Effectiveness of training intervention to improve medical student’s information literacy skills

This study aimed to assess the efficiency of delivering a 4-month course of “effective literature search” among medical postgraduate students for improving information literacy skills. This was a cross-sectional study in which 90 postgraduate students were randomly selected and participated in 12 training sessions. Effective search strategies were presented and the students’ attitude and competency concerning online search were measured by a pre- and post-questionnaires and skill tests. Data were analyzed by SPSS version 16 using t-test. There was a significant improvement (p=0.00), in student’s attitude. The mean (standard deviation [SD]) was 2.9 (0.8) before intervention versus the mean (SD) 3.9 (0.7) after intervention. Students’ familiarity with medical resources and databases improved significantly. The data showed a significant increase (p=0.03), in students’ competency score concerning search strategy design and conducting a search. The mean (SD) was 2.04 (0.7) before intervention versus the mean (SD) 3.07 (0.8) after intervention. Also, students’ ability in applying search and meta search engine improved significantly. This study clearly acknowledges that the training intervention provides considerable opportunity to improve medical student’s information literacy skills

Heart failure: a prevalence-based and model-based cost analysis

IntroductionHeart failure (HF) imposes a heavy economic burden on patients, their families, and society as a whole. Therefore, it is crucial to quantify the impact and dimensions of the disease in order to prioritize and allocate resources effectively.MethodsThis study utilized a prevalence-based, bottom-up, and incidence-based Markov model to assess the cost of illness. A total of 502 HF patients (classes I–IV) were recruited from Madani Hospital in Tabriz between May and October 2022. Patients were followed up every two months for a minimum of two and a maximum of six months using a person-month measurement approach. The perspective of the study was societal, and both direct and indirect costs were estimated. Indirect costs were calculated using the Human Capital (HC) method. A two-part regression model, consisting of the Generalized Linear Model (GLM) and Probit model, was used to analyze the relationship between HF costs and clinical and demographic variables.ResultsThe total cost per patient in one year was 261,409,854.9 Tomans (21,967.21 PPP). Of this amount, 207,147,805.8 Tomans (17,407.38 PPP) (79%) were indirect costs, while 54,262,049.09 Tomans (4,559.84 PPP) (21%) were direct costs. The mean lifetime cost was 2,173,961,178 Tomans. Premature death accounted for the highest share of lifetime costs (48%), while class III HF had the lowest share (2%). Gender, having basic insurance, and disease class significantly influenced the costs of HF, while comorbidity and age did not have a significant impact. The predicted amount closely matched the observed amount, indicating good predictive power.ConclusionThis study revealed that HF places a significant economic burden on patients in terms of both direct and indirect costs. The substantial contribution of indirect costs, which reflect the impact of the disease on other sectors of the economy, highlights the importance of unpaid work. Given the significant variation in HF costs among assessed variables, social and financial support systems should consider these variations to provide efficient and fair support to HF patients

The Barriers to Implementation of New Public Management Strategies in Iran’s Primary Health Care: A Qualitative Study

INTRODUCTION: New Public Management (NPM) is a special management philosophy used by governments. OBJECTIVES: The aim of NPM is to increase efficiency, effectiveness and cost saving in public sector through employing private sector characteristics and market mechanisms. Therefore, objective of this study is to identify barriers and challenges to understand the limitations of implementing the NPM model. STUDY DESIGN: A qualitative study STUDY SETTING: Managers of primary health care (PHC), East Azerbaijan, Iran. METHODOLOGY: The researchers performed a series of semi-structured interviews with health managers (n=30) and three focus group discussions with policy makers and district health managers (n=9) in 2016. A questionnaire was used for collecting demographic characteristics and managers’ perspectives. RESULTS: Lack of authority, executive bureaucracy, traditional budgeting system, poor payment systems, inadequate resources were considered to be the most common managerial barriers to the implementation of NPM. From the experts' view, the other factors that can affect poor implementation of NPM reforms in public health complexes are as follow: a shortage of trained managers, centralized decision-making process, organization's unwillingness to compete, lack of customer-oriented culture, lack of supervisor support and feedback, disharmony between employee needs and appraisal goals, absence of clear and independent performance dimensions, and biases in the process of evaluation. CONCLUSION: Designing and implementing an NPM reform need to be based on the operational reality and conditions of every country because most of the NPM programs in different countries are suffering from non-implementation syndrome. Therefore, before implementing this reform, identifying managerial barriers and challenges helps managers to execute the NPM in their desired sector properly

The impact of walnut leaf on the lipid and glucose profiles in diabetic patients: A systematic review and meta-analysis

Managing risk factors associated with cardiovascular diseases, such as blood lipids and blood sugar in people with diabetes (PWDs), is important. Besides antidiabetic medicines, herbal remedies such as walnut leaves have long been utilized to decrease blood sugar and blood lipid levels in PWDs. Hence, this study aimed to investigate the impact of walnut leaf on the lipid and glucose profiles of PWDs through a systematic review and meta-analysis. To gain access to the primary empirical studies, domestic and international databases were searched using MeSH keywords. The databases included Barakat Gostar, SID, Magiran, IranDoc, PubMed, Scopus, Web of Science, Embase, Cochrane, International Standard Randomized Controlled Trial Number (ISRCTN), International Clinical Trials Registry Platform (ICTRP), and Clinical Trial.gov (a clinical trial registration system). Data analysis was performed within Stata 14 software. The P-value was considered P <0.05. In 4 studies with a sample size of 101 individuals, which were published between 2014 and 2018, post-test scores of the treatment and control groups pointed out that the difference between insulin and FBS levels was statistically significant. The FBS level was higher in the control group than in the treatment group. However, their insulin level was lower than those in the treatment group. The difference between the levels of HbA1C, cholesterol, triglyceride, LDL, HDL, AST, ALT, ALP, and creatinine in the control and treatment groups was not statistically significant. The pre and post-test scores of the treatment group were compared. The levels of FBS, HbA1C, and LDL decreased significantly, while the patients' insulin levels increased remarkably. No noticeable correlation was observed in other lipid profiles. Due to the thoroughly limited research resources, further studies are required to confirm the findings more confidently

Mapping catquest scores onto EQ-5D utility values in patients with cataract disease

Background: Mapping from non-performance-based measures onto generic performance-based measures provides an appropriate solution to derive utilities to be used in economic evaluations. Objectives: This study aimed to create a model through which EQ-5D utilities for cataracts can be obtained from scores on the disease-specific Catquest measure. Patients and Methods: One hundred ninety-nine observations from 103 patients who self-administered the EQ-5D, the Catquest and questions on demographic and clinical characteristics were included in the analysis. Data was divided into estimation and validation datasets. To predict EQ-5D utilities, multiple regression analysis, using the Ordinary Least Square (OLS) and the censored least absolute deviation (CLAD), was performed. Catquest scores, age, gender, and performing surgery were included as explanatory variables. An estimation dataset was used to derive the coefficients, and these coefficients were then validated using a validation dataset. Based on the explanatory power, the consistency, the simplicity, the mean absolute error (MAE) and the correlations between observed and fitted utilities, the most appropriate model was selected. Results: The mean EQ-5D and Catquest scores of the total sample were 0.631 and 15.8, respectively. Age and surgery showed no significant effect for either method. Removing age and surgery, model II was built and given an R2of 0.697, an MAE of 0.1176 for the OLS and an R2of 0.614, and an MAE of 0.1153 for the CLAD method. In the validation stage, the CLAD revealed better prediction ability, with an MAE of 0.198 versus an MAE of 0.209 for the OLS. ICC and Bland-Altman analysis put the CLAD as a preferred method with the following equation: Utilities (EQ-5D) = 0.988 - 0.0281 × Catquest (PD) + 0.102 × gender (male = 1). Conclusions: Based on these results, a mapping function was obtained which appears to be valuable in predicting EQ-5D utilities from Catquest scores. This function gives an appropriate solution to estimate utilities when primary EQ-5D data is not available. Although the model represents good consistency and predictive ability, further examination of obtained function is required with large samples. © 2016, Iranian Red Crescent Medical Journal

Molecular mechanisms related to colistin resistance in enterobacteriaceae

Colistin is an effective antibiotic for treatment of most multidrug-resistant Gram-negative bacteria. It is used currently as a last-line drug for infections due to severe Gram-negative bacteria followed by an increase in resistance among Gram-negative bacteria. Colistin resistance is considered a serious problem, due to a lack of alternative antibiotics. Some bacteria, including Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacteriaceae members, such as Escherichia coli, Salmonella spp., and Klebsiella spp. have an acquired resistance against colistin. However, other bacteria, including Serratia spp., Proteus spp. and Burkholderia spp. are naturally resistant to this antibiotic. In addition, clinicians should be alert to the possibility of colistin resistance among multidrug-resistant bacteria and development through mutation or adaptation mechanisms. Rapidly emerging bacterial resistance has made it harder for us to rely completely on the discovery of new antibiotics; therefore, we need to have logical approaches to use old antibiotics, such as colistin. This review presents current knowledge about the different mechanisms of colistin resistance. © 2019 Aghapour et al

Vectorial crystal growth of oriented vertically aligned carbon nanotubes using statistical analysis

In this present work, crystalline growth conditions of oriented carbon nanotubes based on chemical vapor deposition (CVD) were optimized. The crystallinity and degree of alignment of the grown carbon nanotubes (CNTs) were characterized by field emission scanning electron microscopy, transmission electron microscopy, and Raman spectroscopy. The effects of four variables, namely, deposition time, deposition temperature, annealing process, and concentration of the precursor on the crystallinity of the CNTs, were explored. Furthermore, the correlation of parameters with the growth mechanism was examined using response surface methodology in an attempt to determine the complex interactions between the variables. A total of 30 runs, including predicting and consolidation runs to confirm the results, were required for screening the effect of the parameters on the growth of the CNTs. On the basis of the investigated model, it was found that the crystallinity of the CNTs grown by the CVD method can be controlled via restriction of the effective parameters. (Graph Presented)