Does a socially well integrated university have anything to do with faculty retention? A study on Kerman University of Medical Sciences-2011

Purpose – The purpose of this paper is to measure the relationship between organizational social capital and retention of faculty members in Kerman University of Medical Sciences in 2011. Design/methodology/approach – Using a stratified multistage sampling, 120 faculty members were recruited to fill the questionnaire. Findings – There were a direct and positive bilateral (r¼0.65) relationship between social capital and retention of faculty members. Originality/value – The university officials and policy makers need to pay closer attention to some issues such as providing welfare facilities, salary and wages, benefits, interests and appreciation for faculty members. Keywords Socia

Evidence for Policy Making: Clinical Appropriateness Study of Lumbar Spine MRI Prescriptions Using RAND Appropriateness Method

Background : MRI is a new and expensive diagnostic technology, which has been used increasingly all over the world. Low back pain is a worldwide prevalent disorder and MRI technique is one of the several ways to diagnose it. This paper aims to identify the appropriateness of lumbar spine MRI prescriptions in Shiraz teaching hospitals using standardized R AND Appropriateness Method (R AM) criteria in 2012. Methods : This study consisted of two phases. The first phase involved a qualitative enquiry and the second phase had a quantitative cross-sectional nature. In the first phase RAM was used for developing lumbar spine MRI indications and scenarios. In the second phase, the finalized scenarios were compared with the history and physical examination of 300 patients with low back pain. The rate of appropriateness of lumbar spine MRI prescription was then calculated. Results : Of 300 cases of lumbar spine MRI prescriptions, approximately 167 (56%) were considered inappropriate, 72 (24%) were uncertain, and 61 (20%) were deemed to be appropriate. The economic burden of inappropriate prescriptions was calculated at 88,009,000 Rials. In addition, the types of expertise and physical examination were considered as related factors to appropriateness of prescriptions. Conclusion : In conclusion, a large proportion of lumbar spine MRI prescriptions, which result in financial burden on the insurance companies and the patients alike is unnecessary. This study suggests that policy makers consider this evidence while decision-making. Our findings highlight the imperative role of Health Technology Assessment (HTA) and Clinical Practice Guidelines (CPGs). As a result, developing local clinical guidelines may create the commitment needed in physicians in prescribing appropriate prescriptions within the health sector. The study further recommends that appropriate scenarios should be considered as a criterion for payment and reimbursement

Chitosan nanoparticles: a versatile platform for biomedical applications

Chitosan is a biodegradable and biocompatible natural polymer that has been extensively explored in recent decades. The Food and Drug Administration has approved chitosan for wound treatment and nutritional use. Furthermore, chitosan has paved the way for advancements in different biomedical applications including as a nanocarrier and tissue-engineering scaffold. Its antibacterial, antioxidant, and haemostatic properties make it an excellent option for wound dressings. Because of its hydrophilic nature, chitosan is an ideal starting material for biocompatible and biodegradable hydrogels. To suit specific application demands, chitosan can be combined with fillers, such as hydroxyapatite, to modify the mechanical characteristics of pH-sensitive hydrogels. Furthermore, the cationic characteristics of chitosan have made it a popular choice for gene delivery and cancer therapy. Thus, the use of chitosan nanoparticles in developing novel drug delivery systems has received special attention. This review aims to provide an overview of chitosan-based nanoparticles, focusing on their versatile properties and different applications in biomedical sciences and engineering.info:eu-repo/semantics/publishedVersio

Refractive Error and Ocular Biometric Changes in the Treatment of Diabetes Mellitus

Background and Objectives: Evaluation of changes in refractive errors and biometric parameters in the process of glycemic control in people with type 2 diabetes during three-month treatment. Methods: Patients with the first diagnosis of type 2 diabetes or a history of poor glycemic control (hemoglobin glycate more than 7.5%) and without any systemic disease other than diabetes were included. Hemoglobin glycate, refractive error, and biometric parameters were evaluated before treatment and one and a half and three months after treatment, and their changes were examined by generalized estimating equation (GEE) analysis. Results: A total of 60 eyes of 30 patients with a mean age of 51.63±6.79 years were evaluated. Hemoglobin glycate decreased by an average of 1.028% compared to the baseline measurement in the third month (P<0.001). Mean spherical (P=0.554), spherical equivalent (P=0.340), axial length (P=0.147), and anterior chamber depth (P=0.336) did not show a significant difference between the three examinations. In contrast, the lens thickness showed a significant decrease during treatment (P=0.001). Finally, generalized estimating equation (GEE) analysis showed that a 1% decrease in hemoglobin glycate increased by 0.226 mm. (P=0.002) in the axial length. It should be mentioned in tables FU1means Follow-up 1.5 months and FU2 means Follow-up 3 months. Conclusion: The present study shows that refractive errors and most ocular biometric parameters do not change significantly compared to the baseline levels in the period of one and a half and three months after the start of glycemic control

Effects of ethanol concentrations of acrylate-based dental adhesives on microtensile composite-dentin bond strength and hybrid layer structure of a 10 wt% polyhedral oligomeric silsesquioxane (POSS)-incorporated bonding agent

Background: The aim of this study was to assess for the first time the effects of different amounts of ethanol solvent on the microtensile bond strength of composite bonded to dentin using a polyhedral oligomeric silsesquioxane (POSS)-incorporated adhesive. Materials and Methods: This experimental study was performed on 120 specimens divided into six groups (in accordance with the ISO TR11405 standard requiring at least 15 specimens per group). Occlusal dentin of thirty human molar teeth was exposed by removing its enamel. Five teeth were assigned to each of six groups and were converted to 20 microtensile rods (with square cross-sections of 1 mm × 1 mm) per group. The “Prime and Bond NT” (as a common commercial adhesive) was used as the control group. Experimental acrylate-based bonding agents containing 10 wt% POSS were produced with five concentrations of ethanol as solvent (0, 20, 31, 39, and 46 wt%). After application of adhesives on dentin surface, composite cylinders (height = 6 mm) were bonded to dentin surface. The microtensile bond strength of composite to dentin was measured. The fractured surfaces of specimens were evaluated under a scanning electron microscope to assess the morphology of hybrid layer. Data were analyzed using one-sample t-test, one-way analysis of variance (ANOVA), and Tukey tests (α = 0.05). Results: the mean bond strength in the groups: “control, ethanol-free, and 20%, 31%, 39%, and 46% ethanol” was, respectively, 46.5 ± 5.6, 29.4 ± 5.7, 33.6 ± 4.1, 59.0 ± 5.5, 41.9 ± 6.2, and 18.7 ± 4.6 MPa. Overall difference was significant (ANOVA, P < 0.0001). Pairwise differences were all significant (Tukey P < 0.05) except those of “ethanol 0% versus 20%” and “20% versus 31%.” All groups except “0% and 46% ethanol” had bond strengths above 30 MPa (t-test P < 0.05). Conclusion: Incorporation of 31% ethanol as solvent into a 10 wt% POSS-incorporated experimental dental adhesive might increase the bond strength of composite to dentin and improve the quality and morphology of the hybrid layer. However, higher concentrations of the solvent might not improve the bond strength or quality of the hybrid layer

Evidence for Policy Making: Clinical Appropriateness Study of Lumbar Spine MRI Prescriptions Using RAND Appropriateness Method

MRI is a new and expensive diagnostic technology, which has been used increasingly all over the world. Low back pain is a worldwide prevalent disorder and MRI technique is one of the several ways to diagnose it. This paper aims to identify the appropriateness of lumbar spine MRI prescriptions in Shiraz teaching hospitals using standardized RAND Appropriateness Method (RAM) criteria. Methods This study consisted of two phases. The first phase involved a qualitative enquiry and the second phase had a quantitative cross-sectional nature. In the first phase RAM was used for developing lumbar spine MRI indications and scenarios. In the second phase, the finalized scenarios were compared with the history and physical examination of 300 patients with low back pain. The rate of appropriateness of lumbar spine MRI prescription was then calculated. Results Of 300 cases of lumbar spine MRI prescriptions, approximately 167 (56%) were considered inappropriate, 72 (24%) were uncertain, and 61 (20%) were deemed to be appropriate. The economic burden of inappropriate prescriptions was calculated at 88,009,000 Rials. In addition, the types of expertise and physical examination were considered as related factors to appropriateness of prescriptions. Conclusion In conclusion, a large proportion of lumbar spine MRI prescriptions, which result in financial burden on the insurance companies and the patients alike is unnecessary. This study suggests that policy makers consider this evidence while decision-making. Our findings highlight the imperative role of Health Technology Assessment (HTA) and Clinical Practice Guidelines (CPGs). As a result, developing local clinical guidelines may create the commitment needed in physicians in prescribing appropriate prescriptions within the health sector. The study further recommends that appropriate scenarios should be considered as a criterion for payment and reimbursement

Health Policy and Management Original Article Evidence for Policy Making: Clinical Appropriateness Study of Lumbar Spine MRI Prescriptions Using RAND Appropriateness Method

Background: MRI is a new and expensive diagnostic technology, which has been used increasingly all over the world. Low back pain is a worldwide prevalent disorder and MRI technique is one of the several ways to diagnose it. This paper aims to identify the appropriateness of lumbar spine MRI prescriptions in Shiraz teaching hospitals using standardized RAND Appropriateness Method (RAM) criteria in 2012. Methods: This study consisted of two phases. The first phase involved a qualitative enquiry and the second phase had a quantitative cross-sectional nature. In the first phase RAM was used for developing lumbar spine MRI indications and scenarios. In the second phase, the finalized scenarios were compared with the history and physical examination of 300 patients with low back pain. The rate of appropriateness of lumbar spine MRI prescription was then calculated. Results: Of 300 cases of lumbar spine MRI prescriptions, approximately 167 (56%) were considered inappropriate, 72 (24%) were uncertain, and 61 (20%) were deemed to be appropriate. The economic burden of inappropriate prescriptions was calculated at 88,009,000 Rials. In addition, the types of expertise and physical examination were considered as related factors to appropriateness of prescriptions. Conclusion: In conclusion, a large proportion of lumbar spine MRI prescriptions, which result in financial burden on the insurance companies and the patients alike is unnecessary. This study suggests that policy makers consider this evidence while decision-making. Our findings highlight the imperative role of Health Technology Assessment (HTA) and Clinical Practice Guidelines (CPGs). As a result, developing local clinical guidelines may create the commitment needed in physicians in prescribing appropriate prescriptions within the health sector. The study further recommends that appropriate scenarios should be considered as a criterion for payment and reimbursement. A B S T R A C T A R T I C L E I N F O Keywords: MRI Prescription Background The ever changing population&apos;s needs and increasing costs of treatment are two major challenges facing health systems worldwide (1). A number of studies have shown that large volumes of provided health care may be inappropriate or unnecessary. Some studies show that the quality of and access to health care services are not necessarily related to spending more on health care systems (2,3). RAND (Research AND Development) Appropriateness Method (hereafter RAM) is a transparent approach to assess the appropriateness of health care services. This method was designed in the 1980s by RAND Corporation and University of California, Los Angeles and has been used in a number of studies on appropriateness of health care services (4-6). Radiologic diagnostic methods help physicians in early diagnosis of disorders, and prevent the provision of subsequent aggressive treatments. However, studies show that during the past two decades, the radiologic diagnostic procedures have been progressively more common all over the world. According to statistics of the review conducted by the Board of Radiologic Imaging in the United States, 30% to 40% of diagnostic imaging performed in this country have been unnecessary or have failed to detect the disease (7). As a result, inappropriate order of medical imaging procedures doi: 10.15171/ijhpm.2013.04 Salari et al/International Journal of Health Policy and Management, 2013, 1(1), 17-21 18 by physicians may result in serious problems in terms of economy and quality of health care (8). Low back pain is a prevalent musculoskeletal disorder and has a huge burden to the health care systems of several countries including Iran. Around 80% of people deal with this problem during their lives. In the United States, low back pain is the second most common prevalent disorder after headaches (9-11). Analysing and understanding the pattern of medical imaging technology usage is of great significance for planning health systems, especially in low-and middleincome countries (12). However, based on our literature review, no published paper has ever addressed this issue in Iran. The current study aims to fill this gap by investigating the appropriateness and necessity of lumbar spine MRI prescriptions in hospitals affiliated with Shiraz University of Medical Sciences (SUMS) in 2012. Methods This study consisted of two phases. The first phase involved a qualitative enquiry and the second phase had a quantitative cross-sectional nature. The two phases of study are described in details below. Phase one: developing appropriateness criteria In this study, RAM was used to develop the appropriate scenarios for lumbar spine MRI prescriptions. This phase consisted of two rounds; in the first round, the panel members scored the scenarios independently and there was no interaction among them, while the second round involved interaction among the panel members. According to RAM, the available clinical guidelines on lumbar spine MRI were searched, from which the indications and scenarios were extracted. After that, in order to come to an appropriate consensus on scenarios, two rounds of expert panel were held. Each panel composed of nine specialists: two neurosurgeons, two orthopedists, two radiologists, one neurologist, one rheumatologist, and one physiatrist, all of whom were faculty members working in teaching hospitals. First round was without interaction among panel members. We asked panel members to score the scenarios. Based on the scores of panel members, scenarios were placed into three categories: appropriate, uncertain, and inappropriate. The criteria for this categorization are explained below. For each indication, the panel members rated the benefitto-harm ratio of the procedure on a scale of 1 to 9, where 1 meant that the expected harms greatly outweighed the expected benefits, and 9 meant that the expected benefits greatly outweighed the expected harms. Each indication was considered appropriate if the panel&apos;s median rating was 7-9 without disagreement, inappropriate if the value was 1-3 without disagreement, or uncertain if the median rating was 4-6 or if the members of the panel disagreed (4). The panel members further added some indications and scenarios on the list based on their experiences and published papers. In the second round, the members were invited to a meeting. In the meeting, they scientifically discussed the appropriateness of the scenarios and reached a consensus. The process of development of appropriate scenarios and its results are described elsewhere (13). Phase two: identifying the appropriateness of prescription This part of work was a descriptive analytical and crosssectional study performed in hospitals affiliated with SUMS in 2012. It aimed to identify the appropriateness of lumbar spine MRI prescription. Sample size was calculated to be 300 samples and the convenient sampling was used. In the data gathering phase, the first author, accompanied by a trained physician, attended in MRI centers of two hospitals affiliated with SUMS to have the questionnaires filled. They asked the patients some questions and performed physical examinations on the patients. Before selecting the samples, the research aims were explained to patients and if they were willing to participate, they would be recruited. This work continued until a sample size of 300 was reached. A short questionnaire, including 13 questions, designed by the authors, was used as the data gathering instrument. Out of 13 questions, six questions were about the patient demographic information (Additional file 1) and seven were on MRI prescription (Additional file 2). The last question concerned the appropriateness of MRI prescription and was regarded as the key question in the questionnaire. Its response was required for comparing the exact physical examination of patients with the developed scenarios. This sensitive task was performed by a knowledgeable trained physician. The patients&apos; informed written consents were earned prior to the physical examination. SPSS 15 (SPSS Inc., Chicago, IL, USA) was used for data analysis. Frequency tables and chi-square test were selected for statistical analyses. Results Demographic information Of 300 recruited subjects, approximately 51% were male and 49% were female. Most of them were in 20-35 yrs age groups and 35% had primary education. In terms of job status, 53% were housekeeper. In terms of monthly income level, 56% had 2500000-5000000 Rials income per month and 97% had medical insurance (see Prescription information The research results on prescriptions demonstrated that 93% of the patients were outpatient and only 7% were inpatient. In addition, 35% of the patients had only back pain as their symptoms, 17% reported only radicular leg pain, and 44% of the patients had simultaneous back and leg pain as their symptoms. About 18% of patients declared that their prescriptions were administrated without any physical examination, while physical examination had been performed for 82% of the patients. Around 9% of the patients had asked the doctors for MRI prescription. Almost 40% of patients had been referred from public hospitals, 11% from private hospitals, and 49% from private offices. About 31% of patients were referred to the hospital to conduct lumbar spine MRI by neurosurgeon, 15% by physiatrist, 10% by neurologist, 31% by orthopedists, 9% by rheumatologist, and 4% by other specialists. Appropriateness of physicians&apos; orders The research results further revealed that about 56% of prescriptions were inappropriate, 24% were uncertain, and only 20% could be considered appropriate. Financial burden The costs of 167 cases of inappropriate MRIs were considered as a financial burden imposed on both the insurance companies and the patients Related factors The Chi-square test shows a significant relationship between the type of expertise and appropriateness of prescriptions (P&gt;0.001). According to finalized indications, among the physiatrists and neurosurgeons prescriptions, 64% and 60% were inappropriate respectively. Also, 48% of rheumatologists prescriptions were appropriate and 26% of orthopedics prescriptions were uncertain Discussion The results of this study indicate that 56% of lumbar spine MRI prescriptions were inappropriate, about 24% were uncertain and around 20% were appropriate. MRI is a very expensive diagnostic procedure and imposes huge financial and emotional burden on both the society and patients. These unnecessary healthcare procedures could impose high intangible costs on the patients such as wasting time, energy, and money. Therefore, physicians should prescribe them only when necessary. Although in the finalized scenario (the first phase of study), performing an appropriate MRI is recommended after a careful physical examination and six weeks of maintenance therapy, the results of the second phase of the study disclosed that MRI was chosen as the first diagnostic procedure for low back pain. It seems that the inappropriate rate of MRI prescriptions in Iran is higher than that of the US and Canada. According to the study of Lehnert and Bree (14), the inappropriate rate of lumbar spine MRI prescription was 26% in the US; similarly Emery et al. revealed that the inappropriate rate of MRI prescription was 28.50% in Canada The inappropriate prescriptions were 56% (regardless of the uncertain cases). Probably we can generalize our results to the whole country; if 56% of the MRI prescriptions in Iran are considered inappropriate at least half of the reimbursement costs will be wasted. It is claimed that the number of MRI machines installed in Tehran province was enough for the whole population of the country (17). Therefore we can imply that many of imported MRI machines to the country are unnecessary. The authors hypothesize the high availability of MRI machines within the country could be a possible reason for the overuse of MRI procedures. The problem is exacerbated knowing the fact that the price of a MRI machine is about one to three million dollars. In addition, among all imaging diagnostic devices, MRI had a more inappropriate distribution in the country (18). Given that the country is highly dependent on import of this technology (i.e. MRI machines) coupled with the high international sanctions posed on the country, policy makers should adopt proper HTA polices. Palesh and colleagues conducted a qualitative research in order to investigate policy makers&apos; view about diffusion and utilisation of MRI in Iran (17). They found that the process of policy making does not seem to be based on a full understanding of HTA and the country does not follow an official plan for MRI adoption and diffusion. According to this study factors that contribute to the health technology diffusion and utilisation are posed by market forces such as advertisements, and physician and consumer demand. Besides, dual practice can increase the induced demand and also reduce the supervision of the private sector by the Ministry of Health. This study reported another major deficit in HTA process in Iran; a lack of need assessment, where the import of health technologies is not based on need assessment and structured planning (17). The following is a brief discussion of factors related to appropriateness. Firstly, prescriptions without physical examinations were more inappropriate. When a physician makes MRI prescription without any physical examination, it is more probable to be inappropriate. Secondly, those prescriptions, which were performed by rheumatologists, Strengths and limitations The present study enjoys some advantages. First, this was the first published study assessing appropriateness of MRI prescriptions using RAND in Iran. Second, this study, similar to other studies conducted in Iran (1,19), recommends RAM for the healthcare system in Iran, because the evidence is needed for policy making. Third, in order to avoid influence of professional biases in the scoring process, the expert panel members were selected from seven different areas of specialties. Last but not least, in contrast to the majority of RAM studies whose judgment is based on medical records, in this study physical examination was performed for all cases according to standardized clinical indications and scenarios. This process was very time-consuming and costly, but it could obtain more precise results due to the fact that medical records do not always contain a complete set of required data. This study also has several limitations. First, in phase one, although a full-participation of expert panel members was required, this was not perfectly met due to the busy schedule of experts. As such, a great deal of time was devoted to coordinate the expert panel meetings. Second, in data gathering phase, the researchers had to wait a long time for patients with lumbar spine MRI orders in MRI centers. Conclusion This study set out to examine the appropriateness of lumbar spine MRI prescriptions in Shiraz teaching hospitals using standardized RAM criteria. This study generated two main outcomes. Firstly, this was the first study which developed a local clinical practice guideline using RAND appropriateness method for lumbar spine MRI for the country. Secondly, it assessed appropriateness of lumbar spine MRI prescriptions. The research findings revealed that the large proportion of lumbar spine MRI prescriptions was unnecessary which result in a financial burden on the insurance companies and the patients alike. The findings provide policy makers with a number of practical recommendations to improve evidence-based policy making. The results also highlight the imperative role of HTA and clinical practice guidelines. Developing local clinical guidelines may create the commitment needed in physicians in performing appropriate prescriptions in the health sector. The Ministry of Health should develop and completely follow the HTA programs. We need a national coordination between HTA policies. Acknowledgments We would like to thank members of expert panel who were Bagher

Burden of ischemic heart disease in the Middle East and North Africa (MENA) and attributable risk factors: An epidemiological analysis from 1990 to 2019

Introduction: Despite the burden of ischemic heart disease (IHD), there remains a paucity of research on the incidence, mortality, and burden of this condition in the Middle East and North Africa (MENA) regions. This study aimed to evaluate the epidemiology and the risk factors associated with IHD in the MENA region. Methods: This study was performed based on the GBD study 2019 data. We retrieved the data related to the epidemiology and burden of IHD, including prevalence, incidence, years of life lost due to premature death (YLLs), years lived with disability (YLDs), and mortality at the global level and in MENA countries across years and sexes. Results: IHD accounted for approximately 2.55 million (95 % UI 2.29–2.83) incident cases in MENA in 2019, with an age-standardized incidence rate of 613.87 (95 % UI 555.84–675.16) per 100 000 people, which has decreased by 9 % between 1990 and 2019. IHD accounted for 11.01 % of DALYs causes in MENA in 2019, an increase of 68 % compared to 1990. The DALYs rate from IHD increased with age in both men and women and was higher in men than in women in all age groups, except 85–89 years age-group, in 2019. Conclusion: The age-standardized prevalence and incidence of IHD are decreasing in MENA. However, this reduction is lower than the global level, which can be due to a weaker performance of the countries in the region in reducing the prevalence and incidence of the disease compared to the global average