Efficacy of Granisetron versus Sufentanil on Reducing Myoclonic Movements Following Etomidate: A double-blind, randomized clinical trial

Objective: Etomidate-induced myoclonus occurs in up to 85% of patients under general anesthesia. This type of myoclonus can induce significant clinical and economic problems in patients with special conditions. Hence, to reduce the intensity of myoclonus movements, the present study was conducted to compare the effectiveness of granisetron and sufentanil on reducing the intensity of etomidate-induced myoclonic movements. Methods: This double-blind randomized clinical trial study consisted of 96 adult patients. Using block randomization, subjects were divided into three groups of 32: the group receiving granisetron 40 μg / kg (group G), the group receiving sufentanil 0.2 μg / kg (group S), and the control group who did not receive the pretreatment (group C). Patients received these medications as pretreatments 120 seconds before induction with etomidate. After injection of etomidate with a dose of 0.3 mg/kg, the incidence of myoclonus was evaluated. After evaluating the myoclonus, the full dose of narcotics (fentanyl 1 μg / kg) and muscle relaxants (atracurium 0.5 mg/kg) were administered to patients, and a suitable airway was established for them. Results: The findings indicated that granisetron reduced the intensity and incidence of myoclonic movements more than sufentanil. In addition, myoclonic movements were observed at a significantly higher intensity in the control group (P=0.001). Conclusion: The results obtained from the current study indicate that granisetron and sufentanil as pretreatments are effective for reducing myoclonus in patients. Keywords: Granisetron; Sufentanil; Etomidate; Myoclonus; Movement

El impacto de las fluctuaciones del precio del petróleo en el poder de préstamo bancario en Irán: una aplicación del enfoque GMM

The abundance of oil resources and the dependence of the state budget on crude oil exports have exposed Iran's single-product economy to oil price fluctuations and its consequences. On the other hand, according to the country's financial system and its being bank-centric, one of the sectors that are constantly affected by oil price fluctuations is the banking system and its performance. To this end, the present study investigated the impact of oil price fluctuations on lending power of specialized banks in Iran using seasonal data from 1999 to 2018 using by Generalized Method of Moments (GMM). The results of this study indicate that during the period under review, oil price fluctuations has been a negative and significant effect (coefficient of -0.01) on the credit growth of specialized banks. In addition, GDP growth and inflation have been, respectively, a positive and negative effect (coefficients of 0.09 and -0.09) on the lending power of specialized banks during the period under review.La abundancia de recursos petroleros y la dependencia del presupuesto estatal de las exportaciones de petróleo crudo han expuesto la economía de un solo producto de Irán a las fluctuaciones del precio del petróleo y sus consecuencias. Por otro lado, de acuerdo con el sistema financiero del país y su bancarización, uno de los sectores que se ve constantemente afectado por las fluctuaciones del precio del petróleo es el sistema bancario y su desempeño. Con este fin, el presente estudio investigó el impacto de las fluctuaciones del precio del petróleo en el poder de préstamo de los bancos especializados en Irán utilizando datos estacionales de 1999 a 2018 utilizando el Método Generalizado de Momentos (GMM). Los resultados de este estudio indican que durante el período bajo revisión, las fluctuaciones del precio del petróleo han tenido un efecto negativo y significativo (coeficiente de -0.01) en el crecimiento del crédito de los bancos especializados. Asimismo, el crecimiento del PIB y la inflación han tenido, respectivamente, un efecto positivo y negativo (coeficientes de 0,09 y -0,09) sobre el poder crediticio de los bancos especializados durante el período analizado

Measuring hospital service quality and its influence on patient satisfaction: An empirical study using structural equation modeling

This paper presents an empirical investigation to measure different dimensions of hospital service quality (HSQ) by gap analysis and patient satisfaction (PS). It also attempts to measure patients’ satisfaction with three dimensions extracted from exploratory factor analysis (EFA) by Principle component analysis method and conformity factor analysis (CFA). In addition, the study analyzes relationship between HSQ and PS in the context of Iranian hospital services, using structural equation modeling (SEM) from patients’ perspectives. The maximum gap observed in “responsiveness” and the minimum one in “assurance”. In addition, patients had the most satisfaction in “trust” with the mean of 3.83 followed by “General Satisfaction” with the mean of 3.68 and they had the least satisfaction in “Acceptance” with the mean of 3.53. Two measurement models were used for measuring hospital service quality and patient satisfaction and one structural model, which showed the relationship between them. The result of this study showed that there was a positive and significant impact from hospital service quality on patient satisfaction (0.463). In addition, there was a positive and significant relationship between hospital service quality and five dimensions. Furthermore, it was shown that patient satisfaction and three dimensions (General Satisfaction, Trust, and Acceptance) were associated with each other, significantly and positively. At last management strategies and practical suggestions were presented to hospital

Effect of Reengineering on the Information and Statistics Process in the Iran University of Medical Sciences

Introduction: Nowadays, organizations working in dynamic and competitive environments have to change their processes from both the inside and outside of the organization. One of the most effective strategies for monitoring and controlling these changes is re-engineering. This study aimed to refine the collection and classification process of data through re-engineering. Methods: This study was done with an analytical-descriptive approach in 2012, in the Planning and Budget department of the Iran University of Medical Sciences. Data were collected by documents, interviews and observations. Three main process indicators include: number of activities, time, and costs of human resource. These were calculated and compared before and after the implementation of the reengineering. Data were analyzed using Microsoft Excel 2007. Results: The current status of the process included 53 activities that reduced to 27 after reengineering. Total process time was reduced from 79 to 38 days and direct human costs decreased to about 15 million Rls. Thus, by the implementation of reengineering, the number of activities, time and costs were decreased to 49%, 52% and 54% respectively. Conclusion: Based on the findings, re-engineering led to improvements of performance and saved resources. Therefore the use of this technique is recommended in order to have an improvement in different performances, increases satisfaction and saves resources

The Effects of Body Acupuncture on Obesity: Anthropometric Parameters, Lipid Profile, and Inflammatory and Immunologic Markers

A randomized controlled clinical trial in 196 obese subjects was performed to examine the effectiveness of body acupuncture on body weight loss, lipid profile and immunogenic and inflammatory markers. Subjects received authentic (cases) or sham (controls) acupuncture for 6 weeks in combination with a low-calorie diet. In the following 6 weeks, they received the low-calorie diet alone. Subjects were assessed at the beginning, 6 and 12 weeks later. Heat shock protein (Hsps)-27, 60, 65, 70 antibody titers and high sensitivity C-reactive protein (hs-CRP) levels were also assessed. A significant reduction in measures of adiposity and improvement in lipid profile were observed in both groups, but the levels of anti-Hsp-antibodies decreased in cases only. A reduction in anthropometric and lipid profile in cases were sustained in the second period, however, only changes in lipid profile were observed in the control group. Anti-Hsp-antibodies and hs-CRP levels continued to be reduced in cases but in controls only the reduction in hs-CRP remained. Changes in anthropometric parameters, lipid profile, and anti-Hsp-antibodies were more evident in cases. Body acupuncture in combination with diet restriction was effective in enhancing weight loss and improving dyslipidemia

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Modeling health-oriented behavior patterns based on abnormal personality traits with mediating role of health beliefs in the period of the COVID-19 pandemic

Background. Paying attention to the spread of Corona in the last few years and the problems related to the health of hospital employees is very important. This research was conducted with the aim of modeling health-oriented behavior patterns based on abnormal personality traits with mediating role of health beliefs in the period of the COVID-19 pandemic. Methods. The research method of this study was descriptive-correlation and structural equation modeling. The statistical population included the personnel of Al-Zahra State Hospital in Isfahan, of which 385 people were selected based on a convenience sampling method. The research tools included the personality abnormal dimensions questionnaire (PID-5), the health belief scale and health-oriented behavioral patterns. Pearson's correlation coefficient (with SPSS.23 software) and structural equation modeling (SMART PLS.3) were used for data analysis. Results. There was a relationship between abnormal personality traits and health-oriented behavior patterns during the COVID-19 pandemic period (β=0.47 and P<0.01). There was a relationship between health beliefs and health-oriented behavioral patterns during the COVID-19 pandemic period (β=0.223 and P<0.01). However, the mediating role of health beliefs in the relationship between abnormal personality traits and health-oriented behavioral patterns was not significant (β=0.026 and P<0.05). Conclusion. Abnormal personality traits had a direct effect on health-oriented behavioral patterns. Practical Implications. Paying attention to the destructive role of the corona virus in all aspects of people's lives, especially the medical staff and the role of medical staff in caring for and improving the physical and mental condition of patients can show its importance in the results of this research

Comparison of two methods for quantification of Acinetobacter baumannii biofilm formation

Introduction: ‏ Medical devices are made from a variety of materials such as polypropylene, polycarbonate, poly styrene, glass and etc. by attaching to this surfaces, Acinetobacter baumannii can form biofilms and then cause several device associated infections. Biofilms are communities of bacteria attached to the surfaces. In this study, biofilm formation ability in clinical isolates of Acinetobacter baumannii was assessed by two methods on different surfaces. Materials and methods: ‏ Biofilm formation by 75 clinical isolates of A. baumannii was evaluated on polycarbonate surface (microtiter plate) and polypropylene surface (falcon) by crystal violet and 2,3-Bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide salt (XTT tetrazolium sodium salt) assay methods. Falcon or tube method was carried out under static and agitation conditions. Results: ‏ Results showed the most isolates can form biofilm but higher numbers of isolates form biofilm on polypropylene surface under agitation. XTT method confirmed strong biofilm formation ability of 10 isolates. Discussion and conclusion: Each of the two assays showed an excellent applicability for the quantification of biofilms. The Crystal violet assay is cheap, easy and is usually used for the quantification of biofilms formed by microorganisms but XTT is more reliable and repeatable. Most of A. baumannii isolates have potential to form biofilm on the medical devices which may result in device-associated infections

Management Science Letters Measuring hospital service quality and its influence on patient satisfaction: An empirical study using structural equation modeling

This paper presents an empirical investigation to measure different dimensions of hospital service quality (HSQ) by gap analysis and patient satisfaction (PS). It also attempts to measure patients&apos; satisfaction with three dimensions extracted from exploratory factor analysis (EFA) by Principle component analysis method and conformity factor analysis (CFA). In addition, the study analyzes relationship between HSQ and PS in the context of Iranian hospital services, using structural equation modeling (SEM) from patients&apos; perspectives. The maximum gap observed in &quot;responsiveness&quot; and the minimum one in &quot;assurance&quot;. In addition, patients had the most satisfaction in &quot;trust&quot; with the mean of 3.83 followed by &quot;General Satisfaction&quot; with the mean of 3.68 and they had the least satisfaction in &quot;Acceptance&quot; with the mean of 3.53. Two measurement models were used for measuring hospital service quality and patient satisfaction and one structural model, which showed the relationship between them. The result of this study showed that there was a positive and significant impact from hospital service quality on patient satisfaction (0.463). In addition, there was a positive and significant relationship between hospital service quality and five dimensions. Furthermore, it was shown that patient satisfaction and three dimensions (General Satisfaction, Trust, and Acceptance) were associated with each other, significantly and positively. At last management strategies and practical suggestions were presented to hospital