Perceived hospital managerial competency in Tehran, Iran: Is there a difference between public and private hospitals?

Background Hospital managers should have enough managerial competencies to coordinate the complex environment. The underlying assumption is that there is a potential gap in management capacity between public and private hospitals in Iran. This study aims to evaluate competency level of hospital managers and to compare their competencies in public and private hospitals. Materials and methods This study was descriptive-analytic, carried out in 2015. A survey using a selfadministered questionnaire was conducted among 127 public and private hospitals managers in Tehran Province, Iran. Respondents were asked to rate their competencies in a five-key subscale that included people-related skills, health delivery, self-management, task-related skills, and strategic planning and management. Ratings were based on a five-point Likert scale ranging from very low to excellent competency level. Results Self-assessment of competencies level showed that managers in all state hospitals evaluate their competency at a low level. Managers felt most competent in healthdelivery skills (3.71), people-related skills (3.61), and strategic planning and management (3.57), relatively less competent in self-management (3.54) and taskrelated skills (3.49). While being the mean total competency levels were significantly higher among male managers, those who participated in the healthcare/hospital management training courses, and those whose primary formal qualification was management in healthcare/hospital management (P<0.05). Similarly, managers who had more experience in their current position were more likely to report higher competencies level (P<0.05). Managers in private hospitals perceived themselves to be significantly more competent than their public hospitals colleagues in most of the management facets (P<0.001). Conclusion and recommendations There is a perceived lack of management capacity by managers of both public and private hospitals and the gap between public and private hospitals is small. There is widespread need for management training to be made available in Iran. © 2016 Egyptian Public Health Association

Hip morphology influences the pattern of damage to the acetabular cartilage. Femoroacetabular impingement as a cause of early osteoarthritis of the hip

Recently, femoroacetabular impingement has been recognised as a cause of early osteoarthritis. There are two mechanisms of impingement: 1) cam impingement caused by a non-spherical head and 2) pincer impingement caused by excessive acetabular cover. We hypothesised that both mechanisms result in different patterns of articular damage. Of 302 analysed hips only 26 had an isolated cam and 16 an isolated pincer impingement. Cam impingement caused damage to the anterosuperior acetabular cartilage with separation between the labrum and cartilage. During flexion, the cartilage was sheared off the bone by the non-spherical femoral head while the labrum remained untouched. In pincer impingement, the cartilage damage was located circumferentially and included only a narrow strip. During movement the labrum is crushed between the acetabular rim and the femoral neck causing degeneration and ossification. Both cam and pincer impingement lead to osteoarthritis of the hip. Labral damage indicates ongoing impingement and rarely occurs alone. © 2005 British Editorial Society of Bone and Joint Surgery

Accurate Analysis of Practical 3D Periodic Leaky-Wave Patch Antennas

This paper presents a new analysis method based on the finite integral technique (FIT) of practical three-dimensional leaky-wave antennas comprised of a finite number of patches arranged in arrays. Radiation patterns and scattering parameters are calculated and compared with corresponding measured results to demonstrate the adequacy and the accuracy of the proposed method. The technique is then used as an antenna design tool to obtain the desired radiation patterns and beam scanning by selective choice of array elements dimensions, spacing, and substrate parameters

Rosetta Brains: A Strategy for Molecularly-Annotated Connectomics

We propose a neural connectomics strategy called Fluorescent In-Situ Sequencing of Barcoded Individual Neuronal Connections (FISSEQ-BOINC), leveraging fluorescent in situ nucleic acid sequencing in fixed tissue (FISSEQ). FISSEQ-BOINC exhibits different properties from BOINC, which relies on bulk nucleic acid sequencing. FISSEQ-BOINC could become a scalable approach for mapping whole-mammalian-brain connectomes with rich molecular annotations

Situational analysis of essential surgical care management in Iran using the WHO tool

Background: Surgery is an essential component of health care, yet it has usually been overlooked in public health across the world. Objectives: This study aimed to perform a situational analysis of essential surgical care management at district hospitals in Iran. Materials and Methods: This research was a descriptive and cross-sectional study performed at 42 first-referral district hospitals of Iran in 2013. The World Health Organization (WHO) Tool for the situational analysis of emergency and essential care was used for data collection in four domains of facilities and equipment, human resources, surgical interventions, and infrastructure. Data analysis was conducted using simple descriptive statistical methods. Results: In this study, 100 of the studied hospitals had oxygen cylinders, running water, electricity, anesthesia machines, emergency departments, archives of medical records, and X-ray machines. In 100 of the surveyed hospitals, specialists in surgery, anesthesia, and obstetrics and gynecology were available as full-time staff. Life-saving procedures were performed in the majority of the hospitals. Among urgent procedures, neonatal surgeries were conducted in 14.3 of the hospitals. Regarding non-urgent procedures, acute burn management was conducted in 38.1 of the hospitals. Also, a few other procedures such as cricothyrotomy and foreign body removal were performed in 85.7 of the hospitals. Conclusions: The results indicated that suitable facilities and equipment, human resources, and infrastructure were available in the district hospitals in Iran. These findings showed that there is potential for the district hospitals to provide care in a wider spectrum. © 2016, Iranian Red Crescent Medical Journal

The effects of combined low level laser therapy and mesenchymal stem cells on bone regeneration in rabbit calvarial defects

Abstract: This study evaluated the effect of Low Level Laser Therapy (LLLT) and Mesenchymal Stem Cells (MSCs) on bone regeneration. Background data: Although several studies evaluated the effects of MSCs and LLLT, there is little information available regarding in vivo application of LLLT in conjunction with MSCs. Methods: Forty-eight circular bone defects (6 mm in diameter) were prepared in the calvaria of 12 New- Zealand white rabbits. The defects of each animal were randomly assigned to 4 groups: (C) no treatment; (L) applying LLLT; (SC) filled with MSCs; (SCL) application of both MSCs and LLLT. LLL was applied on alternate days at wavelength of 810 nm, power density of 0.2 W/cm2 and a fluency of 4 J/cm2 using a Gallium–Aluminum–Arsenide (GaAlAs) diode laser. The animals were sacrificed after 3 weeks and then histological samples were evaluated to determine the amount of new bone formation and the remaining scaffold and inflammation. Results: The histological evaluation showed a statistically significant increase in new bone formation of LLLT group relative to the control and the other two experimental groups (p < 0.05). There was no significant difference in bone formation of the control group compared to experimental groups filled with MSCs. Laser irradiation had no significant effect on resorption of the scaffold material. In addition, inflammation was significantly reduced in LLLT group compared to the control defects and the other two experimental groups. Conclusion: Low level laser therapy could be effective in bone regeneration but there is no evidence of a synergistic effect when applied in conjunction with MSCs

Nurses� perception of patient safety culture and its relationship with adverse events: a national questionnaire survey in Iran

Background: Patient safety culture is an important factor in determining hospitals� ability to address and reduce the occurrence of adverse events (AEs). However, few studies have reported on the impact of nurses� perceptions of patient safety culture on the occurrence of AEs. Our study aimed to assess the association between nurses� perception of patient safety culture and their perceived proportion of adverse events. Methods: A cross-sectional survey was carried out among 2295 nurses employed in thirty-two teaching hospitals in Iran. Nurses completed the Persian version of the hospital survey of patients� safety culture between October 2018 and September 2019. Results: Positive Response Rates of overall patient safety culture was 34.1 and dimensions of patient safety culture varied from 20.9 to 43.8. Also, nurses estimated that the occurrence of six adverse events varied from 51.2�63.0 in the past year. The higher nurses� perceptions of �Staffing�, �Hospital handoffs and transitions�, �Frequency of event reporting�, �Non-punitive response to error�, �Supervisor expectation and actions promoting safety�, �Communication openness�, �Organizational learning continuous improvement�, �Teamwork within units�, and �Hospital management support patient safety� were significantly related to lower the perceived occurrence at least two out of six AEs (OR = 0.69 to 1.46). Conclusions: Our findings demonstrated that nurses� perception regarding patient safety culture was low and the perceived occurrence of adverse events was high. The research has also shown that the higher level of nurses� perception of patient safety culture was associated with lowered occurrence of AEs. Hence, managers could provide prerequisites to improve patient safety culture and reduce adverse events through different strategies, such as encouraging adverse events� reporting and holding training courses for nurses. However, further research is needed to assess how interventions addressing patient safety culture might reduce the occurrence of adverse events. © 2021, The Author(s)

Spatially clustered type I interferon responses at injury borderzones

Sterile inflammation after myocardial infarction is classically credited to myeloid cells interacting with dead cell debris in the infarct zone1,2. Here we show that cardiomyocytes are the dominant initiators of a previously undescribed type I interferon response in the infarct borderzone. Using spatial transcriptomics analysis in mice and humans, we find that myocardial infarction induces colonies of interferon-induced cells (IFNICs) expressing interferon-stimulated genes decorating the borderzone, where cardiomyocytes experience mechanical stress, nuclear rupture and escape of chromosomal DNA. Cardiomyocyte-selective deletion of Irf3 abrogated IFNIC colonies, whereas mice lacking Irf3 in fibroblasts, macrophages, neutrophils or endothelial cells, Ccr2-deficient mice or plasmacytoid-dendritic-cell-depleted mice did not. Interferons blunted the protective matricellular programs and contractile function of borderzone fibroblasts, and increased vulnerability to pathological remodelling. In mice that died after myocardial infarction, IFNIC colonies were immediately adjacent to sites of ventricular rupture, while mice lacking IFNICs were protected from rupture and exhibited improved survival3. Together, these results reveal a pathological borderzone niche characterized by a cardiomyocyte-initiated innate immune response. We suggest that selective inhibition of IRF3 activation in non-immune cells could limit ischaemic cardiomyopathy while avoiding broad immunosuppression

Various indicators for the assessment of hospitals' performance status: Differences and similarities

Background: Hospitals are the most costly operational and really important units of health system because they consume about 50-89 of total health resources. Therefore efficient use of resources could help in saving and reallocating the financial and physical resources. Objectives: The aim of this study was to obtain an overview of hospitals' performance status by applying different techniques, to compare similarities and differences between these methods and suggest the most comprehensive and practical method of appraisal for managers and policy makers. Patients and Methods: This is a cross sectional study conducted in all hospitals of Ahvaz (eight hospitals affiliated with Jundishapur University of Medical Sciences and eight non-affiliated hospitals) during 2007 to 2011. Two kinds of data were collected through separate special checklists. Excel 2007 and Windeap 2.1 software were applied for data analysis. Results: The present findings show that the average of bed occupancy rate (BOR) in the studied hospitals was about 65.91 ± 1.16. The maximum number of inefficient hospitals in the present study happened in the years 2007, 2008 and 2010 (four hospitals) but there were two hospitals in the third part of the present graph which had maximum level of efficiency and optimal level of productivity in the years 2007 and 2009. Data Envelopment Analysis (DEA) showed that the mean score of technical efficiency for the studied hospitals is 0.924 ± 0.105 with the minimum of 0.585 ± 0.905 for hospital number 1. Furthermore It shows that only five hospitals (31.25) reach complete technical efficiency (TE) scores across all five years of 2007-11 (TE = 1). Conclusions: Results of the present and similar studies should be considered for the future planning and resource allocation of Iranian public hospitals. At the same time it is very important to consider need assessment results for each region according to its potentials, population under the coverage and other geographical and cultural indices. Furthermore because of potential limitations of each of the above models it is highly recommended to apply different methods of performance evaluation to reach a complete and real status view of the hospitals for future planning. © 2014, Iranian Red Crescent Medical Journal; Published by Kowsar Corp