فهرست مطالب mohammadreza vafaeenasab

Despite many challenges, public-private partnership in hospitals is recognized as one of the most attractive investment platforms for the private sector. This study conducted to assess the challenges of private sector partnership with public hospitals using the public-private partnership model in public hospitals in Yazd.

The present qualitative research conducted in 2021. The viewpoints of 15 faculty members, directors, managers and operational experts on the participation of the private sector, those related to the transfer and contracts and the parties of the private sector are extracted through a semi-structured interview guide and analyzed using content analysis in three stages.

A total of 10 main themes including economic and policymaking problems, insufficient manpower readiness, lack of support authority, weak partnership laws, lack of knowledge and experience of managers in partnership, lack of financial transparency, conflict of interest, poor coordination, lack of cultural readiness and trust-building and lack of plans and supervision in the field of partnership in 28 sub-themes extracted.

There are challenges related to policymaking issues and the resulting instability, incoordination of different units, unpreparedness of manpower and contract details in using different models of public-private partnership in hospitals, in which the use of the same procedures, transparency and the meeting requirements of the private sector are recommended for partnership and the formulation of laws and contracts free from any shortcomings and weaknesses that could lead to the loss of the public sector.

One of the most common causes of chronic back pain is spinal stenosis.This disorder is common in the elderly.Treatments for spinal stenosis include surgery, laser therapy, ozone therapy, physical therapy, and medication.Since no study has been done to compare laser therapy and ozone therapy, this study was performed to evaluate the effectiveness of intramuscular injection of ozone gas in paravertebral muscles compared to high-power laser in patients with lumbar spinal stenosis.

This study was a randomized clinical trial.Patients referred to the Physical Medicine and Rehabilitation Clinic with spinal canal stenosis were evaluated in three groups: laser therapy, ozone therapy, and drug & physical therapy.After treatment, a valid SSSQ questionnaire was used to collect and the outcome of treatment.After data collection, they were analyzed by spss25 software.

The results showed that the mean score of pain and neuroischemic symptoms, physical activity and patients' satisfaction with the intervention performed immediately after treatment (p = 0.04), 4 weeks after the intervention (p = 0.001) and 8 weeks after the intervention (p = 0.001) Was statistically significant.

The results of the present study showed that laser therapy and ozone therapy versus drug and physical therapy alone were effective in reducing pain and neuroischemic symptoms in patients as well as improving patients' physical activity but there was no significant difference between laser therapy and ozone therapy during the time the patients were examined.

To investigate and understand the current status of inter-organizational management in relief organizations as well as the relief organizations personnel behavior when facing mass traffic incidents (MCTI). The inter-organizational barriers and facilitators are also discussed in response to MCTI management and in order to help direct future actions to improve pre-hospital emergency services.

The current qualitative study was performed through face-to-face, semi-structured interviews with 31 individuals from pre-hospital emergency services authorities and personnel, Red Crescent and Yazd, Kohgiluyeh and Boyer-Ahmad, Fars, and Qom provinces police. These provinces were selected by purposive sampling in 2018-2019. The conventional content analysis method was applied to analyze the data in this research.

Three main categories and 14 subcategories were determined. The categories are including relief organizations coordination (having four subcategories: independent relief organizations, interdepartmental services integration, insufficient knowledge of organizations about one other, and performance based on job descriptions), resource and infrastructure management (having four subcategories: adverse information management, proper information management, lack of medical resources and capacities considered, and upgrading of medical resources and capacities considered), and response management of relief organizations (having six subcategories: incomplete assessment, improving the quality of assessment, weakness in establishing scene security, scene security management, poor response, and cooperation in response).

Relief organizations need to perform under a unified command. It has inter-organizational cooperation and provide integration of interdepartmental services in order to manage responsiveness at the scene. It also prevents an independent, chaos, and inability of the injured to properly understand and needs in MCTI.

Menopause is the natural termination of menstruation which affects the quality and important aspects of womenchr('39')s life.

To evaluate the effect of regular resistance training (Ex) with vitamin D (Vit. D) and calcium (Ca) supplements in the postmenopausal period on muscle tissue in rats.

In this experimental study, 72 female Wistar rats (8-10-wk old) were randomly divided into control, placebo, Vit. D, Ca, Ex, Ca + Vit. D, Ex + Ca, Ex + Vit. D, and Ex + Ca + Vit. D groups. Control and placebo groups were fed with a standard diet and sesame oil, respectively. Two month after the ovariectomy, Ex, Ca (35 mg/kg), and Vit. D (10000 IU) were administred in all groups except the control. The number of muscle and inflammatory cells, fiber diameter, endomysium thickness, and degenerative collagen fiber area were assessed through hematoxylin-eosin staining.

Muscle cell number was increased in the Ex + Vit. D + Ca, Vit. D + Ex, and Vit. D groups compared to the control group; also, inflammatory cell number showed significant increase in the Ex + Vit. D + Ca (12 ± 5.46), Vit. D + Ex (14 ± 3.25), Ex (13 ± 4.08), Vit. D (11 ± 3.26), Ca + Vit. D (10 ± 1.01), and Ca + Ex (9 ± 2.87) groups. Muscle fiber diameter in the Ex + Vit. D + Ca and Vit. D + Ex groups was higher than the other groups. Endomysium thickness was significantly decreased in the Ex + Vit. D + Ca and Vit. D + Ex groups compared to the control and placebo groups (p < 0.001). Degenerative collagen fiber area showed a significant increase in the Ex + Vit. D + Ca and Vit. D + Ex groups (p ≤ 0.001) comparison with the control group.

Regular resistance exercise, Vit. D, and Ca supplements can improve muscle morphological features in the postmenopausal period.

Postmenopausal osteoporosis progressively occurs due to alteration in the estrogen level during the menopause period, and subsequently elevates the risk of fractures.

To evaluate the effect of regular resistance exercise, vitamin D, and calcium supplements on bone mineral content and density, postmenopausal rats used.

In this experimental study, 72 female Sprague-Dawley rats (8-10 wk: 250 ± 15 gr) were ovariectomized and randomly divided into nine groups (n = 8/each): control, placebo, exercise (EX), exercise with vitamin D supplement (EX + D), exercise with calcium (EX + Ca), exercise with calcium and vitamin D (EX + Ca + D), vitamin D administration (D), calcium administration (Ca), and calcium and vitamin D (Ca + D) groups. Finally, the tail, hip, and lumbar bone mineral content, bone mineral density, bone thickness, and bone cells were evaluated in each group.

The tail, hip, and lumbar bone mineral density was increased significantly in the EX + Vit D group compared to the control group (p = 0.004, p = 0.007, p = 0.003, respectively). However, there were no significant changes in the bone mineral content of the hips and lumbar among the groups. Besides, bone thickness in the Ex + Vit D group was more than the other groups (p = 0.02). The number of osteoclast cells were decreased in the Ca + Vit D, Ex + Ca, Ex + Vit D, and Ex + Vit D + Ca groups compared to the control group. Osteocyte numbers were increased only in the Ex + Vit D group.

Resistance exercise in combination with vitamin D and calcium have a positive effect on the bone mineral density and bone mineral content and might be able to prevent or delay the osteoporosis among elderly women. However, additional researches are needed to assess the molecular pathways of this process.

Menopause can change the musculoskeletal system by reducing estrogen hormone levels. The aim of this study was to evaluate the effect of regular resistance training accompanied by vitamins D and calcium supplements during pre-menopausal period on muscle tissues of Wistar rats’ postmenopausal period.

In this experimental study, female Wistar rats were randomly divided into control, placebo, vitamins D, Calcium, excercise, vitamins D- Calcium, vitamins.D- excercise, Calcium - excercise, and vitamins.D‐ Calcium - excercise groups. Control and placebo groups were fed with a standard diet and sesame oil, respectively. The amount of calcium consumed was 35 mg / kg and the amount of vitamin D was 10000 IU during the two-month period, and in the resistance training groups, two months of training was performed with a ladder. Then ovariectomy was done and sample of the gastrocnemius muscle was taken and the diameter of muscle fiber, the number of muscle and adipocyte cell as well as the number of inflammatory cells were studied. The statistical analysis by means of one-way ANOVA and SPSS version 20 was performed.

Compared to the control group, the increase in the number of adipocyte cells were observed in the vitamin D, calcium-vitamin D, vitamin D-resistance exercise and placebo groups but it was not significantly different. Muscle fiber diameter significantly increased in all groups compared to the control group (P <0.001). The number of muscle cells increased significantly in the calcium-resistance exercise group (103± 9), vitamin D-resistance exercise (105 ±6.9) and calcium-vitamin D-resistance exercise (114 ± 3.16) compared to the control group, while, there was a significant increase in inflammatory cells only in the control and placebo groups (p≤0.05).

Regular resistance exercise accompanied with vitamin D and Calcium supplements in premenopausal period can improve muscle fiber diameter and muscle cell numbers; in addition, the process of decrease in the muscle strength and muscle inflammation during menopause will be delayed

Menopause is the natural termination of menstruation, which affects the quality, and important aspects of women life. The aim of this study was to investigate regular resistance training along with vitamins D and calcium intake in the pre-menopausal period on bone mineral density (BMD) in rats.

 In this experimental study, the rats were randomly divided into control groups, placebo, vitamin D, calcium, resistance training, vitamin D + calcium, vitamin D + resistance training, calcium + resistance training, vitamin D + calcium + resistance training. Control and placebo groups were fed with a standard diet and sesame oil, respectively. Ovariectomy was done after two months of resistance training (Ex), calcium (35 mg/kg) and vitamin D (10000 IU) administration. BMD and bone mineral content (BMC) were measured. Hematoxylin-eosin staining was performed to examine bone total diameter and osteoclast and osteocyte cell numbers. The statistical analysis was done by a one-way analysis of variance (SPSS 20).

There was an increasing trend in BMD lumbar of the Ex group (P<0.001) in comparison with the control group. The amount of bone mineral in the whole body in calcium and calcium + resistance groups was higher than the control group (P <0.05). BMC total in the vitamin D, calcium + resistance training, vitamin D + resistance training and calcium + vitamin D + resistance-training groups was lower than the other groups. Osteoclast cell numbers were decreased in Ex, Vit D+Ex (P<0.05), Ca+Vit D, Ca+Ex and Ex+Vit D+Ca groups (P<0.001) compared to the control group, also, osteocyte numbers were decreased in VitD, Ca+Vit D (P<0.05), Ex, Vit D+Ex, and Ex+Vit D+Ca groups (P<0.001).

Regular resistance exercise, vitamin D and calcium supplements in pre-menopausal period can improve BMD and BMC and delay the process of osteoporosis in postmenopausal period.

Correct triage is one of the most important issues in delivering proper healthcare in the emergency department. Despite the availability of various triage guidelines, triage is not still appropriately implemented. Therefore, this study was conducted to investigate the role of different underlying factors in triaging emergency patients through a qualitative approach. This study was conducted by conventional content analysis. For this purpose, 30 interviews were conducted with 25 participants. The participants included triage nurses, emergency general physicians, emergency medicine specialists, and expert managers at different position rankings in hospitals and educational and administrative centers in Yazd, selected by purposeful sampling. Data were collected through in‑depth and unstructured interviews from April 2017 to January 2018, and then analyzed by inductive content analysis. Four categories of profit triage, exhibitive triage, enigmatic, and tentative performance triage were drawn from the data, collectively comprising the main theme of responsibility‑evading performance. The dominant approach to the triage in the emergency departments in a central city of Iran is responsibility evasion; however, the triage is performed tentatively, especially in critical cases. To achieve a better implementation of triage, consideration of the underlying factors and prevention of their involvement in triage decision‑making is necessary.

The aim of this study was to investigate the effect of an 8-week resistance exercise program on balance, walking speed, and muscle strength in elderly women.
 
This randomized controlled trial was performed on 50 elderly women aged 60-66 years who were assigned to two groups of experimental and control. The Time Up and Go test, was used to measure dynamic balance, Romberg's test was used to measure static balance, and the 10 Meter Walk Test was used to measure walking speed, and the 30 Second Chair Stand test was used to measure muscle strength. Paired t-test and independent t-test was used for comparing balance time before and after the exercise program.
 
The mean duration of static balance increased in the experimental group from 21.64 ± 10.98 before exercise to 28.20 ± 13.47 after exercise (p < 0.001). The mean duration of Up and Go Time decreased from 12.88 ± 1.45 seconds before exercise to 10.80 ± 1.80 seconds after exercise (p < 0.001). Ten-meter walking time in the experimental group decreased from 1.15 ± 0.1 seconds before exercise to 1.00 ± 0.11 seconds after exercise (p < 0.001) and muscle strength in the experimental group increased from 7.8 ± 1 before exercise to 9.56 ± 1.71 after exercise (p < 0.001). 
 
Lower limb resistance exercises with elastic band improve static and dynamic balance and also walking speed, which possibly improve muscle strength. It is recommended that these exercises be considered in developing the elderly women's health care programs due to their accessibility, affordability, and reliability.

Hospitals are expected to be able to provide quality services during disasters. However, hospital capacity is limited and most hospital beds are almost always occupied. The aim of this study was to determine the feasibility of increasing hospital surge capacity during disasters through identification of patients suitable for safe early discharge. This cross-sectional study was conducted from May 2017 to February 2018 in two phases. In phase I, the Early Discharge Checklist was developed by a multidisciplinary panel of experts. Then in phase II, the checklist was used to assess the dischargeability of 396 in-patients in general wards of hospitals in Alborz province, Iran. Data were analyzed through the SPSS software (v. 22.0) and the results were presented by descriptive and analytical statics at a significance level of less than 0.05. Of 396 patients, (64.65%) were male, (68.9%) were married, and (38.6%) aged more than 54. Moreover, (34.6%) patients were dischargeable. Patients in cardiology wards were more dischargeable. At follow-up assessment, 33.3% of patients had been discharged after 48 hours. There was a significant relationship between patient dischargeability and 48-hour hospitalization status (p=0.001). Dischargeability had no significant relationships with patients’ demographic characteristics (p>0.05). A considerable percentage of in-patients are dischargeable during disasters. The Early Discharge Assessment Checklist, developed in this study, is an appropriate tool to provide reliable data about early dischargeability in disasters.

Balance in the elderly is one of the important issues, and imbalance can create irreparable problems for the elderly. The aim of this study was to investigate the effect of Frenkel balance exercise and aerobic exercise (walking) on improving the balance of elderly patients in Kerman province in 2016-2017.

We used a randomized block design, with 4 participants in each block; 48 elderly men and women living in the nursing homes of Kerman province were randomly assigned to two groups, balance (Frenkel) exercises and aerobic exercises (walking). The two groups performed Frenkel exercises and aerobic exercises (walking) for three 10- to 15-min sessions a week for five weeks. The balance time using the Sharpened Romberg test was recorded to measure static balance and the Get Up and Go test used to measure dynamic balance before and after the exercise program. To describe the variables studied, central tendency indicators and dispersion were used. Paired t-test was used to compare the time of balance before and after intervention and independent t-test to compare changes in balance time between two groups.

The mean static balance (with Sharpend Römberg test) was increased from 3.16 s to 6.01 s in Frenkel exercise, and from 3.33 s to 4.95 s in aerobic training group, indicating an improvement in the static balance after intervention. The mean time of dynamic balance (in the Get Up and Go test) during Frenkel exercise reduced from 17.07 s to 12.03 s, and during aerobic training from 17.08 s to 10.9 seconds, indicating an improvement in dynamic balance (p < 0.01). However, there was no significant difference in the mean changes in the duration of dynamic and static balance before and after intervention in the two groups.

Both Frenkel exercise and walking equally improve static and dynamic balance in the elderly in different settings.  

One of the recommended treatments for atrioventricular nodal reentrant tachycardia (AVNRT), is radiofrequency catheter ablation (RFCA). However, RFCA may affect the autonomic system. This study aims to evaluate the effect of RFCA on autonomic system in patients with PSVT by head‑up tilt table (HUTT) test.

In a before–after study, 22 patients with PSVT were enrolled. Data were collected with a data collection form that included two parts. Electrocardiogram (ECG), echocardiogram, 24‑h Holter monitoring, HUTT test, heart rate variability (HRV) indexes, and symptoms of all patients were recorded 24 h before and 1 month after the ablation. Wilcoxon, McNemar, Mann–Whitney U, and Chi‑square tests were used to analyze the data.

Of the total 22 patients, 31.8% were male and 68.2% were female. There were significant differences in heart palpitation (P < 0.0001) and non‑specific symptoms (P = 0.031) and no significant difference in head‑up tilt test results and HRV indices before and after RFCA. The results showed that there were no significant differences in specific and non‑specific symptoms in patients with AVNRT with positive and negative HUTT before and after RFCA.

The observed difference in heart palpitation and non‑specific symptoms emphasized the role of AVNRT in causing these symptoms. Autonomic dysfunction is more probably an accompanying condition of AVNRT than causing symptoms. We could not find any significance in the results of HUTT after RFCA. HUTT cannot determine or predict the symptoms after RFCA.

Congenital heart disease (CHD) is a major health problem and its prevalence is different around the world. The aim of study was determination of the epidemiological aspects of CHD in central and southern district of Iran.

In this descriptive and analytical study, 3714 medical records were evaluated from March 21, 2001 to December 18, 2011. Medical records of inpatients from angiography and outpatients in the Heart Clinic of Afshar hospital (a referral hospital in center and south of Iran) were the source of information. Types of CHD and demographic data including age, sex and residential location are collected. The data were analyzed by SPSS (version 17) software. Chi-square and Fisher's exact tests were used to compare variables between groups.

At the study, the mean age of the patients at diagnosis time was 8.8 ± 11.6 year (at the range of one day to 76 years with median of 4 years). The percentage of females and males was 54.2 (n: 2014) and 43.8 (n: 1627), respectively. The chi-square test showed that there was significant difference in frequency of CHDs between females and males (P value < 0.0001). Ventricular septal defect (VSD) was found to be the most frequent of CHDs (27%). Patent ductus arteriosus (PDA) (16.8%), atrial septal defect (ASD) (15.8%), pulmonary stenosis (PS) (11%) and Tetralogy of Fallot (TOF) (8.9%) were more prevalent in CHDs after VSD.

The frequency of CHDs in female was more than male and VSD, PDA, ASD, PS, and TOF were most common in CHDs, respectively.