1
|
Rezaee M, Tavakoli N, Tahmasbi S. Exploring the County Level Mortality Pattern Variations in Rural Areas of Iran (2006- 2016). Int J Health Policy Manag 2024. [PMID: 38618838 DOI: 10.34172/ijhpm.2024.8032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Mortality rate in rural areas is a useful measure of the health of the population and the function of the health system, which varies over space and time. The objective of this research is to explore the spatial and temporal variations in the rural mortality rate in Iran at the county level in 2006, 2011 and 2016. METHODS data were gathered from the rural population and mortality statistics published by the Statistical Centre of Iran and the National Organization for Civil Registration. Global spatial patterns were assessed using the Global Moran's I and local clusters through the Local Moran' I. RESULTS Spatial distribution of rural mortality rate shows that during the years under study the number of counties with a lower rate has increased. The counties with rate of less form continuous areas in the southwest, central and east regions. The excess risk map reveals significant variations in both value and extent. Also, the values of Moran's index increased from 0.1848 in 2006 to 0.4041 in 2016, which indicates the strengthening of the cluster spatial pattern of the overall rural mortality rate. Local patterns have undergone substantial changes over space and time. CONCLUSION The findings indicate significant spatial and temporal variations in rural mortality rates in Iran. Policymakers can use this information to plan and enhance healthcare infrastructure in specific counties. The findings serve for evaluating the effectiveness of health policies, enabling policymakers to make informed decisions, allocate resources efficiently and design targeted interventions for improved public health outcomes.
Collapse
Affiliation(s)
- Mehrangiz Rezaee
- Department of Geography Faculty of Humanities & Social Since, Yazd University, Yazd, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Siamak Tahmasbi
- Centre for Remote Sensing & GIS Research, Faculty of Earth Sciences, Shahid Beheshti University, Tehran, Iran
| |
Collapse
|
2
|
Shahzamani M, Shirvani F, Tavakoli N, Sedighi M. Bentall Procedure to Repair Acute Type a Aortic Dissection in Pregnant Marfan Syndrome Woman With Preservation of Pregnancy. Vasc Endovascular Surg 2023; 57:787-790. [PMID: 37096976 DOI: 10.1177/15385744231173191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Background: Acute aortic dissection is the most common life-threatening disorder classically presenting with tearing chest pain radiating to the back yet can have deceiving clinical presentations.Case presentation: The patient was a 22-year-old pregnant woman (gravida 6, para 4, abortion1) at 26 weeks of gestation. She was a known case of Marfan syndrome who developed acute type A aortic dissection during pregnancy. Repair of aortic dissection was done through the Bentall procedure with a composite mechanical valved conduit while Fetal heart rate (FHR) was simultaneously monitored during surgery. Three months after surgical repair, the newborn was delivered via cesarean, and both mother and baby survived without any complications.Conclusions: In this case, we demonstrated that repair of type A aortic dissection can be done in pregnant women with preservation of fetus in the uterus through close cooperation among all members of a multi-disciplinary team.
Collapse
Affiliation(s)
- Mehran Shahzamani
- Department of Cardiovascular Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Shirvani
- Cardiac Intensive Care Unit, Shahid Chamran Heart Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sedighi
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Bahmani F, Parsapour A, Abbasi N, Zahraei S, Tavakoli N, Shamsi-Gooshki E. Priority-setting for early access to COVID-19 vaccines in Islamic Republic of Iran. East Mediterr Health J 2023; 29:587-598. [PMID: 37553748 DOI: 10.26719/emhj.23.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/08/2022] [Indexed: 08/10/2023]
Abstract
BACKGROUND Priority-setting for early access to vaccines during a pandemic optimizes the impact of vaccine rollout, however, low- and middle-income countries (LMICs) have little experience in policymaking on this. In the Islamic Republic of Iran, the national clinical ethics committee developed a policy for early access to COVID-19 vaccines with support from the national committee on COVID-19 vaccine. AIMS This paper reports the process and results of a national COVID-19 vaccine priority-setting in the Islamic Republic of Iran and discusses its ethical and cultural aspects. METHODS A multidisciplinary team of experts planned and developed a national guideline following an extensive literature review and face-to-face consultations. RESULTS We present the list of priority groups and subgroups, tiered through a 4-phase process, as well as the ethical values and sociocultural issues underpinning COVID-19 vaccine prioritization in the Islamic Republic of Iran. CONCLUSIONS Our experience shows that a transparent and well-reasoned policymaking process can inform fair prioritysetting for pandemic vaccines, especially in LMICs.
Collapse
Affiliation(s)
- Fatemeh Bahmani
- Department of Medical Ethics, School of Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Alireza Parsapour
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Nasrin Abbasi
- Medical Ethics Department, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Seyyed Zahraei
- Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Islamic Republic of Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Ehsan Shamsi-Gooshki
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| |
Collapse
|
4
|
Tavakoli N, Chaichian S, Sadraei JS, Sarhadi S, Bidgoli SA, Rokhsat E, Anoushirvani K, Nikfar B, Mehdizadehkashi A. Is it possible to reduce the rate of vertical transmission and improve perinatal outcomes by inclusion of remdesivir in treatment regimen of pregnant women with COVID-19? BMC Pregnancy Childbirth 2023; 23:110. [PMID: 36782188 PMCID: PMC9923661 DOI: 10.1186/s12884-023-05405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is currently one of the world's most critical health issues so far. Given the importance of appropriate treatment in pregnancy and the controversies about Remdesivir effectiveness and complications, the present study aimed to evaluate the impact of Remdesivir on maternal, fetal, and perinatal outcomes in pregnant women with COVID-19 diseases. METHODS A total of 189 pregnant women with positive polymerase chain reaction (PCR) results for SARS-COV-2, and oxygen saturation [SpO2] of < 95%) were admitted to 12 hospitals affiliated with the Iran University of Medical Sciences from March 1st, 2020 to June 7th, 2021, namely the first four COVID-19 Picks in Iran. They were enrolled in this retrospective cohort study by census method and categorized into case and control groups, based on the inclusion of Remdesivir in their treatment protocol. Demographics, clinical outcomes, and pregnancy-related complications of the mothers and the neonates were compared between the two study groups. RESULTS A comparison of 54 mothers in the case and 135 in the control group showed no demographic and clinical characteristics difference. Neonates whose mothers did not receive Remdesivir had a higher rate of positive PCR (10.2%), compared to the Remdesivir group (1.9%) with a relative risk of 0.91 reported for Remdesivir (95% CI: 0.85-0.98, P = 0.04); besides, Remdesivir resulted in fewer neonatal intensive care unit admission rates in mild/moderate COVID-19 group (RR = 0.32, 95% CI: 0.105-1.02, P = 0.03). Although neonatal death between the two groups was not statistically significant, from the clinical point seems important; 1(1.9%) in the case vs. 9(7.2%) in the control group. Interestingly LOS (Length of Stay) in the hospital was longer in the case group (median of 7 vs. 3 days; P < 0.0001). CONCLUSION The inclusion of Remdesivir in the treatment protocol of pregnant women with COVID-19 may reduce vertical transmission and improve perinatal outcomes, thus being suggested to be considered.
Collapse
Affiliation(s)
- Nader Tavakoli
- grid.411746.10000 0004 4911 7066Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahla Chaichian
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran. .,Iranian Society of Minimally Invasive Gynecology, Tehran, Iran.
| | - Jamileh Sadat Sadraei
- grid.411746.10000 0004 4911 7066Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Sarhadi
- grid.488433.00000 0004 0612 8339Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran ,Department of Community Medicine, School of Medicine, Zahedan, Iran
| | - Sepideh Arbabi Bidgoli
- grid.411705.60000 0001 0166 0922Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, Islamic Azad University, Tehran Medical Sciences University, Tehran, Iran
| | - Elnaz Rokhsat
- grid.411746.10000 0004 4911 7066Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Katayoon Anoushirvani
- grid.411746.10000 0004 4911 7066Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Banafsheh Nikfar
- grid.411746.10000 0004 4911 7066Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Mehdizadehkashi
- grid.411746.10000 0004 4911 7066Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Tavakoli N, Nafissi N, Shokri S, Fallahpour M, Soleimani S, Riahi T, Kalantari S, Goodarzi A, Valizadeh R. Comparison of the Onset and End of Specific and Major Side Effects in Iranian Teenage Participants Vaccinated With COVID-19 Vaccine: Sinopharm and Soberana. Med J Islam Repub Iran 2023; 37:15. [PMID: 37123336 PMCID: PMC10134091 DOI: 10.47176/mjiri.37.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 05/02/2023] Open
Abstract
Background Clinical trials were conducted on children on side effects after vaccination. We tried to assess the frequency and onset of the main symptoms in children who were vaccinated. We aimed to evaluate early and delayed adverse effects after coronavirus disease 2019 (COVID-19) vaccine among Iranian pediatrics and adolescents in a national survey. Methods This cross-sectional study included people <18 years who received the Soberana (PastoCoVac) and Sinopharm vaccines since 2021. The basic information was gender, age, type of vaccine, and reaction after vaccination besides the main events that occurred for them. The required data were collected via a predetermined checklist by trained interviewers through phone calls by their parents or legal guardians. The independent t test and Fisher exact test were used. P values less than 0.05 were considered significant. Results A total of 11,042 participants (age range, 10-18 years) consisting of 5374 boys (47.8%) and 5768 girls (52.2%) were studied and 88.1% of the children (n = 9727) were vaccinated by Sinopharm and 11.9% (n = 1315) by Soberana. The data of kidney-related side effects had delayed improvement of side effects after the Sinopharm compared with the Soberana vaccines (P = 0.012). Cardiovascular and hematological side effects showed early-onset (P = 0.006) and delayed improvement of side effects (P = 0.002) after the Soberana vaccine compared with the Sinopharm vaccine. Neurological side effects showed delayed improvement of side effects after the Soberana vaccine compared with the Sinopharm vaccine (P = 0.027). Joint-related side effects showed early-onset (P = 0.004) and delayed improvement of side effects (P = 0.023) after the Soberana vaccine compared with the Sinopharm vaccine. Respiratory side effects showed delayed improvement of side effects after the Soberana vaccine compared with the Sinopharm vaccine (P = 0.013), and dermatological side effects showed early-onset (P = 0.050) and delayed improvement of side effects (P = 0.035) after the Soberana vaccine compared with the Sinopharm vaccine. There was not any statistically significant difference regarding gastrointestinal side effects between the 2 vaccines (P > 0.05). Conclusion The cardiovascular and hematological, joint-related (non-neurologic musculoskeletal) and dermatological side effects after the Soberana vaccine appear earlier and end later compared with the Sinopharm vaccine. Improvement of renal side effects in the Sinopharm vaccine group and improvement of neurological and respiratory side effects in the Soberana vaccine group occurred with delay compared with other vaccines.
Collapse
Affiliation(s)
- Nader Tavakoli
- Department of Emergency Medicine, Trauma and Injury Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Nafissi
- Department of General Surgery, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sima Shokri
- Department of Allergy and Clinical Immunology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Fallahpour
- Department of Allergy and Clinical Immunology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Soleimani
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Taghi Riahi
- Department of Internal Medicine, School of Medicine, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Kalantari
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author:Azadeh Goodarzi,
| | - Rohollah Valizadeh
- Urmia University of Medical Sciences, Urmia, Iran
- Corresponding author:Rohollah Valizadeh,
| |
Collapse
|
6
|
Jamshidi E, Asgary A, Kharrazi AY, Tavakoli N, Zali A, Mehrazi M, Jamshidi M, Farrokhi B, Maher A, von Garnier C, Rahi SJ, Mansouri N. Personalized predictions of adverse side effects of the COVID-19 vaccines. Heliyon 2023; 9:e12753. [PMID: 36597482 PMCID: PMC9800018 DOI: 10.1016/j.heliyon.2022.e12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Background Misconceptions about adverse side effects are thought to influence public acceptance of the Coronavirus disease 2019 (COVID-19) vaccines negatively. To address such perceived disadvantages of vaccines, a novel machine learning (ML) approach was designed to generate personalized predictions of the most common adverse side effects following injection of six different COVID-19 vaccines based on personal and health-related characteristics. Methods Prospective data of adverse side effects following COVID-19 vaccination in 19943 participants from Iran and Switzerland was utilized. Six vaccines were studied: The AZD1222, Sputnik V, BBIBP-CorV, COVAXIN, BNT162b2, and the mRNA-1273 vaccine. The eight side effects were considered as the model output: fever, fatigue, headache, nausea, chills, joint pain, muscle pain, and injection site reactions. The total input parameters for the first and second dose predictions were 46 and 54 features, respectively, including age, gender, lifestyle variables, and medical history. The performances of multiple ML models were compared using Area Under the Receiver Operating Characteristic Curve (ROC-AUC). Results The total number of people receiving the first dose of the AZD1222, Sputnik V, BBIBP-CorV, COVAXIN, BNT162b2, and mRNA-1273 were 6022, 7290, 5279, 802, 277, and 273, respectively. For the second dose, the numbers were 2851, 5587, 3841, 599, 242 and 228. The Logistic Regression model for predicting different side effects of the first dose achieved ROC-AUCs of 0.620-0.686, 0.685-0.716, 0.632-0.727, 0.527-0.598, 0.548-0.655, 0.545-0.712 for the AZD1222, Sputnik V, BBIBP-CorV, COVAXIN, BNT162b2 and mRNA-1273 vaccines, respectively. The second dose models yielded ROC-AUCs of 0.777-0.867, 0.795-0.848, 0.857-0.906, 0.788-0.875, 0.683-0.850, and 0.486-0.680, respectively. Conclusions Using a large cohort of recipients vaccinated with COVID-19 vaccines, a novel and personalized strategy was established to predict the occurrence of the most common adverse side effects with high accuracy. This technique can serve as a tool to inform COVID-19 vaccine selection and generate personalized factsheets to curb concerns about adverse side effects.
Collapse
Affiliation(s)
- Elham Jamshidi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Asgary
- Department of Biotechnology, College of Sciences, University of Tehran, Tehran, Iran
| | | | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Mehrazi
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Jamshidi
- Department of Exercise Physiology, Tehran University, Tehran, Iran
| | - Babak Farrokhi
- Health Network Administration Center, Undersecretary for Health Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Ali Maher
- School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Christophe von Garnier
- Division of Pulmonary Medicine, Department of Medicine, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Sahand Jamal Rahi
- Laboratory of the Physics of Biological Systems, Institute of Physics, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Nahal Mansouri
- Division of Pulmonary Medicine, Department of Medicine, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École polytechnique fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Research Group on Artificial Intelligence in Pulmonary Medicine, Division of Pulmonary Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| |
Collapse
|
7
|
Azh N, Najafimoghadam T, Motamed Gorji N, Koohpayehzadeh J, Asadi Lari M, Tavakoli N, Zahraei SM, Goshtae M, Eshrati B, Moghtadaei M, Motevalian SA, Baradaran HR. Risk Communication in Early Containment of COVID-19 Pandemic in Iran: Implementation of the World Health Organization Strategic Preparedness and Response Plan (WHO-SPRP). Med J Islam Repub Iran 2022; 36:143. [PMID: 36569395 PMCID: PMC9774988 DOI: 10.47176/mjiri.36.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Health systems must have functional and efficient preparedness and response plans to manage pandemics. Moreover, it is essential to adjust to changing circumstances and the dynamic character of pandemics. The World Health Organization (WHO) introduced the Strategic Preparedness and Response Plan (SPRP), emphasizing 144 measures across 10 pillars, helping governments prepare and respond to the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to determine how the Iranian health system, based on the WHO-SPRP, addresses strategic preparedness and response plan in the COVID-19 pandemic at the national level. Methods: The WHO-SPRP was adopted and translated into Persian by 2 bilingual natives. The chief of the health office requested that authorized officers complete the SPRP. Then, a meeting was held by officers of related units involved in COVID-19 management to address the SPRP at regional and national levels. Results: Our findings suggest that up to August 2020, effective risk communication and community engagement were not fully established. Our response plan lacked evidence-based information and educational messaging to consistently shape public opinion and impression of a respiratory pandemic. Conclusion: The Iranian health care system and services were almost able to address the SPRP and perform the major indicators that the WHO had proposed. However, special attention should be paid to risk communication and community engagement to empower informed decision-making by individuals and communities.
Collapse
Affiliation(s)
- Nima Azh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Jalil Koohpayehzadeh
- Department of Community Medicine, Preventive Medicine & Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadi Lari
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Emergency Medicine Department, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Massomeh Goshtae
- Deputy of Healthcare, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Eshrati
- Center for Preventive Medicine, Department of Social Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moghtadaei
- International Affairs Department, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Abbas Motevalian
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran, Corresponding author:Hamid Reza Baradaran,
| |
Collapse
|
8
|
Tavakoli N, Saberian P, Bagheri Faradonbeh S, Hasani Sharamin P, Modaber M, Sohrabi Anbohi Z, Jamshidi R, Abedinejad M, Kolivand P. Cost-effectiveness Analysis of Air Emergency Versus Ground Emergency Medical Services Regarding the Patient's Transportation and Treatment in Selected Hospital. Med J Islam Repub Iran 2022; 36:113. [PMID: 36447535 PMCID: PMC9700417 DOI: 10.47176/mjiri.36.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Indexed: 01/25/2023] Open
Abstract
Background: The prehospital emergency system is the first initiator of medical care as an alternative to hospitals and health care services that helps patients and injured people in critical situations and accidents. This study aimed to evaluate the cost-effectiveness of air ambulance versus ground ambulance regarding the patient's transportation and treatment. Methods: In this cost-effectiveness analysis study, 300 patients who were transferred to the Shohadaye HaftomTir hospital by air ambulance and 300 patients transferred by ground ambulance during the study period were selected in 2021-2022. This study examined the costs from the society's perspective. After drawing the decision tree model in TreeAge software, the incremental cost-effectiveness ratio was calculated; and to evaluate the strength of the analysis results, one-way and two-way sensitivity analyses were done on all costs and consequence parameters. Results: The effectiveness rate in the ground ambulance group and in the air ambulance group was 0.42591 and 0.5566, respectively, and the total cost of transportation and treatment by ambulance in these patients was $412.88 and for patients transported and treated by air ambulance was $11898.05. Therefore, air ambulance costs more and is more effective than ground ambulance, and the amount of incremental cost and effectiveness of air ambulance compared with ground ambulance was $11485.17 and 0.130773 units, respectively. The incremental cost-effectiveness ratio (ICER) of the 2 strategies was 87825.28, and the cost-effectiveness threshold was $7200. To determine the strength of the study results, one-way and two-way sensitivity analyses were done and the results of the cost-effectiveness analysis was not changed. Conclusion: Our study showed that ground ambulance is more cost-effective than air ambulance and the most important reason is that the total cost of air ambulance is 26 times more than ground ambulance, however, it is more effective than ground ambulance.
Collapse
Affiliation(s)
- Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Peyman Saberian
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Bagheri Faradonbeh
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | | | | | | | - Pirhossein Kolivand
- Department of Health Economics, Faculty of Medicine, Shahed University, Tehran, Iran,Corresponding author: Dr Pirhossein Kolivand,
| |
Collapse
|
9
|
Yeganeh A, Moghtadaei M, Ghaznavi A, Tavakoli N, Soleimani M, Cheraghiloohesara S, Taheri N. The distance between new and previous incisions does not affect skin necrosis in total knee arthroplasty: a parallel-randomized controlled clinical trial. BMC Surg 2022; 22:350. [PMID: 36163060 PMCID: PMC9513953 DOI: 10.1186/s12893-022-01791-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background To avoid skin necrosis, an 8 cm distance between the new and previous incision is recommended in patients undergoing total knee arthroplasty (TKA). It was hypothesized that making a new incision less than 8 cm of the prior scar does not increase the risk of skin complications, and the new incision can be made anywhere, regardless of the distance from the previous scar. This study investigated how making a new incision, irrespective of the previous scars, affects skin necrosis. Methods In this parallel, randomized clinical trial, by simple randomization method using a random number table, 50 patients with single longitudinal knee scars were randomly assigned to two groups with a 1:1 ratio and 25 participants in each group. Patients with a minimum age of 60 and a single longitudinal previous scar on the knee were included. The exclusion criteria were diabetes mellitus, hypertension, morbid obesity, smoking, vascular disorders, cardiopulmonary disorders, immune deficiencies, dementia, and taking steroids and angiogenesis inhibitors. TKA was performed through an anterior midline incision, regardless of the location of the previous scar in the intervention group. TKA was performed with a new incision at least 8 cm distant from the old incision in the control group. Skin necrosis and scar-related complications were evaluated on the first and second days and first, second, and fourth weeks after the surgery. Knee function was assessed using the Knee Society Score (KSS) six months after the surgery. Results The baseline characteristics of the groups did not differ significantly. The average distance from the previous scar was 4.1 ± 3.2 cm in the intervention group and 10.2 ± 2.1 cm in the control group. Only one patient in the control group developed skin necrosis (P-value = 0.31). Other wound-related complications were not observed in both groups. The mean KSS was 83.2 ± 10.2 and 82.9 ± 11.1 in the intervention and control groups, respectively (P-value = 0.33). Conclusions It is possible that in TKA patients, the new incision near a previous scar does not increase the risk of skin necrosis and other complications.
Collapse
Affiliation(s)
- Ali Yeganeh
- Department of Orthopedic Surgery, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moghtadaei
- Department of Orthopedic Surgery, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Ghaznavi
- Department of Orthopedic Surgery, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Hazrat-e Rasool Hospital, Iran University of Medical Sciences, Niayesh St, Satarkhan Av, Tehran, Iran
| | - Mohammad Soleimani
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sahand Cheraghiloohesara
- Trauma and Injury Research Center, Hazrat-e Rasool Hospital, Iran University of Medical Sciences, Niayesh St, Satarkhan Av, Tehran, Iran
| | - Nima Taheri
- Trauma and Injury Research Center, Hazrat-e Rasool Hospital, Iran University of Medical Sciences, Niayesh St, Satarkhan Av, Tehran, Iran.
| |
Collapse
|
10
|
Tavakoli N, Nafissi N, Shokri S, Fallahpour M, Soleimani S, Riahi T, Kalantari S, Javan A, Goodarzi A, Valizadeh R. Pediatric and Adolescent COVID-19 Vaccination Side Effects: A Retrospective Cohort Study of Iranian Teenage group in 2021. J Med Virol 2022; 94:4890-4900. [PMID: 35758760 PMCID: PMC9349687 DOI: 10.1002/jmv.27962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/06/2022] [Accepted: 06/24/2022] [Indexed: 12/03/2022]
Abstract
To determine the safety and efficacy profile of teenager COVID‐19 vaccination. In this retrospective cohort study, contact numbers of parents of teenagers under 18 years of age referred to a teenager vaccination centers in Tehran‐Iran to receive the corona vaccine were collected, and the following information was obtained via the phones: demographic information, type of vaccine, and the number of doses received, as well as additional information like complications and required treatments. Eleven thousand forty‐two subjects aged 10−18 years, mean age 14.55 ± 1.83 year including 5374 boys and 5768 girls were investigated. 88.1% received the Sinopharm and 11.9% the Soberana vaccine. General side effects, including fatigue, fever and chills, injection site pain and dizziness, and so forth happened in 2978 cases; 7421 children presented with at least one general or organ‐specific side effect following vaccination, including potentially critical side effects, such as vascular injuries, respiratory complication, and so forth. 0.1% of the subject needed hospital admission. The breakthrough infection happened in 200 individuals. Our study shows that Sinopharm and Soberana (PastoCoVac) COVID‐19 vaccines are generally safe with no serious side effects in less than 18 years old. COVID‐19 infection and reinfection can occur after vaccination, but the incidence is actually tolerable and significantly lower than in the unvaccinated group. Only 0.1% of the children with side effects related to vaccination need hospital admission. Regarding the ABO group, +A and then +O were the dominant blood group that developed COVID‐19. In total, 412 children developed major side effects (observed in 3.73% of all population and account for 5.5% of all observed side effects). In total, 3289 children developed general side effects following vaccination (0.2978 i.e., 2978 cases per 10 000 vaccinated children or about 30% of vaccinated children). There were 7421 children (67%) with at least one general or organ‐specific side effect following vaccination, including dermatological, gastrointestinal, respiratory, joint‐related, neurological, cardiovascular, and renal side effects following vaccination. All children who developed COVID‐19 after vaccination had a previous history of COVID‐19. There is no difference regarding the development of COVID‐19 after vaccination between the two vaccines of Sinopharm and Soberana. Only 1.8% of the children developed COVID‐19 after vaccination (Sinopharm [1.9%] and Soberana [1.5%]). After receiving both doses, the chance of developing COVID‐19 was the lowest. Regarding general side effects, fatigue, pain, and dizziness were higher in the Sinopharm group compared to the Soberana group. Soberana shows early side effects compared to Sinopharm.
Collapse
Affiliation(s)
- Nader Tavakoli
- Department of Emergency Medicine, School of Medicine, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Nafissi
- Department of General Surgery, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Sima Shokri
- Department of Allergy and Clinical Immunology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Fallahpour
- Department of Allergy and Clinical Immunology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Soleimani
- Iran University of Medical Sciences, Tehran, Iran.,Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Taghi Riahi
- Department of Internal Medicine, School of Medicine, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Kalantari
- Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Javan
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Rohollah Valizadeh
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Sedighi M, Amanollahi A, Moghaddam OM, Ghafouri HB, Hoseini SE, Tavakoli N. Linear mixed model analysis to evaluate correlations between remdesivir adverse effects with age and gender of patients with mild Covid‐19 pneumonia. J Med Virol 2022; 94:3783-3790. [PMID: 35491957 PMCID: PMC9348259 DOI: 10.1002/jmv.27800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/06/2022] [Accepted: 04/19/2022] [Indexed: 11/14/2022]
Abstract
We aimed to assess longitudinal changes in clinical indexes of corona disease 2019 (Covid‐19) patients with mild pulmonary infection during 5 days of remdesivir therapy and determine the effect of age and gender on remdesivir adverse effects (AE). Patients' clinical data including inflammatory markers, liver and renal function tests, and heart rate (HR) were extracted from medical records. Linear mixed model (LMM) was used to analyze longitudinal changes in patients' clinical indexes. Gender and age were inserted in LMM as covariates to find their correlation with AE and clinical indexes. Of 84 patients, 35 patients met our criteria for the study. There were significant increases in mean levels of white blood cell (WBC; p = 0.005), alanine aminotransferase (ALT; p = 0.001), aspartate aminotransferase (p = 0.001), blood urea nitrogen (BUN; p = 0.001), and creatinine (p = 0.006), whereas mean levels of erythrocyte sedimentation rate (p = 0.005), C‐reactive protein (p = 0.001), alkaline phosphatase (p = 0.001), and potassium (p = 0.003) decreased significantly. Estimated glomerular filtration rate (p = 0.001) and HR (p = 0.001) showed a notable decline over the course of treatment. LMM analysis showed that mean changes in WBC (β = 0.94, p = 0.029), creatinine (β = 0.12, p = 0.020), and HR (β = 6.47, p = 0.008) were greater in males than in females. Also, age of patients had a significant effect on the mean changes of WBC (β = −0.02, p = 0.023), sodium (β = −0.06, p = 0.010), BUN (β = 0.23, p = 0.001), and HR (β = −0.29, p = 0.001). Despite no renal and liver dysfunction, Covid‐19 patients with mild pulmonary infection may develop some remdesivir AE and attributed side effects might be affected by gender and age of patients.
Collapse
Affiliation(s)
- Mohsen Sedighi
- Trauma and Injury Research Center, Iran University of Medical SciencesTehranIran
| | - Alireza Amanollahi
- Department of EpidemiologySchool of Public Health and Safety, Shahid Beheshti University of Medical SciencesTehranIran
| | | | - Hamed Basir Ghafouri
- Trauma and Injury Research Center, Iran University of Medical SciencesTehranIran
| | | | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical SciencesTehranIran
| |
Collapse
|
12
|
Yeganeh A, Tavakoli N, Soleimani M, Taheri SN, Cheraghiloohesara S. Inferior Hip Dislocation in a 60-Year-Old Man; a Case Report. Arch Acad Emerg Med 2022; 10:e17. [PMID: 35402998 PMCID: PMC8986494 DOI: 10.22037/aaem.v10i1.1498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Inferior hip dislocation or luxatio erecta femoris is among the rarest hip dislocations, which has been described in limited studies. The patients usually present with their hip in flexion, abduction, and external rotation. Hip dislocation is an orthopedic emergency, and a reduction needs to be performed promptly to avoid devastating complications such as avascular necrosis. Here, we present a rare case of inferior hip dislocation in a 60-year-old man following a car-motorcycle collision. The patient presented to the emergency department with left hip flexion, abduction, external rotation, and inability to move his leg due to pain. Closed reduction under procedural sedation was attempted in the emergency department once, which was unsuccessful. The patient was then taken to the operating room for another attempt of closed reduction under general anesthesia. The patient was discharged after two days with pin traction and double crutches. After two weeks, the pin was removed, and full weight-bearing was permitted. After 12 weeks, the patient had mild pain with unusual activity and slight limping; however, imaging revealed no signs of any complications.
Collapse
Affiliation(s)
- Ali Yeganeh
- Trauma and Injury Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Nima Taheri
- Trauma and Injury Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sahand Cheraghiloohesara
- Trauma and Injury Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Corresponding author: Sahand Cheraghiloohesara; Hazrate Rasool Akram Hospital, Niayesh St, Satarkhan Av, Tehran, Iran; Postal Code: 1449614535; Telephone number: 00982164352264 , Fax Number: 00982166502248,
| |
Collapse
|
13
|
Jamshidi E, Asgary A, Tavakoli N, Zali A, Setareh S, Esmaily H, Jamaldini SH, Daaee A, Babajani A, Sendani Kashi MA, Jamshidi M, Jamal Rahi S, Mansouri N. Using Machine Learning to Predict Mortality for COVID-19 Patients on Day 0 in the ICU. Front Digit Health 2022; 3:681608. [PMID: 35098205 PMCID: PMC8792458 DOI: 10.3389/fdgth.2021.681608] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/22/2021] [Indexed: 01/28/2023] Open
Abstract
Rationale: Given the expanding number of COVID-19 cases and the potential for new waves of infection, there is an urgent need for early prediction of the severity of the disease in intensive care unit (ICU) patients to optimize treatment strategies. Objectives: Early prediction of mortality using machine learning based on typical laboratory results and clinical data registered on the day of ICU admission. Methods: We retrospectively studied 797 patients diagnosed with COVID-19 in Iran and the United Kingdom (U.K.). To find parameters with the highest predictive values, Kolmogorov-Smirnov and Pearson chi-squared tests were used. Several machine learning algorithms, including Random Forest (RF), logistic regression, gradient boosting classifier, support vector machine classifier, and artificial neural network algorithms were utilized to build classification models. The impact of each marker on the RF model predictions was studied by implementing the local interpretable model-agnostic explanation technique (LIME-SP). Results: Among 66 documented parameters, 15 factors with the highest predictive values were identified as follows: gender, age, blood urea nitrogen (BUN), creatinine, international normalized ratio (INR), albumin, mean corpuscular volume (MCV), white blood cell count, segmented neutrophil count, lymphocyte count, red cell distribution width (RDW), and mean cell hemoglobin (MCH) along with a history of neurological, cardiovascular, and respiratory disorders. Our RF model can predict patient outcomes with a sensitivity of 70% and a specificity of 75%. The performance of the models was confirmed by blindly testing the models in an external dataset. Conclusions: Using two independent patient datasets, we designed a machine-learning-based model that could predict the risk of mortality from severe COVID-19 with high accuracy. The most decisive variables in our model were increased levels of BUN, lowered albumin levels, increased creatinine, INR, and RDW, along with gender and age. Considering the importance of early triage decisions, this model can be a useful tool in COVID-19 ICU decision-making.
Collapse
Affiliation(s)
- Elham Jamshidi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Asgary
- Department of Biotechnology, College of Sciences, University of Tehran, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soroush Setareh
- Department of Biotechnology, College of Sciences, University of Tehran, Tehran, Iran
| | - Hadi Esmaily
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Jamaldini
- Department of Genetic, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Amir Daaee
- School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Amirhesam Babajani
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Masoud Jamshidi
- Department of Exercise Physiology, Tehran University, Tehran, Iran
| | - Sahand Jamal Rahi
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Nahal Mansouri
- Division of Pulmonary Medicine, Department of Medicine, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Laboratory of the Physics of Biological Systems, Institute of Physics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| |
Collapse
|
14
|
Golfiroozi S, Tavakoli N, Namdar P, Zare MA. Agreement between Prehospital and Final Diagnosis in Patients with Acute Allergic Reactions: A Cross-Sectional Study. JPRI 2021. [DOI: 10.9734/jpri/2021/v33i48a33231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Acute allergic reactions are usually first encountered in the prehospital setting and account for about 0.3% to 0.8% of prehospital runs in different countries. Right, and rapid recognition and treatment are necessary to decrease mortality and morbidity, especially in severe critical cases. This study evaluates the accuracy of prehospital care providers’ diagnosis in patients with acute allergic reactions in comparison with final (discharge) diagnosis as the gold standard.
Methods: Patients who were transported to 2 urban referral hospitals between 2008 and 2014 under the dispatch code of “acute allergic reaction” were included in the study, retrospectively. Demographic data, etiology of an allergic reaction, clinical presentations, vital signs stability, and need for epinephrine injection were evaluated. The prehospital care providers’ diagnosis (documented on-call report) was compared with the final diagnosis (documented on discharge summary form).
Results: A total of 300 patients were included in the study. In 55 (18.3%) cases the prehospital care providers’ and final diagnoses were different. Diagnoses were similar in 245 (81.6%) patients. Kappa coefficient was calculated as 0.621which shows a moderate-to-substantial agreement between prehospital and final diagnoses. Fifteen patients (5%) were discharged from the hospital with a diagnosis of anaphylaxis and only 4 cases (26.6%) were diagnosed in the prehospital setting.
Conclusion: Although the overall agreement between prehospital and final diagnosis of acute allergic reactions calculated in this study was good, the accuracy of diagnosing the anaphylaxis (as the most critical allergic reaction with a potential fatality) was less than optimal.
Collapse
|
15
|
Goudarzi Z, Nikfar S, Kebriaeezadeh A, Yousefi Zenouz R, Abdollahi Asl A, Tavakoli N. A Scoping Review of Different Methods of Assessing the Impact of New Medical Technologies at Early Stages of Development. Med J Islam Repub Iran 2021; 35:141. [PMID: 35321374 PMCID: PMC8840857 DOI: 10.47176/mjiri.35.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Investing in the R & D sector of new medical technologies is associated with the risk of being rejected by paying organizations because of the lack of value-for-money. The purpose of this study is to investigate the different methods of evaluating the impacts of emerging medical technologies. Methods: Using scoping review method, we analyzed studies that investigated methods for assessing the impacts of emerging medical technologies on development. To find these studies, the Cochran Library, ISI Web of Knowledge, Embase, Ebsco and Pubmed databases from 2000 to 2018 were searched. The methodological quality of the studies was assessed using the STROBE Checklist. Two reviewers independently selected the qualified studies. Charting and collating the data were used based on the method proposed by Arksey and O'Malley. Results: Overall, 38 studies met the inclusion criteria. Sixteen methods were identified and put in five distinct categories: forecasting, Pro-HTA, Early-HTA, priority setting, and HHS were found to measure the impact of emerging technologies. The quality of these studies was acceptable. Few studies were conducted on emerging pharmaceutical technologies, and they were mostly on emerging medical devices. The Early HTA methods were often used to measure the effects of pharmaceutical technologies and medical devices technologies. The Pro-HTA method used dynamic modeling to examine the impact of medical technologies on a broad range of dimensions, while the HTA and Early-HTA methods used cost-effectiveness techniques throughout the development process. The HHS method used a multivariate decision-making technique. Conclusion: Different methods were used to investigate the impacts of emerging medical technologies. Chronologically Pro-HTA methods are new ways for investigating emerging medical technologies beyond clinical and economic impacts. Assessing the feasibility of implementing Pro-HTA in real environments deserves further research.
Collapse
Affiliation(s)
- Zahra Goudarzi
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Health Human Resources Research Centre, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical sciences, Tehran, Iran
| | - Reza Yousefi Zenouz
- Department of Operations and Information Technology Management, Faculty of Management, Kharazmi University, Tehran, Iran
| | - Akbar Abdollahi Asl
- Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical sciences, Tehran, Iran
- Corresponding author: Dr Akbar Abdollahi Asl,
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
Kia F, Rahnamay Rood Poshti F, Ghafari F, Hashemi SA, Tavakoli N. Identification of the Requirements for the Effective Human Resource Development in the Health System. Med J Islam Repub Iran 2021; 35:135. [PMID: 35321389 PMCID: PMC8840880 DOI: 10.47176/mjiri.35.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Fatemeh Kia
- Department of Management, UAE Branch, Islamic Azad University, Dubai, United Arab Emirates
| | - Fraydoon Rahnamay Rood Poshti
- Department of Economics, Sciences & Research Branch, Islamic Azad University,Tehran, Iran
- Corresponding author: Dr Fraydoon Rahnamay Rood Poshti,
| | - Farhad Ghafari
- Department of Economics, Sciences & Research Branch, Islamic Azad University,Tehran, Iran
| | - Seyed Ahmad Hashemi
- Department of Educational Sciences, Lamerd Branch, Islamic Azad University, Lamerd, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
17
|
Jamshidi E, Asgary A, Tavakoli N, Zali A, Dastan F, Daaee A, Badakhshan M, Esmaily H, Jamaldini SH, Safari S, Bastanhagh E, Maher A, Babajani A, Mehrazi M, Sendani Kashi MA, Jamshidi M, Sendani MH, Rahi SJ, Mansouri N. Symptom Prediction and Mortality Risk Calculation for COVID-19 Using Machine Learning. Front Artif Intell 2021; 4:673527. [PMID: 34250465 PMCID: PMC8262614 DOI: 10.3389/frai.2021.673527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/14/2021] [Indexed: 01/28/2023] Open
Abstract
Background: Early prediction of symptoms and mortality risks for COVID-19 patients would improve healthcare outcomes, allow for the appropriate distribution of healthcare resources, reduce healthcare costs, aid in vaccine prioritization and self-isolation strategies, and thus reduce the prevalence of the disease. Such publicly accessible prediction models are lacking, however. Methods: Based on a comprehensive evaluation of existing machine learning (ML) methods, we created two models based solely on the age, gender, and medical histories of 23,749 hospital-confirmed COVID-19 patients from February to September 2020: a symptom prediction model (SPM) and a mortality prediction model (MPM). The SPM predicts 12 symptom groups for each patient: respiratory distress, consciousness disorders, chest pain, paresis or paralysis, cough, fever or chill, gastrointestinal symptoms, sore throat, headache, vertigo, loss of smell or taste, and muscular pain or fatigue. The MPM predicts the death of COVID-19-positive individuals. Results: The SPM yielded ROC-AUCs of 0.53-0.78 for symptoms. The most accurate prediction was for consciousness disorders at a sensitivity of 74% and a specificity of 70%. 2,440 deaths were observed in the study population. MPM had a ROC-AUC of 0.79 and could predict mortality with a sensitivity of 75% and a specificity of 70%. About 90% of deaths occurred in the top 21 percentile of risk groups. To allow patients and clinicians to use these models easily, we created a freely accessible online interface at www.aicovid.net. Conclusion: The ML models predict COVID-19-related symptoms and mortality using information that is readily available to patients as well as clinicians. Thus, both can rapidly estimate the severity of the disease, allowing shared and better healthcare decisions with regard to hospitalization, self-isolation strategy, and COVID-19 vaccine prioritization in the coming months.
Collapse
Affiliation(s)
- Elham Jamshidi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Asgary
- Department of Biotechnology, College of Sciences, University of Tehran, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Dastan
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Daaee
- School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mohammadtaghi Badakhshan
- School of Electrical and Computer Engineering, Engineering Faculty, University of Tehran, Tehran, Iran
| | - Hadi Esmaily
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Jamaldini
- Department of Genetic, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Saeid Safari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Bastanhagh
- Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Maher
- School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhesam Babajani
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Mehrazi
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Masoud Jamshidi
- Department of Exercise Physiology, Tehran University, Tehran, Iran
| | | | - Sahand Jamal Rahi
- Laboratory of the Physics of Biological Systems, Institute of Physics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Nahal Mansouri
- Division of Pulmonary Medicine, Department of Medicine, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Research Group on Artificial Intelligence in Pulmonary Medicine, Division of Pulmonary Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| |
Collapse
|
18
|
Rezapour A, Tavakoli N, Akbar S, Hajahmadi M, Ameri H, Mohammadi R, Bagheri Faradonbeh S. Medical therapy versus percutaneous coronary intervention in ischemic heart disease: A cost-effectiveness analysis. Med J Islam Repub Iran 2021; 34:155. [PMID: 33500882 PMCID: PMC7813149 DOI: 10.47176/mjiri.34.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Ischemic heart disease is categorized into two acute and chronic groups, and its treatments include revascularization and medical therapy. The aim of this study is to evaluate the economic burden of medical therapy compared to percutaneous coronary intervention in ischemic heart disease.
Methods: This study has been done in two steps. The first was a systematic review and meta-analysis to measure the effectiveness of two interventions and the second step was a cost-effectiveness analysis from the perspective of society. The data analysis included a meta-analysis and the Markov cohort simulation. RewMan v5 and tree age software were utilized. Uncertainties related to the model parameters were evaluated using one-way and two-way sensitivity analyses.
Results: Regarding the effectiveness of interventions, the odd ratio of the quality of life in the medical therapy group (CI: 0.76-1.10) was 0.91 times the PCI group (p=0.34). This rate for mortality in medical therapy (CI: 0.52-9.68) was 2.23 times more than the PCI group; this result was not significant (p=0.02). In the cost-effectiveness analysis, the cost-effectiveness threshold was $ 16,482; ICER in increasing the QoL and reduction in the mortality rate was $ 25320.11 and $ 562.6691, respectively. Regarding the sensitivity analysis, the model was not sensitive in changing parameters in a specific domain.
Conclusion: According to this study, PCI is more cost-effective than medical therapy in the reduction of mortality rate and in the field of increasing quality of life. MT strategy is more cost-effective than the PCI. This study considers controversies regarding the most appropriate treatment for patients with ischemic heart disease that is helpful for health policymakers, cardiologists and health managers.
Collapse
Affiliation(s)
- Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sadaf Akbar
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Hajahmadi
- Department of Cardiology, Hazrat Rasoul Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hosein Ameri
- Department of Healthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reza Mohammadi
- Firouzabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Bagheri Faradonbeh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
19
|
Tavakoli N, Abbasi S, Tayebi A. Concordance of triage performed with emergency severity index in the emergency departments of Rasoul Akram and Haft Tir hospitals. J Prev Epidemiol 2020. [DOI: 10.34172/jpe.2020.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Triage is prioritizing patients by disease severity in the shortest possible time. Proper triage increases the quality of patient care services, increases patient’s satisfaction, decreases patient waiting time, decreases mortality, and enhances emergency department efficiency. Objectives: The aim of this study was to evaluate the concordance of triage performed by nurses with ESI standard, at Rasoul Akram and Haft Tir hospitals, which are the most important educational centers of Iran University of Medical Sciences. Patients and Methods: This is a cross-sectional design study done in 2019. The study population is patients referred to Rasoul Akram and Haft Tir hospitals. A sample of 800 patients was selected. In this study, we determined how triage level were determined and compared with triaging by emergency medicine assistant. Data were analyzed by SPSS 23. Results: Out of 800 samples, the highest triage level was related to level three (79.1%) and levels two, four and one were in the next levels. 13.5% of the cases were not properly triaged according to the ESI standard and the adaptation coefficient (kappa) between the triage level specified in the patient file with the emergency severity index (ESI) triage level between physician and nurse was 58%, which was a significant difference (P<0.001). The relationship between correct triage leveling and patients’ complaints was significant (P<0.001). Conclusion: Nurses triage education about appropriate triage and ESI tool should be one of the most urgent topics and priorities of the studied hospitals. Over triage causes resources wasted and under triage may harm the patient’s health.
Collapse
Affiliation(s)
- Nader Tavakoli
- Emergency Medicine Department, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Abbasi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Afrooz Tayebi
- Emergency Physician, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
20
|
Keshmiri F, Rezai M, Tavakoli N. The effect of interprofessional education on healthcare providers' intentions to engage in interprofessional shared decision-making: Perspectives from the theory of planned behaviour. J Eval Clin Pract 2020; 26:1153-1161. [PMID: 32114699 DOI: 10.1111/jep.13379] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/31/2022]
Abstract
AIMS AND OBJECTIVES The present study aimed to investigate the effects of interprofessional education on healthcare providers' intentions to engage in an interprofessional shared decision-making (IP-SDM) process at emergency department and exploring the affecting factors on their intentions. METHODS We conducted the study through a sequential explanatory mixed method (quantitative-qualitative) design. All ED residents and nurses from two university hospitals were invited and assigned to the intervention and control groups. The intervention group was exposed to case-based learning sessions conducted by applying interprofessional strategies. The intentions of the participants engaged in IP-SDM were assessed before and 2 weeks after the intervention by a questionnaire designed based on the theory of planned behaviour. The questionnaire scores were compared between the intervention and control groups using analysis of covariance (ANCOVA). Partial eta-squared (η2 ) was used for effect size calculations in ANCOVA. Subsequently, to explore the affecting factors in engagement in IP-SDM, qualitative data were collected through semi-structured individual interviews. The inductive content analysis approach by Elo and Kyngas was employed to analyze the qualitative data. RESULTS Out of 117 potentially eligible healthcare professionals, 113 completed the study in the intervention (n = 55) and control (n = 58) groups. The results showed that the difference between the mean scores of the learners in the intervention (1.41 ± 0.27) and control (0.80 ± 0.52) groups was statistically significant (P-value = .00001). The main effect of the intervention and a large educational effect size for the intervention were found to be statistically significant F (1, 11) = 180.54, P-value = .00001, η2 = 0.62. The qualitative data analysis showed two main categories of "team-based facilitators" and "contextual challenges" as the main affecting factors in the engagement of participant in IP-SDM. CONCLUSION Our findings suggested that applying interprofessional education strategies could improve the learners' intention to engage in IP-SDM. Moreover, the results showed that the interprofessional collaboration among team members, adherence to the team-based care principles, and administrative support at different levels could be the influential factors the intentions of the participants to engage in IP-SDM.
Collapse
Affiliation(s)
- Fatemeh Keshmiri
- Medical Education Department, Educational Development Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdi Rezai
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Emergency Medicine Department, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
21
|
Saberian P, Tavakoli N, Hasani-Sharamin P, Sezavar SH, Dadashi F, Vahidi E. The effect of prehospital telecardiology on the mortality and morbidity of ST-segment elevated myocardial infarction patients undergoing primary percutaneous coronary intervention: A cross-sectional study. Turk J Emerg Med 2020; 20:28-34. [PMID: 32355899 PMCID: PMC7189824 DOI: 10.4103/2452-2473.276380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/03/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The sooner the primary percutaneous coronary intervention (PPCI) is performed, the better prognosis is expected in patients with acute myocardial infarction. The objective is to evaluate the effect of prehospital triage based on electrocardiogram (ECG) and telecardiology on the mortality and morbidity of ST-segment elevated myocardial infarction (STEMI) patients undergoing PPCI. METHODS This cross-sectional study was conducted based on the data extracted from the hospital information system (HIS) of one general hospital, which had the capability of performing PPCI 24 h a day, 7 days a week. All patients with STEMI who undergone PPCI during 1 year, transferred by emergency medical service (EMS) and their data were registered in the HIS were eligible. Besides the baseline characteristics, first medical contact (FMC)-to-balloon time was recorded. Morbidity based on predischarge left ventricular ejection fraction (LVEF) and mortality based on Global Registry of Acute Cardiac Events (GRACE) score were also recorded. Patients who were referred to the hospital by EMS with prehospital ECG and telecardiology were compared with those without prehospital ECG. RESULTS Totally, 298 patients with STEMI were enrolled, of whom 183 patients (61.4%) had prehospital ECG (telecardiology), and 115 patients (38.6%) had not. The means of predischarge LVEF of the patients in the first and the second groups were 40.7 ± 10.4 and 40.6 ± 11.2, respectively (P = 0.946). The mean of the probability of 6-month mortality based on GRACE score in the first group was significantly less than that of the second group (P = 0.004). Analyses of multivariable ordinal logistic regression showed that 6-month mortality severity risk in the second group was 1.5 times more than the first group (95% confidence interval 0.8-2.6), although this difference was not statistically significant (P = 0.199). CONCLUSIONS It is likely that prehospital telecardiology, with shortening FMC to balloon time result in reducing probability 6-month mortality in STEMI patients who undergone PPCI. However, the process of telecardiology had no effect on predischarge LVEF in the current study.
Collapse
Affiliation(s)
- Peyman Saberian
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Hasani-Sharamin
- Tehran Emergency Medical Service Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Dadashi
- Tehran Emergency Medical Service Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Vahidi
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
22
|
Saberian P, Tavakoli N, Hasani-Sharamin P, Modabber M, Jamshididana M, Baratloo A. Accuracy of the pre-hospital triage tools (qSOFA, NEWS, and PRESEP) in predicting probable COVID-19 patients' outcomes transferred by Emergency Medical Services. Caspian J Intern Med 2020; 11:536-543. [PMID: 33425272 PMCID: PMC7780871 DOI: 10.22088/cjim.11.0.536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/14/2020] [Accepted: 10/28/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND This study aimed to evaluate the efficiency of pre-hospital triage tools including the qSOFA, NEWS, and PRESEP in determining the prognosis of probable COVID-19 patients. METHODS In this diagnostic accuracy study, all probable COVID-19 patients older than 16-year-old who were transferred to the hospital by the Tehran Emergency Medical Services (EMS) during the first month of the pandemic, entered to the study. The scores of qSOFA, NEWS, and PRESEP were calculated using data gathered while providing pre-hospital care. The primary outcome was death; and the secondary outcomes were ICU admission, length of stay in the ICU, and length of hospital stay. RESULTS The data of 557 individuals with the mean age of 56.93±18.31 were analyzed of whom 67.5% were males. The area under the ROC curve (AUC) of qSOFA, NEWS, and PRESEP for ICU admission was 0.553, 0.557, and 0.551, respectively. The AUC of qSOFA, NEWS, and PRESEP for death was 0.596, 0.566, and 0.604, respectively. The best obtained cut-off point for qSOFA was a score >0 (the sensitivity and specificity were 25.0 and 85.68%, respectively), for NEWS was a score >2 (the sensitivity and specificity were 83.61 and 32.67%, respectively), and for PRESEP was a score >1 (the sensitivity and specificity were 54.10 and 55.56%, respectively). CONCLUSION Based on the findings of the current study, it is likely that the available pre-hospital triage tools (qSOFA, NEWS, and PRESEP) do not have proper efficacy to predict death, ICU admission, and disease severity of COVID-19 patients.
Collapse
Affiliation(s)
- Peyman Saberian
- Pre-hospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Alireza Baratloo
- Pre-hospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
23
|
Amirhajlou L, Bidari A, Alipour F, Yaseri M, Vaziri S, Rezai M, Tavakoli N, Farsi D, Yasinzadeh MR, Mosaddegh R, Hashemi A. Validity, reliability and acceptability of Professionalism Mini-Evaluation Exercise (P-MEX) for emergency medicine residency training. J Med Ethics Hist Med 2019; 12:12. [PMID: 32328225 PMCID: PMC7166245 DOI: 10.18502/jmehm.v12i12.1641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 09/15/2019] [Indexed: 01/08/2023] Open
Abstract
Professionalism is a core competency in the medical profession. In this paper, we aimed to confirm the validity, reliability and acceptability of the Professionalism Mini-Evaluation Exercise (P-MEX) instrument for the emergency medicine (EM) residency program. Twenty-two EM attending physicians completed 383 P-MEX forms (the Persian version) for 90 EM residents. Construct validity was assessed via structural equation modeling (SEM). The reliability coefficient was estimated by the generalizability theory, and acceptability was assessed using two researcher-made questionnaires to evaluate the perspectives of residents and assessors. There was a consensus among the participants regarding the content of P-MEX. According to the results of SEM, the first implementation of the original model was associated with a moderate fit and high item loadings. The model modified with correlated error variances for two pairs of items showed an appropriate fit. The reliability of P-MEX was 0.81 for 14 occasions. The perception survey indicated high acceptability for P-MEX from the viewpoint of the residents and increasing satisfaction with P-MEX among the assessors over time. According to the results of the research, P-MEX is a reliable, valid, and acceptable instrument for assessing professionalism in EM residents.
Collapse
Affiliation(s)
- Leila Amirhajlou
- Researcher, Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Bidari
- Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fateme Alipour
- Associate Professor, Department of Ophthalmology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Associate Professor, Department of Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Vaziri
- Assistant Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Rezai
- Assistant Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Associate Professor, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Davood Farsi
- Associate Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Yasinzadeh
- Assistant Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Mosaddegh
- Assistant Professor, Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Hashemi
- Assistant Professor, Department of Medical Ethics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
24
|
Amirhajlou L, Sohrabi Z, Alebouyeh MR, Tavakoli N, Haghighi RZ, Hashemi A, Asoodeh A. Application of data mining techniques for predicting residents' performance on pre-board examinations: A case study. J Educ Health Promot 2019; 8:108. [PMID: 31334260 PMCID: PMC6615122 DOI: 10.4103/jehp.jehp_394_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/01/2019] [Indexed: 05/24/2023]
Abstract
CONTEXT Predicting residents' academic performance is critical for medical educational institutions to plan strategies for improving their achievement. AIMS This study aimed to predict the performance of residents on preboard examinations based on the results of in-training examinations (ITE) using various educational data mining (DM) techniques. SETTINGS AND DESIGN This research was a descriptive cross-sectional pilot study conducted at Iran University of Medical Sciences, Iran. PARTICIPANTS AND METHODS A sample of 841 residents in six specialties participating in the ITEs between 2004 and 2014 was selected through convenience sampling. Data were collected from the residency training database using a researcher-made checklist. STATISTICAL ANALYSIS The analysis of variance was performed to compare mean scores between specialties, and multiple-regression was conducted to examine the relationship between the independent variables (ITEs scores in postgraduate 1st year [PGY1] to PG 3rd year [PGY3], sex, and type of specialty training) and the dependent variable (scores of postgraduate 4th year called preboard). Next, three DM algorithms, including multi-layer perceptron artificial neural network (MLP-ANN), support vector machine, and linear regression were utilized to build the prediction models of preboard examination scores. The performance of models was analyzed based on the root mean square error (RMSE) and mean absolute error (MAE). In the final step, the MLP-ANN was employed to find the association rules. Data analysis was performed in SPSS 22 and RapidMiner 7.1.001. RESULTS The ITE scores on the PGY-2 and PGY-3 and the type of specialty training were the predictors of scores on the preboard examination (R 2 = 0.129, P < 0.01). The algorithm with the overall best results in terms of measuring error values was MLP-ANN with the condition of ten-fold cross-validation (RMSE = 0.325, MAE = 0.212). Finally, MLP-ANN was utilized to find the efficient rules. CONCLUSIONS According to the results of the study, MLP-ANN was recognized to be useful in the evaluation of student performance on the ITEs. It is suggested that medical, educational databases be enhanced to benefit from the potential of DM approach in the identification of residents at risk, allowing instructors to offer constructive advice in a timely manner.
Collapse
Affiliation(s)
- Leila Amirhajlou
- Department of Medical Education, Iran University of Medical Sciences, Tehran, Iran
| | - Zohre Sohrabi
- Department of Medical Education, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Alebouyeh
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Roghye Zare Haghighi
- Department of Deputy of Specialty and Subspecialty Education, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Hashemi
- Department of Medical Ethics, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Asoodeh
- Health Laboratories Administration, Birjand University of Medical Sciences, Birjand, Iran
| |
Collapse
|
25
|
Saberian P, Tavakoli N, Ramim T, Hasani-Sharamin P, Shams E, Baratloo A. The Role of Pre-Hospital Telecardiology in Reducing the Coronary Reperfusion Time; a Brief Report. Arch Acad Emerg Med 2019; 7:e15. [PMID: 30847450 PMCID: PMC6377217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Telecardiology is defined as using telecommunication for remote treatment of cardiac patients. This study aimed to assess the role of pre-hospital triage via telecardiology on coronary reperfusion time of patients with ST segment elevation myocardial infarction (STEMI). METHODS This cross-sectional study was conducted from September, 2015 to January, 2018 in six academic referral hospitals, Tehran, Iran. Studied patients were divided into two groups of percutaneous coronary intervention (PCI) following telecardiology or PCI following emergency department (ED) diagnosis of STEMI and time to reperfusion was compared between them. RESULTS 1205 patients with the mean age of 58.99 ± 12.33 (19-95) years entered the study (82.7% male). 841 (69.8%) cases were transferred directly to the Cath-Lab following telecardiology and 364 (30.2%) cases were first admitted to the ED. There was no significant difference between the groups regarding mean age (p = 0.082) and gender (p = 0.882) of participants. Symptom-to-device interval time in patients who underwent PCI following telecardiology was significantly lower (p < 0.001); however, the difference was not significant in the first medical contact (FMC)-to-device interval time (p = 0.268). CONCLUSIONS It is likely that the use of telecardiology in pre-hospital triage plays an important role in reducing time to PCI for patients with STEMI.
Collapse
Affiliation(s)
- Peyman Saberian
- Prehospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Anesthesiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran.,Corresponding author: Nader Tavakoli; Department of Emergency Medicine, Rasool-e-Akram Hospital, Sattarkhan Street, Tehran, Iran. Tel: +989171131098,
| | - Tayeb Ramim
- Cancer Pharmacogenetics Research Group (CPGRG), Iran University of Medical Sciences, Tehran, Iran
| | | | - Elham Shams
- Cancer Pharmacogenetics Research Group (CPGRG), Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Baratloo
- Prehospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
26
|
Tavakoli N, Shaker SH, Soltani S, Abbasi M, Amini M, Tahmasebi A, Hosseini Kasnavieh SM. Job Burnout, Stress, and Satisfaction among Emergency Nursing Staff after Health System Transformation Plan in Iran. Emerg (Tehran) 2018; 6:e41. [PMID: 30584557 PMCID: PMC6289161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
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.
Collapse
Affiliation(s)
- Nader Tavakoli
- Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hosein Shaker
- Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Siamak Soltani
- Department of Forensic Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Abbasi
- Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Amini
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Tahmasebi
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
27
|
Abdolrazaghnejad A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain Management in the Emergency Department: a Review Article on Options and Methods. Adv J Emerg Med 2018; 2:e45. [PMID: 31172108 PMCID: PMC6548151 DOI: 10.22114/ajem.v0i0.93] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- Ali Abdolrazaghnejad
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Banaie
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury research center, Iran university of medical sciences, Tehran, Iran
| | - Mohammad Safdari
- Department of Neurosurgery, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | | |
Collapse
|
28
|
Tavakoli N, Mokhtare M, Agah S, Azizi A, Masoodi M, Amiri H, Sheikhvatan M, Syedsalehi B, Behnam B, Arabahmadi M, Mehrazi M. Comparison of the efficacy of intravenous tranexamic acid with and without topical administration versus placebo in urgent endoscopy rate for acute gastrointestinal bleeding: A double-blind randomized controlled trial. United European Gastroenterol J 2017; 6:46-54. [PMID: 29435313 DOI: 10.1177/2050640617714940] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 05/06/2017] [Indexed: 01/24/2023] Open
Abstract
Background Tranexamic acid (TXA), a synthetic antifibrinolytic drug, is effective as a treatment for serious hemorrhage, including bleeding arising from major trauma and post-operative interventions. Significant acute gastrointestinal bleeding may have a poor outcome despite routine medical and endoscopic treatments. The aim of this study was to assess whether early intravenous and/or intravenous plus topical administration of TXA reduces the need for urgent endoscopy for acute gastrointestinal bleeding. Method This double-blind randomized clinical trial included 410 patients with proven acute gastrointestinal bleeding. All patients received conventional therapy. The subjects were randomized to three groups: (A) 138 patients received intravenous TXA (1 g q6h); (B) 133 patients received topical TXA (1 g single dose by nasogastric tube) plus systemic TXA; and (C) 139 patients received a placebo (sodium chloride 0.9%) for 24 hours. Subgroup statistical analyses were conducted for urgent endoscopy, mortality, re-bleeding, blood transfusion, endoscopic and/or surgical intervention rates, and health status. Results The time to endoscopy was significantly shorter in group C (15.58 ± 7.994, p < 0.001). A need for urgent endoscopy was seen in 14.49%, 10.52%, and 30.21% of patients in groups A, B, and C, respectively (p < 0.001). No significant statistical differences were seen between treatment groups regarding mortality, re-bleeding, blood transfusion, and endoscopic and/or surgical intervention rates. No thromboembolic event was documented during the 1-week follow up. Conclusions Our results showed that the antifibrinolytic properties of TXA can aid in changing an urgent endoscopy to an elective procedure, with better outcomes for both physicians and patients.
Collapse
Affiliation(s)
- Nader Tavakoli
- Emergency Medicine Management Research Center, Iran University of Medical Science, Tehran, Iran
| | - Marjan Mokhtare
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Agah
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Azizi
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Masoodi
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Amiri
- Emergency Medicine Management Research Center, Iran University of Medical Science, Tehran, Iran
| | - Mehrdad Sheikhvatan
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahare Syedsalehi
- Emergency Medicine Management Research Center, Iran University of Medical Science, Tehran, Iran
| | - Behdad Behnam
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Arabahmadi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Mehrazi
- Shahid Beheshti University of Medical Science, Tehran, Iran
| |
Collapse
|
29
|
Keshmiri F, Rezai M, Mosaddegh R, Moradi K, Hafezimoghadam P, Zare MA, Tavakoli N, Cheraghi MA, Shirazi M. Effectiveness of an interprofessional education model based on the transtheoretical model of behaviour change to improve interprofessional collaboration. J Interprof Care 2017; 31:307-316. [PMID: 28276841 DOI: 10.1080/13561820.2016.1276051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to assess the effectiveness of an interprofessional education model (IPE) based on the transtheoretical model to improve the participants' interprofessional collaborative practice. The study was conducted in Iran using a controlled before-and-after study design. The participants (n = 91) were the residents of emergency medicine and nurses of the emergency units from two teaching hospitals affiliated to Iran University of Medical Sciences. The participants in the intervention group (n = 40) were 22 residents and 18 nurses. The control group (n = 51) consisted of 20 residents and 31 nurses. The participants were classified based on their stage of readiness to change. The interventions were two-day workshops for each stage (i.e., attitude and intention). We used the Interprofessional Collaborator Assessment Rubric (ICAR) to assess the effectiveness of the developed model. The interprofessional collaboration of the participants in the intervention and control groups was assessed at four time points before and after the intervention in the real emergency unit environment. Student's t-test and repeated measures analysis of variance (RM-ANOVA) were used to analyse the data. We used partial eta-squared (η2) for effect size calculations. The mean values of ICAR scores in the intervention and control groups were 95.63 ± 19.14 and 89.19 ± 16.11 before the intervention. The mean values of ICAR scores at 3 months after the intervention were 99.82 ± 22.32 and 88.29 ± 16.87 in the intervention and control groups, respectively. After 6 months, the mean values of ICAR scores of the intervention and control groups were 98.6 ± 23.40 and 87.98 ± 16.01, respectively. The results showed that the intervention had a medium educational effect size (partial η2 = 0.06) on performance of the participants. Our results showed that an IPE model that is tailored to the learners' stage of readiness to change improves interprofessional collaboration in the participants. The developed model could be applied for improving interprofessional collaborative performance in other IPE programmes.
Collapse
Affiliation(s)
- Fatemeh Keshmiri
- a Department of Medical Education, Faculty of Medicine , Tehran University of Medical Sciences , Tehran , Iran
| | - Mahdi Rezai
- b Emergency Medicine Management Research Center , Iran University of Medical Sciences , Tehran , Iran
| | - Reza Mosaddegh
- b Emergency Medicine Management Research Center , Iran University of Medical Sciences , Tehran , Iran
| | - Kamran Moradi
- c Evidence-Based Medicine and Critical Thinking Group, Endocrine and Metabolism Research Institute, Shariati Hospital , Tehran University of Medical Sciences , Tehran , Iran
| | - Peyman Hafezimoghadam
- d Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital , Iran University of Medical Sciences , Tehran , Iran
| | - Mohammad Amin Zare
- e Department of Emergency Medicine, Hazrat-e-Rasoul Akram Medical Center , Iran University of Medical Sciences , Tehran , Iran
| | - Nader Tavakoli
- f Hazrat-e-Rasoul Akram Medical Center , Iran University of Medical Sciences , Tehran , Iran
| | - Mohammad Ali Cheraghi
- g School of Nursing and Midwifery , Tehran University of Medical Sciences , Tehran , Iran
| | - Mandana Shirazi
- a Department of Medical Education, Faculty of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,h Educational Development Center , Tehran University of Medical Sciences , Tehran , Iran.,i Department of Clinical Science and Education , Södersjukhuset, Karolinska Institute , Stockholm , Sweden
| |
Collapse
|
30
|
Mehrara M, Tavakoli N, Fathi M, Mahshidfar B, Zare MA, Asadi A, Hosseinzadeh S, Safdarian M. Protocol Adherence in Prehospital Medical Care Provided for Patients with Chest Pain and Loss of Consciousness; a Brief Report. Emerg (Tehran) 2017; 5:e40. [PMID: 28286847 PMCID: PMC5325911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
Collapse
Affiliation(s)
- Mostafa Mehrara
- Department of Emergency Medicine, Hazrat-e-Rasoul Akram Medical Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Department of Emergency Medicine, Hazrat-e-Rasoul Akram Medical Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Fathi
- Department of Emergency Medicine, Hazrat-e-Rasoul Akram Medical Centre, Iran University of Medical Sciences, Tehran, Iran.,Corresponding author: Marzieh Fathi; Emergency Department, Hazrat-e-Rasoul Akram Hospital, Satarkhan St., Niyayesh St., Tehran, Iran.
| | - Babak Mahshidfar
- Department of Emergency Medicine, Hazrat-e-Rasoul Akram Medical Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Zare
- Department of Emergency Medicine, Hazrat-e-Rasoul Akram Medical Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Azita Asadi
- Department of Emergency Medicine, Hazrat-e-Rasoul Akram Medical Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Hosseinzadeh
- Department of Emergency Medicine, Hazrat-e-Rasoul Akram Medical Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Safdarian
- Department of Emergency Medicine, Hazrat-e-Rasoul Akram Medical Centre, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
31
|
Ghafourian N, Maniae NH, Taherikalani M, Mehrazi M, Hossieni M, Valian F, Karami S, Rahmatian Y, Tavakoli N. Combination of Vasopressin -Epinephrine as a Novel Candidate in Patients with Cardiac Arrest. ACTA ACUST UNITED AC 2016; 10:65-9. [PMID: 26767546 DOI: 10.2174/157489011001160111163856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Out-hospital Cardiac arrest is considered as a global disease, which causes high rate of morbidity and mortality. Although, the return of spontaneous circulation occurs in 10 to 60 percent of cases in OHCA, with variety of treatment, the most patients faced with multiple organ failure and ultimately death. The investigations demonstrated that endogenous vasopressin levels in patients with successful resuscitation is more than died patients. Therefore, it seems the administration of vasopressin during cardiopulmonary resuscitation could be useful. The current study aimed to investigate the administration of vasopressin and epinephrine on neurological surviving of cardiac-respiratory arrest via evaluation of S100b serum factor. METHODS For this reasons, after collecting of sera from two vasopressin-epinephrine and epinephrine receiving patients, sera were subjected for ELISA to evaluate S100b. RESULTS The findings demonstrated that the great reductions of S100b in sera of patients that receiving vasopressinepinephrine in comparison with those patients that only got the epinephrine. Although no significant difference was observed between two groups, but survival rates after hospital discharge in group that receiving vasopressin-epinephrine was significantly higher than those patients that only got only epinephrine. CONCLUSION Today, no advantages of vasopressin over epinephrine have been observed in clinical trials and more studies needed to improve the OHAC patient's surveillance. But, The combination vasopressin-epinephrine in the current study demonstrated that efficacy of this combination should be noted.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Nader Tavakoli
- M.D. Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
32
|
Tavakoli N, Hosseini Kasnavieh SM, Yasinzadeh M, Amini M, Mahmoudi Nejad M. Evaluation of Appropriate and Inappropriate Admission and Hospitalization Days According to Appropriateness Evaluation Protocol (AEP). Arch Iran Med 2016; 18:430-4. [PMID: 26161707 DOI: 0151807/aim.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Inappropriate admission and hospitalization days are the factors that impose more costs to hospitals. By considering current condition of hospitals, it is vital to have an insight into the data on inappropriate admission and hospitalization days in order to eliminate obstacles to the proper and appropriate hospitalization. METHODS In this study, 198 patients who were admitted to receive surgical or non-surgical treatment in Sina public hospital were selected. An appropriateness Evaluation Protocol (AEP) was used for data collection. The validity of AEP is well established by the preceding studies. In order to achieve the study objectives, binary logistic regression test was used. RESULTS According to our findings, 39.4% of hospitalization days and 16.2% of admissions are inappropriate. In this study, inappropriate admission was observed among married patients eight times more than among single ones. Inappropriate hospitalization days were 12 times more prevalent among patients from provinces than among those from Tehran. With increasing age of the patient the probability of inappropriate admission decreases slightly, i.e. the probability of inappropriate admission decreases 10% as the age increases one year. The number of hospitalization days was significantly correlated to the following parameters: type of admission, patient's city of residence, type of treatment, and length of stay (P < 0.05). CONCLUSION Regarding the results of this study, a large number of admissions and specially hospitalization days are inappropriate. According to other studies, with suitable programming many inappropriate admissions and hospitalization days are preventable.
Collapse
Affiliation(s)
- Nader Tavakoli
- Department of Emergency Care, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Milad Amini
- Department of Quality Improvement, Nikan Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Mahmoudi Nejad
- Department of Emergency Care, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
33
|
Fathi M, Rahiminiya A, Zare MA, Tavakoli N. Risk factors of delayed pre-hospital treatment seeking in patients with acute coronary syndrome: A prospective study. Turk J Emerg Med 2015; 15:163-7. [PMID: 27239620 PMCID: PMC4882210 DOI: 10.1016/j.tjem.2015.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Despite enormous efforts in public education, treatment seeking time still remains more than optimal in patients with acute coronary syndrome. This prospective study tries to determine the risk factors of pre-hospital delay in patients with acute coronary syndrome. METHODS Descriptive data of 190 patients with diagnosis of acute coronary syndrome attending in 2 tertiary level teaching hospital emergency departments were analyzed to determine risk factors of delayed pre-hospital treatment seeking. Demographic, social and clinical characteristics of patients were obtained and they were asked to fully describe their symptoms and the actions they had done after their symptoms onset. RESULTS Thirty nine (20.52%) of patients were arrived in emergency department in <1 h of their symptoms onset, 73 (38.43%) were arrived between 1 and 6 h and 78 (41.05%) were arrived in >6 h. Sex, route of transport, scene-to-hospital distance, attributing the symptoms to non-cardiac causes and outpatient physician consultation and cigarette smoking were the risk factors of delayed treatment seeking in our studied patients with acute coronary syndrome. Patients with previous history of ischemic heart disease and Coronary Care Unit admission and patients with underlying diseases like diabetes mellitus, hypertension and hyperlipidemia showed a trend to have more delayed treatment seeking behavior but not with a statistically significant difference. Patients with positive family history of acute coronary syndrome arrived in emergency department earlier than other patients but again with not a statistically significant difference. CONCLUSION Most patients with acute coronary syndrome arrived in emergency department in >6 h of their symptoms onset. Sex, route of transport, scene-to-hospital distance, attributing the symptoms to non-cardiac origins, outpatient physician consultation and cigarette smoking were risk factors of delayed treatment seeking in studied patients.
Collapse
Affiliation(s)
- Marzieh Fathi
- Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | | | | |
Collapse
|
34
|
Hasani SA, Fathi M, Daadpey M, Zare MA, Tavakoli N, Abbasi S. Accuracy of bedside emergency physician performed ultrasound in diagnosing different causes of acute abdominal pain: a prospective study. Clin Imaging 2015; 39:476-9. [PMID: 25667065 DOI: 10.1016/j.clinimag.2015.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/07/2015] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Abdominal pain is a common complaint in the emergency department and accurate diagnosis of its etiology may affect the patient's outcome. METHOD Patients with abdominal pain underwent ultrasound study first by trained emergency physicians and then by radiologists blinded to emergency physician's results. RESULT Emergency physician who performed bedside ultrasound had 78% diagnostic accuracy. Emergency physicians showed better results in diagnosing some entities (abdominal aortic aneurysm and renal stones) than the others (acute appendicitis, cholelithiasis, and cholecystitis). CONCLUSION Bedside ultrasound can accurately identify the etiology of acute nontraumatic abdominal pain in the hands of emergency physicians.
Collapse
Affiliation(s)
| | - Marzieh Fathi
- Emergency Department, Iran University of Medical Sciences (IUMS).
| | - Marzieh Daadpey
- Emergency Department, Iran University of Medical Sciences (IUMS)
| | | | - Nader Tavakoli
- Emergency Department, Iran University of Medical Sciences (IUMS)
| | - Saeed Abbasi
- Emergency Department, Iran University of Medical Sciences (IUMS)
| |
Collapse
|
35
|
Domeneh BH, Tavakoli N, Jafari N. Blood lead level in opium dependents and its association with anemia: A cross-sectional study from the capital of Iran. J Res Med Sci 2014; 19:939-43. [PMID: 25538776 PMCID: PMC4274569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 11/27/2013] [Accepted: 03/05/2014] [Indexed: 10/28/2022]
Abstract
BACKGROUND Opium dependence is one of the most challenging health problems in the developing countries as well as Iran. Among several health problems due to opium dependence, there are limited reports indicating the presence of lead in opium. The aim of this study is to investigate the blood lead level (BLL) in oral and inhalational opium dependents and its association with anemia. MATERIALS AND METHODS A cross-sectional study was done among 86 opium dependent patients who were referred to five large detoxification centers in Tehran city and 48 healthy individuals. BLL was assessed using the atomic absorption spectrometry technique. Multivariate analysis of variance and binary logistic regression analysis were performed for statistical assessment using SPSS version 18 for Windows. RESULTS The highest BLL was detected in oral opium dependent group (mean = 11.75, standard deviation (SD) = 6.06) in comparison to inhalational opium dependent group (mean = 7.07, SD = 3.61) and healthy control group (mean = 6.05, SD = 1.83). Anemia was detected in 38% of oral-opium dependent and 43% of inhalational-opium dependent group. Age (odds ratio (OR): 1.06, 95% confidence interval (CI): 1.03-1.09) and opium dependence (OR: 3.59, 95% CI: 1.69-7.59) were significant predictors of anemia in these patients (P < 0.001). CONCLUSION The results of this study confirmed the higher BLL in opium dependents, especially with an oral form of consumption.
Collapse
Affiliation(s)
- Behrooz Hashemi Domeneh
- Department of Emergency Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh Jafari
- Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Najmeh Jafari, Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| |
Collapse
|
36
|
Fischer-Schliebs E, Ratajczak R, Weber P, Tavakoli N, Ullrich CI, Lüttge U. Concordant Time-Dependent Patterns of Activities and Enzyme Protein Amounts of V-PPase and V-ATPase in induced (Flowering and CAM or Tumour) and Non-Induced Plant Tissues*. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/j.1438-8677.1998.tb00687.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Bahri-Najafi R, Tavakoli N, Senemar M, Peikanpour M. Preparation and pharmaceutical evaluation of glibenclamide slow release mucoadhesive buccal film. Res Pharm Sci 2014; 9:213-23. [PMID: 25657792 PMCID: PMC4311287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Buccal mucoadhesive systems among novel drug delivery systems have attracted great attention in recent years due to their ability to adhere and remain on the oral mucosa and to release their drug content gradually. Buccal mucoadhesive films can improve the drug therapeutic effect by enhancement of drug absorption through oral mucosa increasing the drug bioavailability via reducing the hepatic first pass effect. The aim of the current study was to formulate the drug as buccal bioadhesive film, which releases the drug at sufficient concentration with a sustain manner reducing the frequency of the dosage form administration. One of the advantagees of this formulation is better patient compliances due to the ease of administration with no water to swallow the product. The mucoadhesive films of glibenclamide were prepared using hydroxypropyl methylcellulose (HPMC) K4M, K15M and Eudragit RL100 polymers and propylene glycol as plasticizer and co-solvent. Films were prepared using solvent casting method, and were evaluated with regard to drug content, thickness, weight variations, swelling index, tensile strength, ex vivo adhesion force and percentage of in vitro drug release. Films with high concentrations of HPMC K4M and K15M did not have favorable appearance and uniformity. The formulations prepared from Eudragit were transparent, uniform, flexible, and without bubble. The highest and the lowest percentages of swelling were observed for the films containing HPMC K15M and Eudragit RL100, respectively. Films made of HPMC K15M had adhesion force higher than those containing Eudragit RL100. Formulations with Eudragit RL100 showed the highest mean dissolution time (MDT). Drug release kinetics of all formulations followed Higuchi's model and the mechanism of diffusion was considered non-Fickian type. It was concluded that formulations containing Eudragit RL100 were more favorable than others with regard to uniformity, flexibility, rate and percentage of drug release.
Collapse
Affiliation(s)
- R. Bahri-Najafi
- Department of Pharmaceutics and Novel Drug Delivery Systems Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran,Corresponding author: R. Bahri-Najafi, this paper is extracted from the Pharm.D thesis No. 390471 Tel. 0098 311 792 2582, Fax. 0098 311 6680011
| | - N. Tavakoli
- Department of Pharmaceutics and Novel Drug Delivery Systems Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran
| | - M. Senemar
- Department of Pharmaceutics, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran
| | - M. Peikanpour
- Department of Pharmaceutics, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran
| |
Collapse
|
38
|
Tavakoli N, Bidari A, Shams Vahdati S. Serum Cortisol Levels as a Predictor of Neurologic Survival inSuccessfully Resuscitated Victims of Cardiopulmonary Arrest. J Cardiovasc Thorac Res 2012; 4:107-11. [PMID: 24250997 DOI: 10.5681/jcvtr.2012.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 10/08/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) is the most stressful lifetime event for the victims and an important issue for the emergency physicians. The status of the hypothalamic pituitary- adrenal axis (HPA) function in successfully resuscitated victims of cardiopulmonary arrest has been recently of an interest for the researchers. METHODS In a prospective cohort study, 50 successfully resuscitated OHCA victims' serum cortisol levels were measured 5 minutes and 1 hour after return of spontaneous circulation (ROSC). The data were analyzed comparing the one-week neurologic survival. RESULTS Fifty blood samples were obtained for serum cortisol levels after 5 minutes of ROSC. Fourteen patients (28%) pronounced death during one hour after CPR. Blood sample from living 36 patients after one hour post-CPR were obtained for second cortisol assay. Eleven patients (22%) were neurologically survived after one week. Seven patients (14%) were discharged finally from hospital with good neurologic recovery. The serum cortisol levels in both the neurologically surviving and the non-surviving after 5 minutes of ROSC patients were 63.4 ±13.6 and 43.2±25.5(microg/ml), (mean±S.D., respectively) and after 1 hour of ROSC patients' serum cortisol levels were 64.9±13.1 and 47.3±27.1(microg/ml), (mean±S.D., respectively). The difference was significantly higher in neurologically survived group in both 5 minutes and 1 hour after ROSC (P= 0.015 and 0.013 respectively). CONCLUSION serum cortisol levels after 5 minutes and one hour of ROSC in victims of cardiopulmonary arrest are significantly higher in neurologically survived than non-survived patients.
Collapse
Affiliation(s)
- Nader Tavakoli
- Department of Emergency Medicine, Hazrate-Rasul Hospital ,Tehran University of Medical Science, Tehran, Iran
| | | | | |
Collapse
|
39
|
Bagherinejad M, Korbekandi H, Tavakoli N, Abedi D. Immobilization of penicillin G acylase using permeabilized Escherichia coli whole cells within chitosan beads. Res Pharm Sci 2012. [PMID: 23181084 PMCID: PMC3501903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Entrapment of permeabilized whole cells within a matrix is a common method for immobilization. Chitosan possesses distinct chemical and biological properties, which make it a suitable matrix for entrapment and immobilization of penicillin G acylase (PGA). In the first step, Escherichia coli (ATCC 11105) cells were permeabilized using N-cetyl-N,N,N-trimethyl ammonium bromide (CTAB) (0.1% w/v, 45 min, 45 rpm) which then immobilized using glutaraldehyde (5% w/v) as cross-linker and chitosan (3% w/v) as the matrix. These conditions were established after preliminary trials with CTAB and glutaraldehyde concentrations in the range of 0.05-0.25% w/v and 1-9% v/v, respectively. The hydrolytic activity was assayed using Ehrlich reagent. Permeabilization of cells caused 9% increase in Penicillin G Acylase (PGA) conversion after 15 min compared to the intact cells. Although, immobilization on chitosan decreased the conversion compared to un-immobilized treated cells (13%), the new biocatalyst showed acceptable operational stability, maintaining more than 90% of the initial activity after 20 cycles. Optimum conditions for immobilization of E. coli cells were: CTAB 0.1% w/v and glutaraldehyde 5% v/v. A new combination method was successfully developed and optimized for immobilization of treated whole cells on chitosan matrix.
Collapse
Affiliation(s)
- M.R. Bagherinejad
- Department of Pharmaceutical Biotechnology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran
| | - H. Korbekandi
- Department of Molecular Biology and Genetics, School of Medicine, Isfahan, University of Medical Sciences, Isfahan, I.R.Iran
| | - N. Tavakoli
- Department of Pharmaceutics and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran
| | - D. Abedi
- Department of Pharmaceutical Biotechnology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran,Corresponding author: D. Abedi, Tel. 0098 311 792 2606, Fax. 0098 311 668 0011
| |
Collapse
|
40
|
Jalali M, Abedi D, Varshosaz J, Najjarzadeh M, Mirlohi M, Tavakoli N. Stability evaluation of freeze-dried Lactobacillus paracasei subsp. tolerance and Lactobacillus delbrueckii subsp. bulgaricus in oral capsules. Res Pharm Sci 2012. [PMID: 23181077 PMCID: PMC3500555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Freeze-drying is a common preservation technology in the pharmaceutical industry. Various studies have investigated the effect of different cryoprotectants on probiotics during freeze-drying. However, information on the effect of cryoprotectants on the stability of some Lactobacillus strains during freeze-drying seems scarce. Therefore, the aim of the present study was to establish production methods for preparation of oral capsule probiotics containing Lactobacillus paracasei subsp. tolerance and Lactobacillus delbrueckii subsp. Bulgaricus. It was also of interest to examine the effect of various formulations of cryoprotectant media containing skim milk, trehalose and sodium ascorbate on the survival rate of probiotic bacteria during freeze-drying at various storage temperatures. Without any cryoprotectant, few numbers of microorganisms survived. However, microorganisms tested maintained higher viability after freeze-drying in media containing at least one of the cryoprotectants. Use of skim milk in water resulted in an increased viability after lyophilization. Media with a combination of trehalose and skim milk maintained a higher percentage of live microorganisms, up to 82%. In general, bacteria retained a higher number of viable cells in capsules containing freeze-dried bacteria with sodium ascorbate after three months of storage. After this period, a marked decline was observed in all samples stored at 23°C compared to those stored at 4°C. The maximum survival rate (about 72-76%) was observed with media containing 6% skim milk, 8% trehalose and 4% sodium ascorbate.
Collapse
Affiliation(s)
- M. Jalali
- Food Security Research Center and Department of Food Science and Technology, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, I.R.Iran
| | - D. Abedi
- Department of Pharmaceutical Biotechnology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran
| | - J. Varshosaz
- Department of Pharmaceutics and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran
| | - M. Najjarzadeh
- Department of Pharmaceutics and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran
| | - M. Mirlohi
- Food Security Research Center and Department of Food Science and Technology, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, I.R.Iran
| | - N. Tavakoli
- Department of Pharmaceutics and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran,Corresponding author: this paper is extracted from the Pharm.D thesis No. 388499
Tel. 0098 311 7922594, Fax. 0098 311 6680011
| |
Collapse
|
41
|
Shabanian M, Jabarifar SE, Salavati S, Khosravi K, Tavakoli N, Akhavan A. Effect of fluoride dentifrices on the microhardness of deciduous enamel surfaces. Oral Health Prev Dent 2012; 10:59-64. [PMID: 22908089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To evaluate the changes in the enamel surface microhardness following the application of various suspensions of Crest and Pooneh toothpastes with and without fluoride. MATERIALS AND METHODS Fifty-six enamel blocks of primary incisors were exposed to a pH-cycling regime consisting of demineralisation and remineralisation solution, then suspensions of the dentifrices Crest 1100, Crest 500, Pooneh 500, Pooneh without fluoride. Changes of the enamel surface microhardness in pre-demineralisation (initial), post-demineralisation (demineralised) and post-remineralisation (final) stages were measured for four groups and were analysed using the Student t test and one-way ANOVA. RESULTS The percentages of changes in surface microhardness for Crest 1100, Crest 500, Pooneh 500 and Pooneh without fluoride were 45.4, 35.4, 28.6 and 23.7, respectively. CONCLUSION Average changes of surface microhardness for Crest 1100 were significantly higher than Crest 500, Pooneh 500 and Pooneh without fluoride.
Collapse
Affiliation(s)
- Mitra Shabanian
- Department of Restorative Dentistry, University of Western Australia, Nedlands, WA, Australia
| | | | | | | | | | | |
Collapse
|
42
|
Varshosaz J, Emami J, Tavakoli N, Minaiyan M, Rahmani N, Ahmadi F, Dorkoosh F. Development and validation of a rapid HPLC method for simultaneous analysis of budesonide and its novel synthesized hemiesters in colon specific formulations. Res Pharm Sci 2011; 6:107-16. [PMID: 22224094 PMCID: PMC3249773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A simple and reliable reversed-phase high performance liquid chromatographic (HPLC) method was developed, validated and applied for determination of budesonide and its novel synthesized hemiesters in colon specific formulations and dissolution media. The method was employed on a μ-Bondapak C(18) column (250 mm × 4.6 mm, 5 μm) at ambient temperature. The mobile phase consisted of acetonitrile: monobasic potassium phosphate containing orthophosphoric acid (55:45, pH 3.2) at a flow rate of 1 ml/min. The UV detection wavelength was set at 244 nm and 50 μL of sample was injected into the HPLC system. Dexamethasone was used as the internal standard. The retention times for internal standard and budesonide were 4.5 and 7.2 min, respectively. The method was linear in the concentration range of 1-20 μg/ml of budesonide (R(2)>0.999). Limit of detection and limit of quantitation were 0.05 and 0.5 μg/ml, respectively. The method presented the requisite accuracy, selectivity, sensitivity and precision and showed good resolution for separation of the drug and related derivatives in the presence of excipients. The proposed method was successfully used for analysis of the drug and its derivatives in dissolution media and oral colon specific formulations prepared in our laboratory with enough reproducibility.
Collapse
Affiliation(s)
- J. Varshosaz
- Department of Pharmaceutics and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran.,
Corresponding author: Jaleh Varshosaz, this paper is extracted from the Pharm.D thesis No.184187 Tel. 0098 311 7922579, Fax. 0098 311 6680011
| | - J. Emami
- Department of Pharmaceutics and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran
| | - N. Tavakoli
- Department of Pharmaceutics and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran
| | - M. Minaiyan
- Department of Pharmacology, and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran
| | - N. Rahmani
- Department of Pharmaceutics and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R.Iran
| | - F. Ahmadi
- Department of Pharmaceutics, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, I.R.Iran.,School of Medicine, Fasa University of Medical Sciences, Fasa, I.R.Iran
| | - F. Dorkoosh
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, I.R.Iran
| |
Collapse
|
43
|
Varshosaz J, Emami J, Tavakoli N, Minaiyan M, Rahmani N, Dorkoosh F, Mahzouni P. Development of novel budesonide pellets based on CODES(TM) technology: In vitro/in vivo evaluation in induced colitis in rats. Daru 2011; 19:107-17. [PMID: 22615647 PMCID: PMC3232096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/13/2011] [Accepted: 03/17/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND THE PURPOSE OF THE STUDY Budesonide is the drug of choice for treatment of active inflammatory bowel disease (IBD). The aim of this study was to develop budesonide pellets based on a novel colon drug delivery system (CODES). METHODS Pellet cores containing lactulose or mannitol were prepared by extrusion/spheronization and coated with an acid soluble polymer (Eudragit E100), hydroxypropylmethyl cellulose (HPMC) and an enteric coat (Eudragit FS 30D) sequentially. In vitro drug release of coated pellets was studied using USP dissolution apparatus type II in buffers of pH 1.2 (2 hrs), pH of 7.4 (4 hrs) and pH of 6.8 containing 8% rat cecal contents (RCC) (18 hrs). The efficacy of the optimized formulation (containing 50% lactulose coated with Eudragit E (30% w/w) and Eudragit FS 30D (12% w/w)) was evaluated against 2, 4, 6-trinitrobenzenesulfonic acid (TNBS)-induced colitis in rats. RESULTS The results of the kind of bacteria in vitro dissolution tests indicated absence of drug release in pHs of 1.2 and 7.4 and controlled release in buffer of pH 6.8 containing RCC. It was found that release rate was controlled by the type and amount of polysaccharide and the thickness of the acid soluble layer. The prepared formulation showed promising results in alleviating the conditions of experimental model of colitis. CONCLUSION The results of this study suggest that pellets based on CODES technology could be useful for colonic delivery of budesonide.
Collapse
Affiliation(s)
| | | | | | - M. Minaiyan
- Department of Pharmacology, Faculty of Pharmacy and Isfahan Pharmaceutical Sciences Research CenterIsfahan University of Medical Sciences, Isfahan
| | | | - F. Dorkoosh
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran
| | - P. Mahzouni
- Department of Pathology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
44
|
Varshosaz J, Tavakoli N, Minayian M, Rahdari N. Applying the Taguchi design for optimized formulation of sustained release gliclazide chitosan beads: an in vitro/in vivo study. AAPS PharmSciTech 2009; 10:158-65. [PMID: 19205888 PMCID: PMC2663681 DOI: 10.1208/s12249-009-9191-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 01/14/2009] [Indexed: 11/30/2022] Open
Abstract
Gliclazide is a second generation of hypoglycemic sulfonylurea and acts selectively on pancreatic beta cell to control diabetes mellitus. The objective of this study was to produce a controlled release system of gliclazide using chitosan beads. Chitosan beads were produced by dispersion technique using tripolyphosphate (TPP) as gelating agent. The effects of process variables including chitosan molecular weight, concentration of chitosan and TPP, pH of TPP, and cross-linking time after addition of chitosan were evaluated by Taguchi design on the rate of drug release, mean release time (MRT), release efficiency (RE(8)%), and particle size of the beads. The blood glucose lowering effect of the beads was studied in normal and streptozotocin-diabetic rats. The optimized formulation CL(2)T(5)P(2)t(10) with about 31% drug loading, 2.4 h MRT, and 69.16% RE(8)% decreased blood glucose level in normal rats for 24 h compared to pure powder of gliclazide that lasted for just 10 h.
Collapse
Affiliation(s)
- J Varshosaz
- Isfahan Pharmaceutical Sciences Research Center and Department of Pharmaceutics, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | | | | |
Collapse
|
45
|
Nahavandi M, Tavakkoli F, Wyche MQ, Trouth AJ, Tavakoli N, Perlin E. Effect of transfusion on cerebral oxygenation, flow velocity in a patient with sickle cell anemia and Moyamoya disease: a case report. ACTA ACUST UNITED AC 2007; 11:381-3. [PMID: 17607591 DOI: 10.1080/10245330600938760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Vascular occlusive diseases affect brain blood flow, brain metabolism and are associated with arterial ischemic stroke. This study was designed to measure the brain blood flow velocity, brain oxygenation, hemoglobin concentrations, hematocrit, and cell free hemoglobin at pre- and post-exchange red cell transfusion in an 18 year old male patient with sickle cell disease and moyamoya syndrome (MMS). Exchange transfusion increased cerebral oxygen saturation 12%, total hemoglobin concentration 2%, hemoglobin AA 80%, and reduced sickle (SS) hemoglobin 12%, arterializations 33%, and cell free hemoglobin 33%. Brain blood flow velocity values were unaffected by transfusion. These observations suggest that exchange transfusion increases the hemoglobin carrying capacity and reduces sickle hemoglobin and shunting of blood, which may improve the peripheral and cerebral oxygenation. Transfusion did not affect the brain blood flow in this patient. Therefore the risk of transient ischemic attack and arterial ischemic stroke from mms still exist.
Collapse
Affiliation(s)
- M Nahavandi
- Department of Anesthesiology, College of Medicine, Howard University, Washington, DC, USA
| | | | | | | | | | | |
Collapse
|
46
|
Varshosaz J, Tavakoli N, Roozbahani F. Formulation and in vitro characterization of ciprofloxacin floating and bioadhesive extended-release tablets. Drug Deliv 2006; 13:277-85. [PMID: 16766469 DOI: 10.1080/10717540500395106] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Ciprofloxacin is mainly absorbed in the proximal areas of the gastrointestinal tract. The purpose of our study was production of floating-bioadhesive tablets to lengthen the stay of drug in its absorption area. Effervescent tablets were made using sodium carboxymethyl cellulose (CMC), hydroxypropyl methylcellulose (HPMC), polyacrylic acid (AA), polymetacrylic acid (MAA), citric acid, and sodium bicarbonate. Tablets with 5% effervescent base had longer lag time than 10%. The type of polymer had no significant effect on the floating lag time. All tablets floated atop the medium for 23-24 hr. Increasing CMC caused higher mucoadhesion than AA (p < 0.05). All formulations showed a Higuchi, non-Fickian release mechanism. Tablets with 10% effervescent base, 80% CMC/20% HPMC, or 80% AA /20% MAA seemed desirable.
Collapse
Affiliation(s)
- Jaleh Varshosaz
- Department of Pharmaceutics, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | | |
Collapse
|
47
|
Abstract
OBJECTIVE Goiter is endemic in Iran. The iodine deficiency disorders program was begun a few years ago in Iran, and the coverage of iodized salt is sufficient now. But, in a periodic yearly medical examination of primary school girls in Qom, the prevalence of goiter was above 30% in 2002. This survey was designed to study the risk factors of goiter in those students. DESIGN The study was a randomized (multistage, proportional simple random sampling) case-control study. SUBJECTS AND INTERVENTIONS We selected and performed thyroid examinations in 1050 girl students in primary schools in Qom city of Iran in 2002. We found 284 cases: girls in primary schools had goiter in accordance with the clinical exam of World Health Organization classification. Among students who did not present with goiter in the clinical exam, we randomly selected 288 students as the control group. We used a questionnaire to evaluate them for the risk factors of goiter. RESULTS The mean+/-s.d. ages of cases and controls were 8.7+/-1.3 and 8.9+/-1.3 years, respectively. There is no significant difference between the two groups regarding history of soya, kale, turnip, fish, daily iodized salt usage, education and job of mothers, monthly family income, nationality, immigration and residential situation. By using multinomial logistic regression, we found that storage of iodized salt in open containers, odds ratio (OR): 2.201 (1.412-3.428); P-value <0.0001, medium socioeconomic situation (SES) of family, OR: 2.099 (1.029-4.282), P-value=0.041, district 2 of Qom city, OR: 2.880 (1.376-6.027), P-value=0.005, and district 3 of Qom city, OR: 2.051(1.032-4.078), P-value=0.041, were the major risk factors for goiter in this population. CONCLUSIONS In this study, the main risk factors for goiter were storage of iodized salt in open containers, medium SES and also living in specific districts of Qom city. As the coverage of iodinized salt is over 95% in Iran, we advise the education of the family about storage of iodized salt in closed containers. We also recommend the study of the other risk factors of goiter in the different geographical areas of Iran, because of differences in the SES and nutritional habits. SPONSORSHIP This study was supported by issuing permission letters for our activities: (not funding support) Qom Health Network and Medical Services, Qom Medical University, Qom Primary School Education Office, Fathemieh Medical University.
Collapse
Affiliation(s)
- S M Mousavi
- Cancer Institute, Cancer Research Center, MAHAK Medical/Rehabilitation Complex, Darabad, Tehran, Iran.
| | | | | |
Collapse
|
48
|
Abstract
BACKGROUND Prescription and nonprescription medications constitute a substantial proportion of the health care costs of countries. National drug policies and attitudes toward medication use may play a role in irrational prescribing and consumption of medicines, leading to drug wastage. The limited resources of developing countries warrant more careful assessments of current national drug policies. OBJECTIVE This study quantified the amounts and types of medications that are stored in a sample of urban Iranian households and estimated the extent of drug wastage in these families. METHODS A literature search was conducted using MEDLINE and International Pharmaceutical Abstracts for 1966 to 2004 to identify articles on drug utilization and wastage. Randomly selected households in a large city in Iran were visited to determine the amounts and types of medicines stored in these households. A questionnaire was used to collect information about medication use in these families. RESULTS A total of 512 households were assessed. The mean (SD) family size of household respondents was 4.3 (1.6) members. Mothers were responsible for managing medications in 58.1% (291/501) of families. Presence of chronic illness, insurance coverage, higher economic status, literacy among fathers, and siblings without medically related jobs were the variables that showed a significant relationship with the amount of medicines found in the households. The mean (SD) numbers of unit doses of medicines and of drug products found in these households were 238.5 (198.6) and 22.99 (20.1), respectively. The most common therapeutic classes of medications kept at home were central nervous system agents, anti-infectives, and gastrointestinal medications. The real and potential medication wastage was estimated to be 38.8% and 53.8%, respectively. CONCLUSIONS Medications were stored in large quantities in these urban Iranian households, and a large percentage was being wasted. Drug-use assessments and a comprehensive evaluation of the current national drug policies are warranted to curtail this problem.
Collapse
Affiliation(s)
- A H Zargarzadeh
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Iran.
| | | | | |
Collapse
|
49
|
Dietz KJ, Tavakoli N, Kluge C, Mimura T, Sharma SS, Harris GC, Chardonnens AN, Golldack D. Significance of the V-type ATPase for the adaptation to stressful growth conditions and its regulation on the molecular and biochemical level. J Exp Bot 2001; 52:1969-80. [PMID: 11559732 DOI: 10.1093/jexbot/52.363.1969] [Citation(s) in RCA: 190] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Two electrogenic H(+)-pumps, the vacuolar type H(+)-ATPase (V-ATPase) and the vacuolar pyrophosphatase, coexist at membranes of the secretory pathway of plants. The V-ATPase is the dominant H(+)-pump at endomembranes of most plant cells, both in terms of protein amount and, frequently, also in activity. The V-ATPase is indispensable for plant growth under normal conditions due to its role in energizing secondary transport, maintenance of solute homeostasis and, possibly, in facilitating vesicle fusion. Under stress conditions such as salinity, drought, cold, acid stress, anoxia, and excess heavy metals in the soil, survival of the cells depends strongly on maintaining or adjusting the activity of the V-ATPase. Regulation of gene expression and activity are involved in adapting the V-ATPase on long- and short-term bases. The mechanisms known to regulate the V-ATPase are summarized in this paper with an emphasis on their implications for growth and development under stress.
Collapse
Affiliation(s)
- K J Dietz
- Department of Physiology and Biochemistry of Plants, Faculty of Biology, University of Bielefeld, D-33501 Bielefeld, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Tavakoli N, Kluge C, Golldack D, Mimura T, Dietz KJ. Reversible redox control of plant vacuolar H+-ATPase activity is related to disulfide bridge formation in subunit E as well as subunit A. Plant J 2001; 28:51-9. [PMID: 11696186 DOI: 10.1046/j.1365-313x.2001.01130.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The plant vacuolar proton pump can be subjected to reversible redox regulation in vitro. The redox-dependent activity change involves disulfide bridge formation not only in Vatp A, as reported for bovine V-ATPase, but also in the stalk subunit Vatp E. Microsomal membranes isolated from barley leaves were analysed for their activity of bafilomycin-sensitive ATP hydrolysis and proton pumping using quinacrine fluorescence quenching in vesicle preparations. ATP hydrolysis and proton pumping activity were inhibited by H2O2. H2O2-deactivated ATPase was reactivated by cysteine and glutathione. The glutathione concentration needed for half maximal reactivation was 1 mmol l-1. The activity loss was accompanied by shifts in electrophoretic mobility of Vatp A and E which were reversed upon reductive reactivation. The redox-dependent shift was also seen with recombinant Vatp E, and was absent following site-directed mutagenesis of either of the two cys residues conserved throughout all plant Vatp E sequences. V-ATPase was also inhibited by oxidized thioredoxin. These results support the hypothesis that tuning of vacuolar ATPase activity can be mediated by redox control depending on the metabolic requirements.
Collapse
Affiliation(s)
- N Tavakoli
- Lehrstuhl für Stoffwechselphysiologie und Biochemie der Pflanzen, W5, Universität Bielefeld, 33501 Bielefeld, Germany
| | | | | | | | | |
Collapse
|