therapeutic interventions, and patient outcomes was collected and statistically analyzed using SPSS version 14 software. Results: In the studied time period, 214 attack victims were transferred to 3 Level 1 trauma centers in Iran. The mechanisms of injury were explosion in 130 cases, gunshot in 48, and other causes in the remaining victims. The mean Injury Severity Score (ISS) was 5.91 ± 4.54 (range = 1-34), and the median was 4; 109 cases (51%) had an ISS between 1 and 8, 73 cases (34%) were scored between 9 and 14, 15 cases (7%) were scored from 16 to 24, and 17 cases (8%) had an ISS ≥25. In terms of the number of injured organs, 42 patients (20%) had one, 124 (58%) had 2, 36 (17%) had 3, and 12 patients (5%) had 4 or more injured organs. Procedures included 86 orthopedic, 25 general surgical, 21 ear, nose, and throat (ENT), 18 plastic, 15 neurosurgical, and 10 ophthalmic operations; 25 patients received psychiatric counseling. The mean (±SD) hospital stay was 13.43 (±19.76) days (range = 1-230). Conclusion: The injury pattern in attacks is more severe and differs from other traumas. The medical team should have adequate knowledge in this respect to provide comprehensive healthcare

The Minimum Dataset and Inclusion Criteria for the National Trauma Registry of Iran: A Qualitative Study

Background Burden of injuries is an important public health problem, especially in developing countries. However, a national standard tool for data collection of trauma registry has not been developed in Iran yet. Objectives The present study aimed to describe the steps undertaken in the development of the minimum dataset (MDS) and define the inclusion and exclusion criteria for a case of trauma registry by the national trauma registry of Iran (NTRI). Methods The working group consists of sixteen elected expert representatives from seven established countrywide active trauma research centers. Following a structured extensive review of the literature, the working party identified the data variables that included key registry goals for pre-hospital and hospital, outcome and quality assurance information. We used data variables from three trauma registry centers: National trauma data standard questionnaire, European trauma care (UT stein version), and Sina trauma and surgery research center. Then, we performed two email surveys and three focus group discussions and adapted, modified and finally developed the optimized MDS in order to prepare the quality care registry for injured patients. Results The finalized MDS consisted of 109 data variables including demographic information (n = 24), injury information (n = 19), prehospital information (n = 26), emergency department information (n = 25), hospital procedures (n = 2), diagnosis (n = 2), injury severity (n = 3), outcomes (n = 5), financial (n = 2), and quality assurance (n = 1). For a patient sustained one or more traumatic injury in a defined diagnostic ICD-10 codes, the inclusion criteria considered as one of the followings: If the patient stayed > 24 hours in the hospital, any death after hospital arrival, any transfer from another hospital during the first 24 hours from injury. Conclusions This study presents how we developed the MDS in order to uniform data reporting in the NTRI and define our inclusion and exclusion criteria for trauma registry. Applying the MDS and the case definition in pilot studies are needed in next steps

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

Structural Alteration in Dermal Vessels and Collagen Bundles following Exposure of Skin Wound to Zeolite-Bentonite Compound

Background. This study examines the impact of one-time direct application of haemostatic agent zeolite-bentonite powder to wounded skin on the healing process in rats. Materials and Methods. 24 male Sprague-Dawley rats were randomly allocated into two groups ( = 12): (1) the rats whose wounds were washed only with sterile normal saline (NS-treated) and (2) those treated with zeolite-bentonite compound (ZEO-treated). The wound was circular, full-thickness, and 2 cm in diameter. At the end of the 12th day, six animals from each group were randomly selected and terminated. The remaining rats were terminated after 21 days. Just after scarification, skin samples were excised and sent for stereological evaluation. Results. The results showed a significant difference between the two groups regarding the length density of the blood vessels and diameter of the large and small vessels on the 12th day after the wound was inflicted. Besides, volume density of both the dermis and collagen bundles was reduced by 25% in the ZEO-treated rats in comparison to the NS-treated animals after 21 days. Conclusions. One-time topical usage of zeolitebentonite haemostatic powder on an animal skin wound might negatively affect the healing process through vasoconstriction and inhibition of neoangiogenesis