Transvaginal sonography and surgical findings in the diagnosis of endometriosis individuals: A cross-sectional study

Background: Endometriosis is a challenging gynecological disease and a debilitating condition that profoundly affects the individual’s quality of life. Besides pathological confirmation, diagnostic laparoscopy has been internationally accepted as the standard method to identify the accurate mapping of endometriosis. Transvaginal sonography (TVS) is the first non-invasive imaging modality to estimate the severity of endometriosis. Objective: This study aimed to evaluate the accuracy of TVS in affected women compared with surgical findings. Materials and Methods: This retrospective cross-sectional study surveyed 170 women with deep infiltrating endometriosis (DIE) referred to the endometriosis part of the Avicenna Infertility Center, Tehran, Iran and they underwent TVS followed by laparoscopy. Recorded data of individuals under study in the medical database system were reviewed. Finally, the agreement rate was calculated for ultrasound reports and intraoperative (IO) findings regarding ovarian endometrium, ovarian adhesion, involvement of cul-de-sac, rectovaginal septum, and bowel and ureter. Results: 170 women with DIE entered the study. The agreement of TVS and IO findings were 86.76% for left ovarian endometriosis and 70.86% for right ovarian endometriosis, 93.90% for left ovarian adhesion, and 88.90% for right ovarian adhesion, 88.90% for a cul-de-sac, and 84.82% for bowel nodules. The findings, based on a laparoscopic assessment of the pelvic floor, were completely compatible with ultrasound reports (100%). Conclusion: TVS allows a preoperative evaluation in planning the surgical policy associated. TVS is beneficial for dedicated mapping of DIE; thus, an expert radiologist can aid the surgeon in preoperative evaluation and IO management. Key words: Endometriosis, Laparoscopy, Pathology

Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis

Introduction: The variety of frameworks and models to describe resilience in the health system has led researchers and policymakers to confusion and the inability to its operationalization. Therefore, the purpose of this study was to create a meta-framework using the Critical Interpretive Synthesis method. Method: For this purpose, studies that provide theories, models, or frameworks for organizational or health system resilience in humanitarian or organizational crises were systematically reviewed. The search strategy was conducted in PubMed, Web of Science, Embase, and Scopus databases. MMAT quality appraisal tool was applied. Data were analysed using MAXQDA 10 and the Meta-ethnography method. Results: After screening based on eligibility criteria, 43 studies were reviewed. Data analysis led to the identification of five main themes which constitute different framework dimensions. Health system resilience phases, attributes, tools, and strategies besides health system building blocks and goals are various dimensions that provide a systematic framework for health system resilience analysis. Discussion: This study provides a systemic, comprehensive framework for health system resilience analysis. This meta-framework makes it possible to detect the completeness of resilience phases. It examines the system’s resilience by its achievements in intermediate objectives (resilience system attributes) and health system goals. Finally, it provides policy solutions to achieve health system resilience using tools in the form of absorptive, adaptive, and transformative strategies

Hospitals during economic crisis: a systematic review based on resilience system capacities framework

Background: Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals’ policy solutions during the economic crisis using the resilience system capacities framework. Method: This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system’s six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment). Findings: After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers’ competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies. Conclusion: The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC

Effect of Carob Supplement on Spermogram Parameters and Sexual Function of Infertile Men Referred to the Infertility Center, Hamadan, Iran, 2019: A Randomized Controlled Trial

Objective: The purpose of this study is comparison of carob with placebo in the treatment of male infertility. Materials and methods: This study was performed as a clinical trial with two-group pretest-posttest design. Each group consisted of 30 members. The first group received 1.5 grams of carob per day, and the second group received placebo treatments. Treatment lasted for 12 weeks. Semen analysis as well as testosterone, prolactin, (LH), (FSH) and (TSH) were performed before and after drug treatment in two groups. Sexual function was assessed in the groups in two stages before and after the intervention using the standard International Index of Erectile Function. P-value less than 0.05 was considered statistically significant. Statistical analysis of data was performed using SPSS 16. Results: The participants’ mean age was 34.83 ±6.22 in the placebo and 33.67 ±5.82 years in the Carob group. The results showed in the carob group compared to the placebo group, the rate of normal sperm counts increased by 17% and also the normal level of testosterone was 40% higher than the abnormal levels of the placebo group and these differences were statistically significant (P 0.05). Conclusion: It is recommended to use carob supplements to improve spermogram parameters and male sex hormones

Long and Short-term Metformin Consumption as a Potential Therapy to Prevent Complications of COVID-19

Purpose: The aim of the study is to evaluate the effect of metformin in complication improvement of hospitalized patients with COVID-19. Methods: This was a randomized clinical trial that involved 189 patients with confirmed COVID-19 infection. Patients in the intervention group received metformin-500 mg twice daily. Patients who received metformin before admission were excluded from the control group. Patients who were discharged before taking at least 2000 mg of metformin were excluded from the study. Primary outcomes were vital signs, need for ICU admission, need for intubation, and mortality. Results: Data showed that patients with diabetes with previous metformin in their regimen had lower percentages of ICU admission and death in comparison with patients without diabetes (11.3% vs. 26.1% (P=0.014) and 4.9% vs. 23.9% (P≤0.001), respectively). Admission time characteristics were the same for both groups except for diabetes and hyperlipidemia, which were significantly different between the two groups. Observations of naproxen consumption on endpoints, duration of hospitalization, and the levels of spO2 did not show any significant differences between the intervention and the control group. The adjusted OR for intubation in the intervention group versus the control group was 0.21 [95% CI, 0.04-0.99 (P=0.047)]. Conclusion: In this trial, metformin consumption had no effect on mortality and ICU admission rates in non-diabetic patients. However, metformin improved COVID-19 complications in diabetic patients who had been receiving metformin prior to COVID-19 infection, and it significantly lowered the intubation rates

Relationship between Head Nurses’ Ethical Leadership and Demographic Characteristics with General Self-Efficacy of ICU Nurses in Educational-Treatment Centers of Hamadan University of Medical Sciences, Hamadan, Iran, 2019

Background and Objective: Ethical leadership has emerged as a new approach in the perspective of leadership and has provided a basis for the promotion of individual and organizational effectiveness by prioritizing ethics in the organization. This study aimed to determine the relationship between head nurses’ ethical leadership and demographic characteristics with the general self-efficacy of nurses working in Intensive Care Units (ICUs). Materials and Methods: This descriptive correlational study was conducted in 2019 on 230 nurses working in ICUs of educational-treatment centers of Hamadan University of Medical Sciences, Hamadan, Iran, who were selected using a stratified proportional sampling method. Data were collected by ethical leadership in nursing and the general self-efficacy scale of Scherer. Data were analyzed using SPSS software (version 16) through descriptive and inferential statistics. Results: There was no statistically significant association between the ethical leadership of head nurses and the general self-efficacy of nurses. The general self-efficacy of formal nurses was higher than contractual (P=0.04) and resident nurses (P=0.02), and the self-efficacy of ICU nurses was higher than those working in burn units (P=0.03). Moreover, general self-efficacy decreased with work experience (P<0.05). Considering the output of the artificial neural network, the normalized significance scores of the independent variables on the dependent variable were obtained at 100, 74.8, 56.2, 52, 47.6, 46.4, 38.1, 37.1, 27, and 13.3, for work experience, pioneering, task orientation, moralism, workplace, age, job status, gender, division of power, and education, respectively. Conclusion: Considering the significant association between some demographic variables and the general self-efficacy of nurses, nursing managers are recommended to consider these variables, especially in retraining, to improve the general self-efficacy of nurses

Effect of mobile-assisted education on health promoting lifestyle and blood sugar of women with gestational diabetes: a randomised controlled trial

Background The gestational diabetes causes complications for the mother and the baby.Methods It was a randomised controlled trial that was conducted in Public Health Center No 1 in Baghmalek, Khuzestan province, Iran. Seventy-six women with gestational diabetes mellitus (GDM) were recruited and randomly allocated into an intervention (n=38) and a control group (n=38). A mobile app was developed, and the content of the educational programme was designed according to the six dimensions of Health Promotion Lifestyle Profile (HPLP). Participants in the intervention group followed instructions about healthy lifestyle for 4 weeks, whereas the control group received only routine care. A demographic questionnaire, and the HPLP-II were used to gather the data.Health promoting lifestyle and blood sugar of participants were measured after 4 weeks.Results The total score of HPLP was 98.34±13.99 and 92.39±14.56 before the intervention in intervention and control groups, respectively, which was improved significantly in the intervention group compared with the control group after intervention (143.13±23.41 vs 100.39±16.69, p&lt;0.0001). Also, the scores of stress management, responsibility, interpersonal relationship, spiritual growth, nutrition and physical activity were significantly improved in the intervention group. Fasting blood sugar and blood sugar 2 hours after meal significantly reduced in the intervention group compared with the control group (86.05±7.71 mg/dL vs 93.92±5.52 mg/dL) and (113.65±10.96 mg/dL vs 124.97±9.15 mg/dL), (p=0.001), respectively.Conclusions Our results showed that offering educational programmes based on mobile apps can improve healthy lifestyle and blood sugar in women with GDM.Trial registration number IRCT20200817048434N1Website address https://www.irct.ir/search/result?query=IRCT20200817048434N

Frequency and causes of medication errors of nurses in

Background: Medication orders are an important part of the healing and patient care process. Considering theincreasing statistics of medication errors, a study was conducted to study the frequency, type, and causes ofmedication errors of nurses in medical and surgical wards in different shifts of educational hospitals affiliatedwith ShahidBeheshti University of Medical Science in 2012.Materials and Methods:This is a descriptive study conducted on 218 nurses working at medical and surgicalwards of educational hospitals affiliated with ShahidBeheshti University of Medical Science in 2012. Thesampling method was stratified. Data collection tools were questionnaires. The data was analyzed by SPSS18th version using descriptive statistics, two-sample tests, analysis of variance, and Pearson correlationcoefficient.Results: The average medication errors in one monthwas 31/6 casesper nurse. Gender and shiftwork weresignificantly related to medication errors so that the average medication errors more in men than in women.Furthermore Statistical significant difference was observed in the number of medication errors in differentshiftwork indicating that the average medication errors were the highest in the afternoon and night shifts. Theaverage of medication errors in night shift were more than morning shift while there was no differencebetween the morning shift and the rotation one. Wrong time error was the most frequent one in the study.According to nurses the most important factors in medication errors are high workload, lack of nurses perpatients in each ward, and fatigue.Conclusion:Based on the results of the study, it's necessary for nursing managers to pay more attention tological proportion of patient/staff at different wards, reduction of workload and reduction of nurses" workhours because these factors can lead to their fatigue and a fall in their concentration.Keywords: medication errors, nurses, and factor

A systematic review on diagnostic procedures for specific language impairment: The sensitivity and specificity issues

Background: Identification of children with specific language impairment (SLI) has been viewed as both necessity and challenge. Investigators and clinicians use different tests and measures for this purpose. Some of these tests/measures have good psychometric properties, but it is not sufficient for diagnostic purposes. A diagnostic procedure can be used for identification a specific population with confidence only when its sensitivity and specificity are acceptable. In this study, we searched for tests/measures with predefined sensitivity and specificity for identification of preschool children with SLI from their typically developing peers. Materials and Methods: A computerized search in bibliographic databases from 2000 to August 2015 was performed with the following keywords: "specific language impairment" or SLI" and "primary language impairment" or ′PLI′ with at least one of the followings: "diagnosis," "identification," "accuracy," "sensitivity," and "specificity." In addition, the related citations and reference lists of the selected articles were considered. Results: The results of reviewing 23 included studies show that the index measures used in studies vary in accuracy with the sensitivity ranging from 16% to 100% and the specificity ranging from 14% to 100%. Conclusion: These varieties in sensitivity and specificity of different tests/measures confirm the necessity of attention to the diagnostic power of tests/measures before their use as diagnostic tool. Further, the results indicate there are some promising tests/measures that the available evidence supports their performances in the diagnosis of SLI in preschool-aged children, yet the place of a reference standard for the diagnosis of SLI is vacant among investigations

Changes in Bleached Enamel Microhardness After Application of Fluoride and CPP-ACP

Background and Aim : Tooth bleaching decreases enamel microhardness. The aim of this study was to evaluate the changes in microhardness of bleached enamel after applying fluoride and CPP-ACP (casein phosphopeptide –amorphous calcium phosphate ). Materials and Methods : In this experimental study , sixty extracted human molars were divided into six groups (ten each). The flatted occlusal surface was covered with nail varnish. In the second, third and fourth groups, tooth bleaching was performed. The first and second groups were positive and negative control groups. In the third and fifth groups, the specimens were covered with sodium fluoride varnish and the fourth and sixth groups underwent CPP-ACP therapy. Subsurface enamel microhardness was determined on the occlusal surface with 300 micron distance from the buccal or lingual surface. One way ANOVA and Tukey post hoc were used for statistical analysis . Results : Microhardness of bleached enamel was significantly lower than the other groups. The teeth treated by fluoride agent or CPP-ACP after bleaching had a significant increase in their microhardness in contrast with the bleached enamel. CPP-ACP and fluoride treatment had no significant effect on sound enamel microhardness. Although using CPP-ACP and fluoride increases the enamel microhardness, there was no significant differences between them .  Conclusion : Fluoride and CPP-ACP components increase bleached enamel microhardness