R&D Management in Iran, Opportunities and Threats

Research and Development (R&D) management in Iran has faced many barriers and obstacles, in which R&D units are considered as the basic core of the product development and innovation. Due to structural shortcomings, a great number of organizations and industries have not yet been able to position themselves in the market. There are about 1141 R&D units throughout Iran, due to the geographical decentralization of these units this paper considers and analyzes the R&D case study in one of the provinces located in the north part of Iran, and the findings can be generalized to the other industrialized areas and zones in Iran. In this province, there are about 2504 industrial units of which there are only 44 R&D units certified by the state government. However, there is limited number of these R&D units that are extensively active. This paper also addresses the current status in respect with the R&D activities to find out why little attention has been paid to these activities in the industrial units. Considering the opportunities and challenges of these R&D units reveals that there is a need to activate these units so that they can quickly respond to changes in the market. Finally, a few alternative solutions and improvement plans are proposed, in which the Iranian R&D Society is responsible for supporting and fostering these action plans towards the organization goals. The research methodology was based on a previous field research conducted in Hamedan province, and after the analysis of the research results, a model for the efficiency of R&D units will be presented.R&D management, R&D Society, Innovation, Industrial sectors

Experimental and analytical study on the behavior of steel plate shear walls with box-shaped columns under cyclic loading

Steel plate shear walls are lateral load resisting systems consisting of vertical steel plate infills connected to the surrounding beams and columns. One of the parameters affecting the behavior of steel plate shear wall system under lateral load is characteristic of surrounding members. Since there are lots of experimental and analytical studies on steel plate shear walls with I-shaped surrounding members, this research is an experimental study carried out on a one-third scale steel plate shear wall system with box-shaped columns along with further analytical studies. The objectives were to calculate the stiffness, strength and energy dissipation capacity of the specimen and compare them with a very similar system constructed with I-shaped columns. Cyclic loading protocol of ATC-24 was used for test. Obtained experimental results showed a good conformity between box and I-shaped specimens. It is shown that the system can provide good initial stiffness and high ultimate capacity and remain intact under seismic effects. Some analytical studies on failure modes of system with box-shaped columns were also conducted using finite-element software confirming that the columns bottom connections and their flange buckling at that point are one of the most common modes of failure and a triangular reinforcing plate at that point can improve columns connection behavior effectively

Evaluation of Human Resource Productivity Dimensions Based on ACHIEVE Model: a study on personnel of hospitals affiliated to Iran University of Medical Sciences

Background & Objectives: Productivity and performance improvement of human resource, as the most valuable asset and resource in the organization, have a greater impact on success and productivity of the organization than any other factors. The purpose of this study was to evaluate the dimensions of human resource productivity based on ACHIEVE model among personnel of hospitals affiliated to Iran University of Medical Sciences. Methods: This descriptive-analytical cross-sectional study was performed on 358 clinical and nonclinical personnel in 15 teaching hospitals of Iran University of Medical Sciences in 2019, selected by stratified relative randomized sampling. To collect data, the standard ACHIEVE questionnaire was used. Data analysis was done using one-way ANOVA, T-test and Tukey post hoc and through SPSS version 22 software. Results: Mean score of human resource productivity was 2.8 which was in a moderate condition. The highest and lowest mean scores of productivity were respectively related to environment (3.38) and motivation (2.30) dimensions. There was a significant difference in productivity based on gender, occupational group and educational level. Conclusion: It seems that creating performance-based management systems and fair rewards and benefits systems, as well as continuous performance appraisal sessions between employees and their supervisors could be effective in increasing motivation. Key­words: Evaluation, Productivity, Clinical personnel, Nonclinical personnel, Teaching hospital, ACHIEVE Model Citation: Jafari M, Hedayatirad S, Aryankhesal A, Bordbar N, Tavakoli N. Evaluation of Human Resource Productivity Dimensions Based on ACHIEVE Model: a study on personnel of hospitals affiliated to Iran University of Medical Sciences. Journal of Health Based Research 2019; 5(3): 273-86. [In Persian

Pain Management in the Emergency Department: a Review Article on Options and Methods

Context: The aim of this review is to recognizing different methods of analgesia for emergency medicine physicians (EMPs) allows them to have various pain relief methods to reduce pain and to be able to use it according to the patient’s condition and to improve the quality of their services. Evidence acquisition: In this review article, the search engines and scientific databases of Google Scholar, Science Direct, PubMed, Medline, Scopus, and Cochrane for emergency pain management methods were reviewed. Among the findings, high quality articles were eventually selected from 2000 to 2018, and after reviewing them, we have conducted a comprehensive comparison of the usual methods of pain control in the emergency department (ED).  Results: For better understanding, the results are reported in to separate subheadings including “Parenteral agents” and “Regional blocks”. Non-opioids analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are commonly used in the treatment of acute pain. However, the relief of acute moderate to severe pain usually requires opioid agents. Considering the side effects of systemic drugs and the restrictions on the use of analgesics, especially opioids, regional blocks of pain as part of a multimodal analgesic strategy can be helpful. Conclusion: This study was designed to investigate and identify the disadvantages and advantages of using each drug to be able to make the right choices in different clinical situations for patients while paying attention to the limitations of the use of these analgesic drugs

Pain Management in the Emergency Department: a Review Article on Options and Methods

Context: The aim of this review is to recognizing different methods of analgesia for emergency medicine physicians (EMPs) allows them to have various pain relief methods to reduce pain and to be able to use it according to the patient’s condition and to improve the quality of their services. Evidence acquisition: In this review article, the search engines and scientific databases of Google Scholar, Science Direct, PubMed, Medline, Scopus, and Cochrane for emergency pain management methods were reviewed. Among the findings, high quality articles were eventually selected from 2000 to 2018, and after reviewing them, we have conducted a comprehensive comparison of the usual methods of pain control in the emergency department (ED).  Results: For better understanding, the results are reported in to separate subheadings including “Parenteral agents” and “Regional blocks”. Non-opioids analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are commonly used in the treatment of acute pain. However, the relief of acute moderate to severe pain usually requires opioid agents. Considering the side effects of systemic drugs and the restrictions on the use of analgesics, especially opioids, regional blocks of pain as part of a multimodal analgesic strategy can be helpful. Conclusion: This study was designed to investigate and identify the disadvantages and advantages of using each drug to be able to make the right choices in different clinical situations for patients while paying attention to the limitations of the use of these analgesic drugs

Seven Criteria of Severe COVID-19 (SCSC): A New Pre-Hospital Prognostic Scoring Tool Suggested for Screening of Probable/Confirmed COVID-19 Patients with Severe Outcomes

Introduction: COVID-19 pandemic led to various consequences in medical care that had been long provided for the patients referred to the hospitals. Objective: We conducted this study to derive and validate a new scoring system that can accurately differentiate COVID-19 patients who may have a worse outcome from others at the prehospital stage. Methods: This study was performed on probable/confirmed COVID-19 patients, who were transferred to the hospitals by Tehran emergency medical services (EMS). Occurrence of one of the items including: in-hospital death, intensive care unit (ICU) admission, or hospitalization for more than 20 days was considered to indicate a “severe disease”. Univariate and multivariate logistic regression were used for assessment of the relationship between all independent variables and the outcome. In the validity assessment step, area under the receiver operating characteristic (ROC) curve was calculated for a data set independent from the data based on which the model was designed. The sensitivity and specificity were also presented based on the best suggested cut-off point. Results: In this study, the data of 557 cases were analyzed in the derivation step and 356 cases were assessed in the validation step. The univariate logistic regression showed that age, weakness and fatigue, disease history, systolic blood pressure, SpO2, respiratory rate, and Glasgow coma scale (GCS) were statistically significant in severe disease group. The area under the ROC curve (AUC-ROC) of the tool was 0.808 (95% CI: 0.779, 0.834). The best cut-off point for screening was the score of ≥4, in which the sensitivity and specificity of the tool for the best cut-off point were 71.87% and 78.06%, respectively. In the validation step, the AUC-ROC of the tool was 0.723. Conclusions: Seven criteria of severe COVID-19 (SCSC) tool could properly differentiate probable/confirmed COVID-19 patients with severe outcomes in the pre-hospital stage

Validity of Triage Performed by Nurses Educated by Train-of-Trainer‬ Workshop Participants; a Cross-sectional Study for Assessment of Cascade Training System

Introduction: In 2010, a national triage train-of-trainer (TOT) workshop was held in Tehran, Iran. Objective: The present study aimed to assess the validity of the triage performed by the nurses educated by those who participated in TOT workshop. Method: This cross-sectional study was carried out in 6 teaching hospitals from 4 universities in Iran. Inter-rater and intra-rater reliability of performed triage by participations was measured. Thirteen nurses were randomly selected. Thereafter, at the end of each working shift, patient data recorded in the daily data registry forms were collected. Then, duration of hospital stay, number of cases admitted to general wards or intensive care units, number of cases discharged from the ED within 12 hours and mortality rate were compared with the triage level determined by the nurse. Results: In total, 30 nurses with a mean age of 28.4 ± 3.7 years were enrolled. In this study, 1491 triage cases (61.6% male) were evaluated, of which 4.2% were triaged as level 1, 18.3% as level 2, 37.1% as level 3, 20.4% as level 4 and 20.0% as level 5. The following outcome was observed: 3.64% were discharged, 6.29% were hospitalized, 3% died and 2.3% were discharged against medical advice without completing treatment. The correlation of determined triage level and patients’ duration of hospitalization was significant based on one-way ANOVA test (p = 0.000). The outcome of the patients significantly correlated with the level of triage determined by the study nurses (p = 0.000). Conclusion: Based on the findings, it appears that triage performed by the study nurses educated by those who participated in TOT workshop through cascade training system had perfect validity

Validity of Triage Performed by Nurses Educated by Train-of-Trainer‬ Workshop Participants; a Cross-sectional Study for Assessment of Cascade Training System

Introduction: In 2010, a national triage train-of-trainer (TOT) workshop was held in Tehran, Iran. Objective: The present study aimed to assess the validity of the triage performed by the nurses educated by those who participated in TOT workshop. Method: This cross-sectional study was carried out in 6 teaching hospitals from 4 universities in Iran. Inter-rater and intra-rater reliability of performed triage by participations was measured. Thirteen nurses were randomly selected. Thereafter, at the end of each working shift, patient data recorded in the daily data registry forms were collected. Then, duration of hospital stay, number of cases admitted to general wards or intensive care units, number of cases discharged from the ED within 12 hours and mortality rate were compared with the triage level determined by the nurse. Results: In total, 30 nurses with a mean age of 28.4 ± 3.7 years were enrolled. In this study, 1491 triage cases (61.6% male) were evaluated, of which 4.2% were triaged as level 1, 18.3% as level 2, 37.1% as level 3, 20.4% as level 4 and 20.0% as level 5. The following outcome was observed: 3.64% were discharged, 6.29% were hospitalized, 3% died and 2.3% were discharged against medical advice without completing treatment. The correlation of determined triage level and patients’ duration of hospitalization was significant based on one-way ANOVA test (p = 0.000). The outcome of the patients significantly correlated with the level of triage determined by the study nurses (p = 0.000). Conclusion: Based on the findings, it appears that triage performed by the study nurses educated by those who participated in TOT workshop through cascade training system had perfect validity

Job Burnout, Stress, and Satisfaction among Emergency Nursing Staff after Health System Transformation Plan in Iran

Introduction: Job burnout, stress, and satisfaction are linked to quality of care, patient outcomes and retention of staff. This study was conducted to determine the mentioned issues among emergency nurses.Methods: This cross-sectional study was conducted on all nurses working in the emergency departments of 10 hospitals in Tehran, Iran, in 2017. Standard questionnaires were used for gathering the data of participants regarding job burnout, stress, and satisfaction. Results: 709 (90%) participants returned the completed questionnaires (58.9% female). The mean age of the nurses was 33 (SD = 7) years. The level of job burnout was moderate in 76.1%, low in 22.5%, and high in 1.4% of the nurses. The level of burnout in the married nursing staff was lower than single nurses (3.78 ± 0.98 versus 4.14 ± 0.58, p = 0.049). The level of job satisfaction was moderate in 61.1%, low in 22.2%, and high in 16.7%. There was a significant correlation between age and job satisfaction (p = 0.027, r = 0.3). Job burnout was directly correlated with job stress (p ≤0.001, r = 0.57) and job burnout was negatively correlated with job satisfaction (p = 0.001, r = -0.41). Conclusion: More than 60% of the studied emergency nurses had moderate levels of job burnout, stress, and satisfaction. Job burnout had a direct correlation with job stress and indirect correlation with job satisfaction. Planning to reduce burnout of the emergency nursing staff seems to be necessary

Protocol Adherence in Prehospital Medical Care Provided for Patients with Chest Pain and Loss of Consciousness; a Brief Report

Introduction: Although many protocols are available in the field of the prehospital medical care (PMC), there is still a notable gap between protocol based directions and applied clinical practice. This study measures the rate of protocol adherence in PMC provided for patients with chest pain and loss of consciousness (LOC).Method: In this cross-sectional study, 10 educated research assistants audited the situation of provided PMC for non-traumatic chest pain and LOC patients, presenting to the emergency department of a tertiary level teaching hospital, compare to national recommendations in these regards.Results: 101 cases with the mean age of 56.7 ± 12.3 years (30-78) were audited (55.4% male). 61 (60.3%) patients had chest pain and 40 (39.7%) cases had LOC. Protocol adherence rates for cardiac monitoring (62.3%), O2 therapy (32.8%), nitroglycerin administration (60.7%), and aspirin administration (52.5%) in prehospital care of patients with chest pain were fair to poor. Protocol adherence rates for correct patient positioning (25%), O2 therapy (75%), cardiac monitoring (25%), pupils examination (25%), bedside glucometery (50%), and assessing for naloxone administration (55%) in prehospital care of patients with LOC were fair to poor.Conclusion: There were more than 20% protocol violation regarding prehospital care of chest pain patients regarding cardiac monitoring, O2 therapy, and nitroglycerin and aspirin administration. There were same situation regarding O2 therapy, positioning, cardiac monitoring, pupils examination, bedside glucometery, and assessing for naloxone administration of LOC patients in prehospital setting