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Assessing hospital readiness for radio frequency identification device implementation in Iran: a conceptual model

Abstract

Background

To avoid possible failures and ineffective use of economic resources, necessary infrastructure must be provided before implementing new technologies in a developing country like Iran.

Objectives

To assess the degree of readiness for implementing a radio frequency identification device (RFID) system in hospitals in Iran.

Methods

We adopted a descriptive design and structural equation modeling (LISREL statistical software package) to analyze data collected from the hospitals affiliated with the Semnan University of Medical Sciences. All managers, physicians, residents, nurses, and staff members of the medical records and information technology sectors participated in this study. A questionnaire was designed by the investigators to collect ideas from the participants about organizational readiness, cultural readiness, and human resource readiness in implementing RFID.

Results

We found a significant positive correlation between the variables studied. Human resource readiness significantly predicted RFID implementation, with cultural readiness playing the role of a mediator variable. Cultural readiness itself was influenced by organizational readiness (P < 0.01). We found 0.346 (standard deviation: 0.374) changes in an arbitrary unit of the possibility of RFID implementation was attributed to human resources and cultural readiness.

Conclusions

Paying attention to cultural factors, which play an important role in implementing technological projects such as RFID in developing countries like Iran, can reduce the risk of failure. Hospitals should strengthen organizational factors and improve the support of top rank managers when implementing technological projects. By so doing, they will promote cultural readiness, prepare human resources, and win the cooperation of personnel for such projects.

Open access
Clinical outcomes of acute respiratory distress syndrome in a university hospital

Abstract

Background

Mortality rates of acute respiratory distress syndrome (ARDS) are different, depending on severity, etiology, and management.

Objective

To determine 7-day and 28-day mortalities, hospital length of stay (LOS), duration of mechanical ventilation (MV) of ARDS patients, and factors associated with poor outcomes.

Methods

A retrospective study was conducted to review the database of ARDS patients admitted in medical intensive care units (ICUs) at a university hospital between 2010 and 2014. The cases were identified by using International Classification of Diseases, 10th Revision (ICD-10) code-J80 ARDS.

Results

Of 266 patients, 11.7%, 44.4%, and 44% fulfilled mild, moderate, and severe ARDS criteria, respectively. The main cause of ARDS was pneumonia. The 7-day and 28-day mortalities, median LOS, and median MV duration were 31.1%, 69.3%, 18, and 11 days, respectively. Pressure control was the most favorite mode, used with average tidal volume (TV) of 8.63 (2.16) mL/kg ideal body weight (IBW). Recruitment maneuver was most frequently used as adjunctive intervention, whereas prone position was applied to 3.75% of the patients. One-third of the patients received neuromuscular blockades. The median 7-day fluid balance was +6,600 mL. The mean PaO2/FiO2 ratio during the first 3 days, cumulative fluid balance on day 3, and average daily calories during the first week were independent predictors for adjusted 7-day mortality, whereas Acute Physiology and Chronic Health Evaluation (APACHE II) score, fluid balance on day 1, cumulative fluid balance, and average daily calories during the first week were independent predictors for adjusted 28-day mortality.

Conclusions

The 28-day mortality of ARDS was high. In addition, TV and fluid balance were greater than protective limits. These findings indicated the potential improvement of ARDS outcomes in our hospital.

Open access
Elevation of serum adiponectin in mildly decreased glomerular filtration rate

Abstract

Background

Adiponectin secreted by adipocytes plays a key role in insulin sensitivity, anti-inflammation, and antiatherosclerosis. It is involved in several conditions including obesity, type 2 diabetes mellitus, cardiovascular disease, and chronic kidney disease (CKD). Glomerular filtration rate is monitored to indicate the kidney function and CKD progression.

Objective

To assess the serum adiponectin levels in individuals with normal and mildly decreased glomerular filtration rate, analyze the association of serum adiponectin with various physical and biological parameters, and test whether serum adiponectin is the risk factor of mildly decreased glomerular filtration rate.

Methods

This cross-sectional study was conducted in 172 individuals with 35–60 years of age. Serum samples were collected and divided into two groups, based on estimated glomerular filtration rate (eGFR): 90 with normal eGFR (G1, eGFR ≥90 mL/min/1.73 m2) and 82 with mildly decreased eGFR (G2, eGFR = 60–89 mL/min/1.73 m2). Anthropometric data were recorded. Serum adiponectin was measured by enzyme-linked immunosorbent assay.

Results

Serum adiponectin levels were significantly increased in individuals with mildly decreased eGFR (G2), compared to G1 (8.23 ± 3.26 µg/mL and 6.57 ± 3.24 µg/mL, respectively; P = 0.001). Serum adiponectin was positively associated with age and high-density lipoprotein cholesterol but negatively associated with weight, body mass index, triglyceride, and waist and hip circumferences. Univariate analysis showed that serum adiponectin was significantly correlated with mildly decreased eGFR; however, when adjusting for confounding factors, there were no correlations. Furthermore, multivariate regression analysis showed that individuals at the age of 46–55 years (4.0; 95% CI: 1.9–8.3) and > 55 years (11.4; 95% CI: 3.7–35.5) were significantly correlated with mildly decreased eGFR.

Conclusions

Serum adiponectin was significantly elevated in individuals with mildly decreased eGFR and may be a modulation factor, but was not an independent risk factor for mildly kidney damage. Further study is needed to clarify its potential benefits as monitoring biomarker for CKD progression.

Open access
Osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells encapsulated in Thai silk fibroin/collagen hydrogel: a pilot study in vitro

Abstract

Background

Silk fibroin (SF) can be processed into a hydrogel. SF/collagen hydrogel may be a suitable biomaterial for bone tissue engineering.

Objectives

To investigate in vitro biocompatibility and osteogenic potential of encapsulated rat bone marrow-derived mesenchymal stem cells (rat MSCs) in an injectable Thai SF/collagen hydrogel induced by oleic acid–poloxamer 188 surfactant mixture in an in vitro pilot study.

Methods

Rat MSCs were encapsulated in 3 groups of hydrogel scaffolds (SF, SF with 0.05% collagen [SF/0.05C], and SF with 0.1% collagen [SF/0.1C]) and cultured in a growth medium and an osteogenic induction medium. DNA, alkaline phosphatase (ALP) activity, and calcium were assayed at periodically for up to 5 weeks. After 6 weeks of culture the cells were analyzed by scanning electron microscopy and energy dispersive spectroscopy.

Results

Although SF hydrogel with collagen seems to have less efficiency to encapsulate rat MSCs, their plateau phase growth in all hydrogels was comparable. Inability to maintain cell viability as cell populations declined over 1–5 days was observed. Cell numbers then plateaued and were maintained until day 14 of culture. ALP activity and calcium content of rat MSCs in SF/collagen hydrogels were highest at day 21. An enhancing effect of collagen combined with the hydrogel was observed for proliferation and matrix formation; however, benefits of the combination on osteogenic differentiation and biomineralization are as yet unclear.

Conclusion

Rat MSCs in SF and SF/collagen hydrogels showed osteogenic differentiation. Accordingly, these hydrogels may serve as promising scaffolds for bone tissue engineering.

Open access
Proportion of vulvar premalignant and malignant lesions in overall vulvar specimens in Thailand

Abstract

Background

Vulvar lesion is one of the common gynecologic problems.

Objective

To assess the proportion of vulvar premalignant and malignant lesions in overall vulvar specimens and to evaluate the clinicopathologic features of each vulvar lesion in King Chulalongkorn Memorial Hospital (KCMH).

Methods

Pathological microscopic slides and medical records of the patients who underwent vulvar-related operations between January 1, 2002 and December 31, 2015 were reviewed. Patients’ clinical characteristics and pathologic features were evaluated and analyzed.

Results

A total number of 700 patients were included. The proportion of malignant and premalignant lesions in overall vulvar specimens were 16.3% and 8.4%, respectively. Squamous cell carcinoma was the most common malignant vulvar lesion (48.2%), whereas vulvar intraepithelial neoplasia 1 (VIN1) (33.9%) was the most common lesion in the premalignant group. On multivariate analysis, four clinical factors were significantly associated with malignancy risk: increased parity (odds ratio [OR] 1.19, P = 0.010), large tumor size (OR 2.00, P < 0.001), lesion at clitoris (OR 16.67, P = 0.002), and erythematous lesion (OR 2.41, P = 0.026).

Conclusions

The proportion of malignant and premalignant lesions in overall vulvar specimens was 24.7% in KCMH. Increased parity, large tumor size, clitoris-located lesion, and erythematous lesion were associated with increasing malignancy risk.

Open access
Development of a point-of-care test to detect hepatitis B virus DNA threshold relevant for treatment indication

Abstract

Background

Hepatitis B virus (HBV) has been the most prevalent blood-borne pathogen wherein utero transmission has still not been properly managed. Recent practice guidelines suggested that an antiviral drug should be administered to third-trimester pregnancies with significant viremia (>2 × 105 IU/mL).

Objectives

To develop a novel turbidity-based loop-mediated isothermal amplification (LAMP) coupled with heat treatment DNA extraction method that is a rapid, cost-effective, and feasible viral load assessment and could be applied to antenatal screening.

Methods

Primers and reagents were designed, turbidity-based platform and heat treatment method were added, and evaluated for optimal efficiency. Assay sensitivity was tested from serially diluted standard HBV DNA. Assay specificity was tested with six standard viral DNAs. Clinical samples were analyzed and the results were compared with those of quantitative polymerase chain reaction (qPCR) diagnostic records.

Results

The optimized condition was 60°C with no betaine, 1.4 mM deoxyribonucleotide triphosphates (dNTPs) and 6 mM of MgSO4 for 60 min. The assay accurately detected samples with standard HBV DNA at >2 × 105 IU/mL in both distilled water and spiked serum. Results can be interpreted within 31.48 ± 1.41 min in real-time turbidimeter. The amplification is exclusively specific to HBV, but not with the other six human-specific viruses. Moreover, the assay showed comparable performance within 95% confidence interval to the previously developed HBV LAMP toward clinical specimens.

Conclusions

This newly developed method was accurate, affordable, and flexible to further implementation to large-scale third-trimester pregnancy screening.

Open access
Evidence of growth hormone effect on plasma leptin in diet-induced obesity and diet-resistant rats

Abstract

Background

Plasma leptin is regulated by several factors, including growth hormone (GH), which influences the pathophysiology of obesity.

Objective

To demonstrate the short-term effect of GH on plasma leptin levels in 3 conditions in vivo with the different amount of body fat mass.

Methods

Adult male Wistar rats were fed with standard chow or hypercaloric diet (HC). The HC rats were demonstrated as HC-feeding obese (HC-O) and HC-feeding resistant (HC-R) rats. Then, they were treated with GH or saline for 3 days. Basal plasma leptin levels were measured at 24 and 32 h. For meal-induced condition, all rats were fed for 2 hand plasma leptin was measured. Further 16-h fasting period, plasma leptin, insulin, and insulin sensitivity indexes were determined.

Results

The short-term GH treatment decreased basal plasma leptin at 32 h after the first GH injection in HC-O rats. However, GH treatment had no effect on meal-induced plasma leptin in all rats. Furthermore, GH treatment attenuated fasting effect on plasma leptin in control and HC-R rats. The insulin resistance (IR) induced by the short-term GH treatment was demonstrated by higher fasting plasma insulin and the increased homeostasis model of IR in HC-R rats.

Conclusions

The study demonstrates the important role of greater fat mass in HC-O rats, which results in decreased basal plasma leptin after short-term GH treatment. For meal-induced condition, GH had no effect on plasma leptin in all rats. Interestingly, GH could attenuate fasting effect on plasma leptin in rats that have lower fat mass.

Open access
Lactobacillus plantarum B7 attenuates Salmonella typhimurium infection in mice: preclinical study in vitro and in vivo

Abstract

Background

Salmonella typhimurium is a cause of gastroenteritis including diarrhea. Lactobacillus plantarum is a probiotic widely used to prevent and treat diarrhea.

Objectives

To determine the protective effects of L. plantarum B7 on diarrhea in mice induced by S. typhimurium.

Methods

Inhibition of S. typhimurium growth by L. plantarum B7 was determined using an agar spot method. Mice were divided into 3 groups (n = 8 each): a control group, an S group administered 3 × 109 CFU/mL S. typhimurium, and an S + LP group administered 1 × 109 CFU/mL L. plantarum B7 and 3 × 109 CFU/mL S. typhimurium daily for 3 days. Counts of S. typhimurium and percentage of fecal moisture content (%FMC) were determined from stool samples. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and CXCL1 were determined.

Results

L. plantarum B7 produced a clear zone on S. typhimurium. There were significantly less S. typhimurium in the feces from mice in the S+LP group than in the S group. Serum levels of TNF-α, IL-6, and CXCL1 in mice from the S group were significantly higher than levels in the S+LP and control groups. Feces from mice in the S group were soft and loose, whereas in the S+LP group they were hard and rod shaped. The %FMC in the S+LP group was significantly less than in the S group.

Conclusions

L. plantarum B7 can inhibit growth of S. typhimurium, decrease levels of proinflammatory cytokines, and attenuate symptoms of diarrhea induced in mice by S. typhimurium.

Open access
Outcomes of pancreaticoduodenectomy in patients with obstructive jaundice with and without preoperative biliary drainage: a retrospective observational study

Abstract

Background

Preoperative biliary drainage (PBD) in patients with obstructive jaundice from periampullary neoplasms may reduce the untoward effects of biliary obstruction and subsequent postoperative complications. However, PBD is associated with bile contamination and increases infectious complications after pancreaticoduodenectomy (PD).

Objectives

To determine whether PBD is associated with more complications after PD.

Methods

Patients with obstructive jaundice from periampullary lesions who underwent PD from 2000 to 2015 at our institution were retrospectively enrolled. The cohort was divided into a group with PBD and a group without. PBD was performed using one of the following methods: endoprosthesis, percutaneous transhepatic biliary drainage, surgical biliary-enteric bypass, or T-tube choledochostomy. PDs were performed by the first author using uniform surgical techniques. Postoperative complications were recorded. Statistical analyses were conducted using an unpaired t, Fisher exact, or chi-squared tests as appropriate.

Results

There were 26 with PBD and 28 patients without. Patients in the 2 groups were similar in age, presenting serum bilirubin level, operative time, operative blood transfusion, and hospital stay. The group with PBD had longer duration of jaundice, more patients presenting with cholangitis, and more patients with carcinoma of the ampulla of Vater. The overall complications were higher in patients in the group with PBD than in the group without.

Conclusions

PBD was associated with more complications overall after PD. However, PBD was necessary and lifesaving in certain clinical situations and improved the condition of patients before they underwent PD. Routine PBD in patients with obstructive jaundice without definite indications is not recommended.

Open access