جستجوی مقالات مرتبط با کلیدواژه « management » در نشریات گروه « پزشکی »

The COVID-19 pandemic has significantly affected people's lives and healthcare systems worldwide. Therefore, it is important to determine its effects on the economic and health sectors. This study aimed to calculate and analyze the costs and outcomes of COVID-19 treatment, including mortality and recovery, to improve health system planning. This cross-sectional descriptive study analyzed the costs and consequences of COVID-19 treatment in one of the largest referral training centers for patients in Lorestan province, Iran. The study examined hospital documents from the beginning of January to the end of December 2022. The results showed that the recovery rate of patients was approximately 87%, and the average cost per patient was 161 USD. More than 70% of this cost was related to medication and hospital bed expenses. Lopinavir was the most prescribed medication, and Immunoglobulin and Remdesivir had the highest cost share among all medication expenses. Given the significant proportion of medication and hospitalization expenses, it is recommended that the new approach to prescribing medications and managing patient care should be centered around standardized treatment protocols and home-based care. This is particularly crucial in developing countries with limited resources and clinical evidence. It is important to note that the calculation of standard treatment costs has limitations and should be interpreted cautiously.

Terrorism is the illegal use of power and violence against individuals or society to intimidate or force governments. The occurrence of such incidents is not far from expected, as these incidents have been increasing in recent decades in Iran. On Sunday, August 13, 2023, at 19:30, a terrorist attack was carried out by two terrorists in Shahcheragh shrine (one of the holy and religious places in Shiraz city) in Iran. The main terrorist entered the courtyard from one of the main doors and started shooting with a gun. During this incident, 2 people were killed and 7 people were injured. A few minutes later, the armed person was arrested by the police and the second person ran away. The terrorist group of the Islamic State of Iraq and the Levant (ISIS) took responsibility for this terrorist attack by declaring a statement. This review was written with the aim of investigating why lessons were not learned from previous incidents, especially the Shahcheragh terrorist incident that happened in 2022, and this incident was repeated again.

Anorexia nervosa (AN) is a severe psychiatric disorder, in which an individual suffers from severe weight loss, and disturbed physical and psychosocial functioning. It was previously diagnosed and reported in Western countries but its prevalence is on the rise in a Middle East country like Iran. This study aims to introduce a patient with AN with hyperprolactinoma.

This study is a case report. A single, educated but not currently employed 32-year-old female patient was admitted with the chief complaint of a locked knee, weakness, and lethargy; she was hospitalized in the hematology ward due to electrolyte and hematological complications and then referred to the psychiatric service due to severe weight loss. 

The etiology and severity of the disorder were evaluated; psychiatric, electrolyte, cardiopulmonary, endocrine, gastrointestinal, neurological, hematological, and renal systems were assessed. Low-calorie intake was considered according to the latest guidelines, which prevented relevant complications and caused the patient’s optimal compliance with treatment. 

AN is not necessarily caused by the patient’s body image, and physicians are advised not to rely on such misconceptions for diagnosis. Also, according to the results, the relationship between AN and hyperprolactinoma and pituitary microadenoma is observed. The measures taken led to the patient’s optimal compliance with the treatment.

 Lymphoma, the most predominant neoplastic disorder, is divided into Hodgkin and Non-Hodgkin Lymphoma classifications. Immunotherapeutic modalities have emerged as essential methodologies in combating lymphoid malignancies. Chimeric Antigen Receptor (CAR) T cells exhibit promising responses in chemotherapy-resistant B-cell non-Hodgkin lymphoma cases.

 This comprehensive review delineates the advancement of CAR-T cell therapy as an immunotherapeutic instrument, the selection of lymphoma antigens for CAR-T cell targeting, and the conceptualization, synthesis, and deployment of CAR-T cells. Furthermore, it encompasses the advantages and disadvantages of CAR-T cell therapy and the prospective horizons of CAR-T cells from a computational research perspective. In order to improve the design and functionality of artificial CARs, there is a need for TCR recognition investigation, followed by the implementation of a quality surveillance methodology.

 Various lymphoma antigens are amenable to CAR-T cell targeting, such as CD19, CD20, CD22, CD30, the kappa light chain, and ROR1. A notable merit of CAR-T cell therapy is the augmentation of the immune system’s capacity to generate tumoricidal activity in patients exhibiting chemotherapy-resistant lymphoma. Nevertheless, it also introduces manufacturing impediments that are laborious, technologically demanding, and financially burdensome. Physical, physicochemical, and physiological limitations further exacerbate the challenge of treating solid neoplasms with CAR-T cells.

 While the efficacy and safety of CAR-T cell immunotherapy remain subjects of fervent investigation, the promise of this cutting-edge technology offers valuable insights for the future evolution of lymphoma treatment management approaches. Moreover, CAR-T cell therapies potentially benefit patients, motivating regulatory bodies to foster international collaboration.

Human resource provision in the COVID-19 pandemic crisis is a challenge for nursing managers. The outbreak of the COVID-19 pandemic has made a major challenge of staff for health organizations.

The present study was conducted with aim to provide managerial methods in crisis management in the field of the COVID-19 pandemic.

This study was conducted during the COVID- 19 pandemic in Shariati Hospital. Facing the crisis was done in two steps: "reorganization of the physical environment of the hospital" and "reorganization and provision of the staff". Step 1: integrating the medical wards from 17 wards to 5 wards and classification of units into three levels of care. Step 2: “Transfer of high-risk staff from the hospital to other centers”, “Classification of operational and middle-level managers”, “Providing appropriate staff based on levels of patient care needs”, “Review of job descriptions of head nurses at the crisis stage”, “Working shift scheduling, reviewing the staff planning” and “Rehabilitation of the staff”.

Shariati Hospital had 151 beds, 88 of which were used during the COVID crisis. A total of 88 nurses resigned from the hospital because of high risk conditions, and 117 nurses began cooperating with the hospital on permanent shift or voluntary basis.

Implications for Practice: 

Early response to the crisis in terms of reorganizing medical departments and predicting staff needs in the hospital could lead to staff protection and provision of appropriate staff ratio. Based on this study, crisis management can be done in similar situations.

Dear Editor : The demands on educational managers in medical universities are growing as a result of organizational transformations in healthcare, the increasing complexity of healthcare services, and evolving concepts in medical education, such as new teaching methods, assessment, and learning approaches (1). These demands aim to enhance the quality of medical education and provide better healthcare services to the community. To meet these needs, various strategies are proposed. It is essential to have education development centers (EDCs) and Educational Development Offices (EDOs) that are responsible for guiding and improving the quality of educational activities in universities (2). Studies have shown that the presence of EDCs has led to the improvement of educational quality in medical science universities (3). To manage the quality of educational development activities across all educational institutions within universities, EDOs operate as the executive body of the EDC within medical schools and educational centers. These offices have defined some responsibilities at the conceptual, executive, and supervisory levels to guide the development of educational quality in faculties and teaching hospitals. However, can these offices cope well with these huge tasks? Educational Development Offices face various challenges that reduce their effectiveness in fulfilling these responsibilities. The major known challenges that EDCs and EDOs confront in performing their roles for the development of medical education within medical universities include inadequate familiarity of planners, policymakers, and faculty members with education as a specialized field; inadequacy of educational strategies and programs at universities; issues related to student evaluation of professors and communication of the evaluation results to faculty members; attention to differences in teaching experience and background among faculty members in conducting faculty development programs; supervision of implemented teaching methods by faculty members; and the adoption of various electronic teaching methods. Among the other challenges, one can mention multiple organizational roles of faculty members and the justification of the importance and responsibilities of EDOs by college/hospital administrators and even some EDCs (3-5). The results of conducted studies demonstrated that challenges arising from a lack of scientific awareness or organizational importance are fundamentally significant. These challenges include limited familiarity of educational planners and policymakers with the science of education, as well as an absence of profound understanding by college/hospital administrators and even some EDOs and EDCs of the importance and responsibilities of educational development offices. University faculty members face serious challenges in managing these offices due to their multiple organizational roles and responsibilities within the university. For instance, clinical faculty members should manage hospital-based educational development offices, which, in addition to their educational, clinical, and research roles, present some difficulties. Performing this task becomes more challenging when hospital administrators fundamentally do not believe in the necessity of these offices for improving the quality of the hospital. Considering the increasing complexity and multidimensionality of educational processes in medical universities, and based on existing evidence, it is doubly important to support the readiness of collaborating faculty members in educational development offices to fulfill leadership roles and embrace managerial responsibilities, while also creating motivation to engage in practical and complex issues related to enhancing learning quality. Emphasizing formal and informal training programs within organizations and raising awareness among influential individuals in the education field can be useful in addressing these challenges. Enhancing management and leadership skills through relevant empowerment courses will lead to a change in the perception of leadership roles; gaining awareness of the organization's impact on educational leaders' performance, organizational mission, and commitment to fulfilling them; self-awareness of strengths and weaknesses; increased motivation and self-confidence in assuming leadership responsibilities; increased knowledge of leadership concepts, principles, and strategies; changing one's leadership style; and embracing new leadership roles and responsibilities (6). Focusing on the quality of medical education is at the core of the responsibilities of educational institutions, and to achieve this, it is required to establish and strengthen organizational mechanisms, including the creation and enhancement of educational development offices in faculties and hospitals. Paying attention to the challenges faced by these organizations and striving to address them will significantly enhance the quality of education. To overcome these challenges, the engagement and commitment of all beneficiaries within universities, including administrators and faculty members, are required.

There is limited evidence regarding pain management practice and its associated factors among nurses in Vietnam. Therefore, the study aimed 1) To examine the current state of pain management practices among nurses at Hai Duong Provincial General Hospital, Vietnam; and 2) to identify its associated factors.

Methods & Materials:

 A cross-sectional study design was performed on 200 nurses and 200 medical records needed to be reviewed to match the number of nursing samples. The data collection was conducted from May to June 2022. The modified Cancer Pain Practice Index included 13 evidence-based pain management Indicators applied to measure nurses’ pain management practice by reviewing medical records, and the Knowledge and Attitudes Survey Regarding Pain tool was used to assess the pain management knowledge and attitude of nurses by self-completed questionnaire.

A significant majority, comprising 146 nurses (73%), demonstrated inadequate pain management practices. Several crucial indicators of pain management were suboptimally performed by the majority of nurses. These included failure to document the execution of pain assessments for new patients, inadequate monitoring for side effects of opioid analgesics, and insufficient assessment and care for bowel status when opioids were prescribed. Additionally, participation in prior pain management training courses, along with knowledge and attitude toward pain management, emerged as significant variables associated with pain management practices (p<0.001).

The study highlighted widespread poor pain management practices among nurses. Participation in training courses and good knowledge and attitude correlate with better practices.

Pancreatic neuroendocrine tumors (P-NETs) constitute a subset of pancreatic mass lesions characterized by diverse clinical presentations. Despite their inherent malignant potential, the timely identification and treatment of these tumors are critical for achieving favorable clinical outcomes. This study aims to shed light on the heterogeneous tumor biology of P-NETs and the management strategies employed at a tertiary care center in Pakistan.

A retrospective study encompassing all patients with a biopsy-confirmed diagnosis of P-NETs at Shifa International Hospital between January 1st, 2016, and June 30th, 2021, was conducted. Meticulous data extraction from pathology records and thorough searches of medical records were performed to gather relevant demographic and clinical information.

A total of 24 patients were retrieved from our database, with 13 (54%) female patients. The mean age was 49.5 ± 16.3 years. Eight out of the 24 patients presented with abdominal pain. Most patients (14 out of 24) had lesions in the pancreatic head region. In three cases, lesions exhibited multicentricity. The mean lesion size measured 4.4 ± 2.3 cm. Three of the 24 patients displayed distant liver metastasis at the presentation time. 19 out of the 24 patients underwent surgical resections, while endoscopic ultrasound (EUS)-guided biopsy was performed in 4 out of 24 cases. EUS-guided tissue biopsy yielded accurate diagnoses in all four cases.

Most P-NETs are non-functional, and there is an almost equal distribution between male and female patients. Solitary lesions predominate, and metastasis is uncommon at initial presentation. EUS-guided fine needle biopsy stands out as a dependable diagnostic modality for P-NETs.

Dealing with crises in the current era requires a fundamental change in science and technology, consumption patterns, and people’s relationship patterns, which demands new strategies, alternatives, and administrative methods to deal with different realities of life. Due to the severe outcome of the coronavirus disease 2019 (COVID-19) pandemic, governments had to intensify their efforts to deal with this disease and make decisions to manage the crisis and its extreme economic, health, and educational consequences. This qualitative study was conducted in 2023 and aimed to explain the healthcare executives’ decision-making structure in the COVID-19 crisis.

This qualitative study was conducted using content analysis method. 14 managers working in health and treatment sectors of Kurdistan University of Medical Sciences, Sanandaj, Iran were selected with purposeful samplingin 2023. A semi-structured interview was used to collect data. The conventional content analysis method was used to analyze the data.

The results led to the extraction of 3 main categories, seven sub-categories, and 16 primary categories. The executives had made decisions, based on their point of view, to deal with COVID-19 in pre-crisis (including the sub-categories of crisis initiation signal recognition, preparing to resist the crisis, and preventing the geographical spread), during-crisis (preventing the crisis damage, limiting the crisis injuries), and post-crisis (including sub-categories of recovery of management and guidance systems and learning from the experiences) phases.

Based on the results of this study, scientific management and the characteristic of leadership over people can be a way forward for healthcare managers to organize in crises.

Iran is one of the top 10 countries in the world in terms of plastic consumption. This study aimed to solving the plastic waste crisis with the participation of people in Iran.

The study is a descriptive-analytical one that has been done from 2019 to 2022. The plastic waste produced in 9 provinces (out of 31 provinces) was sampled once a week for 12 months to determine the total weight and per capita per day. Also, the method of collecting and disposing of plastic waste was determined in different cities of the provinces. After that, a training program regarding the in-source separation of plastic and other municipal wastes was implemented in Semnan city to teach people how to reduce and separate their plastic wastes. Finally, a plastic recycling factory was designed and constructed in Semnan.

The study indicates that the plastic waste per capita per day is about 56gr in the studied provinces. Also, currently, only 5% of the total plastic waste is collected separately and more than 95% of it is disposed of as mixed with other wastes. By carrying out an in-source separation and reduction program, the amount of plastic waste produced in this province decreased by 10% in two years, and also a plastic recycling plant with a capacity of 30 tons per day was constructed in Semnan city (the capital of Semnan province) which prevents disposing of 1050 Ton of plastic annually, resulting in environmental pollution preventing.

Based on the results, the implementation of a training program to reduce plastic production and the construction of plastic recycling factories can greatly decrease the plastic crisis in developing countries such as Iran.

 Transformational management (TM) focuses on the characteristics and behaviors required for a manager to empower and motivate team members. Nursing managers and leaders who practice TM mostly demonstrate varying degrees of transformational characteristics.

 This study aimed to explain the characteristics of nursing managers in TM.

 In this study, we used the qualitative content analysis method. Twenty-two nursing managers were selected through purposive sampling within April 2022 to September 2023. Semi-structured interviews were used to collect the data. Data analysis followed the technique recommended by Graneheim and Lundman (2020). All interview sessions were recorded, transcribed in a Word file, and subsequently entered and analyzed in MAXQDA (2020).

 After analyzing the data and extracting 423 open codes, seven subcategories and three final categories emerged regarding the characteristics required for nursing managers in TM. The identified characteristics in this study include the creation of a transformational culture, an ethics-oriented approach, and institutionalization of changes.

 By identifying and applying the characteristics essential to TM, nursing managers can initiate valuable changes. This, in turn, leads to transformation within their management style, the nursing profession, and the improvement of health services.