Mashhad University Of Medical Sciences Research Articles

Effectiveness of postoperative oral administration of cephalexin and metronidazole on surgical site infection among obese women undergoing cesarean section: a randomized, double-blind, placebo-controlled, parallel-group study—phase III

BackgroundCesarean section (CS) is the most frequently performed surgery in the United States. Compared to vaginal delivery, CS has a higher risk of maternal and neonatal mortality, morbidities, and complications, among which surgical site infection (SSI) is the most common. We aimed at evaluating the effectiveness of postoperative oral administration of cephalexin and metronidazole on SSI among obese women undergoing CS.MethodsWe conducted a randomized, double-blind clinical trial comparing the prophylactic effect of oral cephalexin and metronidazole vs cephalexin and placebo on SSI following CS among obese women. who had received preoperative prophylactic cephalosporin antibiotics. The study was conducted at the Ommolbanin Hospital, affiliated with Mashhad University of Medical Sciences from April 2019 to February 2020.ResultThe participants were randomized into the intervention group (n = 210) and the control group (n = 210). At week-1 follow-up, the outcomes were significantly lower in the intervention group as compared to the control group in terms of fever (9% vs 19%, p = 0.003), abnormal discharge from the incision (serous: 8.6% vs 10.5%, purulent: 2.9% vs 16.7%, p < 0.001), incision separation (1% vs 7.1%, p = 0.001), and cellulitis (4.8% vs 13.3%, p = 0.002). At week-2 follow-up, there were no patients in the intervention group with fever, abnormal discharge from the incision, incision separation, or cellulitis and there was a statistically significant difference for fever, abnormal discharge from the incision, and incision separation between the two groups (p < 0.001, p = 0.001, p = 0.014, respectively).ConclusionPost-operative administration of cephalexin and metronidazole for 48-h post-cesarean delivery among obese women, in addition to the standard pre-operative prophylaxis, reduced the overall rate of surgical site infection and wound infection symptoms in a 2-week follow-up.Trial registration The study protocol was approved by the Iranian Registry of Clinical Trials (IRCTID: IRCT20200608047685N2) on 2021-03-15.

A causal model of the relationship between cognitive processes and effective leadership of academic department chairs in Mashhad University of Medical Sciences

A causal model of the relationship between cognitive processes and effective leadership of academic department chairs in Mashhad University of Medical Sciences

Evaluation of the Relationship between Periodontal Indices and Blood Indices of Hematocrit and Hemoglobin in Patients Referring to the Cohort Center of Mashhad University of Medical Sciences

Evaluation of the Relationship between Periodontal Indices and Blood Indices of Hematocrit and Hemoglobin in Patients Referring to the Cohort Center of Mashhad University of Medical Sciences

Acute Coronary Syndrome in Mashhad, Northeastern of Iran: Report of a Decade

Background: Acute coronary syndrome (ACS) is a major cause of morbidity and mortality all over the world. Despite substantial efforts that have been made over the last decades, ACS management still remains challenging in most of the regions. Objectives: This study describes the characteristics and trends of outcomes for ACS patients in a decade in north-east of Iran. Methods: In this cross-sectional study, two tertiary academic hospitals of Mashhad University of Medical Sciences in Iran were investigated during a 10-year period starting from January 1, 2007. Patients were identified according to their final diagnosis at discharge using the international classification of diseases 10th revision (ICD-10). The ten-year trend of prevalence of ACS was plotted. The outcomes (alive, death) were compared between the two types of myocardial infarction (MI) (ST-elevation myocardial infarction (STEMI), and non-ST elevation myocardial infarction (NSTEMI)/unspecific). Results: During the study period, there were a total of 9068 admissions for acute MI or unstable angina. The mean age of admitted patients was 61.6 ± 13.7 years and the majority (67.8%) was male. The in-hospital mortality rate was 12.3% (927), which was significantly higher in NSTEMI/unspecific AMI compared to STEMI patients (15.3% vs. 9.8%, P &lt; 0.001). Females were significantly older than males (65.7 ± 12.5 vs. 59.6 ± 13.8, P &lt; 0.001) and have higher mortality rates compared to males (16.7 vs. 10.1, P &lt; 0.001). The prevalence rate of all MI categories had an increasing secular trend, though the mortality rate was decreased. Conclusions: Although the prevalence rate of AMI has slightly increased, the mortality rate has decreased. Close cooperation between general practitioners, health providers and cardiologists are of great importance in this field.

Assess the Knowledge of Medical Students About HTLV-1 in Mashhad University of Medical Science

Introduction: Human T-cell lymphotropic virus type 1 (HTLV-1) is known to be endemic in the population of northeastern Iran. This study was conducted with the aim of investigating the knowledge and attitude of medical students of Mashhad University of Medical Sciences about the HTLV-1 virus.Material and Methods: The present study was a descriptive-analytical study that was conducted in Mashhad Medical School from April to June 2014. The research population included all medical students studying at the time of the study (307 people). The tool of data collection was a questionnaire including 4 parts of demographic characteristics, the amount of information resources used, the level of awareness about HTLV-1 infection and measuring the attitude of students towards HTLV-1 infection. The data was analyzed in the form of descriptive statistics using SPSS 16.0 software.Results: A total of 271 people responded to the questionnaire (response rate: 88/27). Among the participants, 130 were male and 141 were female. The majority of students, 161 people got their information from the classroom and 157 people were natives of Mashhad. The information obtained from the description of the questions and the percentage of correct answers to the questions showed that the level of students' knowledge about this infection was average with an average score of 16.66 out of 40 points, and the average score of the students' attitude was reported as 68.11 with an average level.Conclusion: The obtained results reported the level of knowledge of the target group as medium-low, and the level of attitude of this group as medium-high. Also, there was a direct relationship between the amount of information and the level of attitude with the year of entering the university and studying in the university, which reports the slope of this change as low.

Change Management in Hospitals: A Framework Analysis.

Hospitals are complex organizations that frequently need changes especially in service delivery processes, organizing, human resource management, monitoring and evaluation and technologies. Maintaining and improving productivity is a key requirement in hospital change management. Therefore, we need to develop and expand an appropriate model for management of changes in hospitals; which is the main purpose of this study. A qualitative approach was used to conduct semi-structured interviews in 2019-2020 with 12 expert managers at Mashhad University of Medical Sciences, Mashhad, Iran. A pre-structured framework was applied for the data analysis. Four main themes and nine sub-themes were identified as the main phases or stages of the framework that can be used to manage changes that aim to improve efficiency in hospitals. The main themes were problem identification and initial support; studying, designing and planning; participation in implementation; considering executive requirements; and implementation, assessment, feedback and stabilization. Management of changes that aim to improve hospital efficiency requires a practical model that was specifically developed by this study. This model should consider all the key elements that were identified; and should consider the expectations of the key stakeholders and their contribution in implementing the change.

Comparison of Ovarian Response in Patients with Cancer and Control Group Treated with In Vitro Fertilisation During 2020-2021

Background: Nowadays, there is a growing tendency to inhibit fertility in women with cancer. This study was designed to evaluate the ovarian response and In vitro fertilisation (IVF) results in infertile women with and without cancer in Zahedan and Mashhad University of Medical Sciences.&#x0D; Methods: Two groups of patients with (30 patients) and without cancer (60 patients) were studied. Initially, 225 units of FSH were started for patients on days 1 to 3, after the follicles reached 13-14 mm, the steroid antagonist was started, after observing at least two follicles larger than 17 mm, HCG ampoule was injected. Metaphase 2 eggs were microinjected and three days later the embryos were evaluated for quality and frozen. For all patients, a questionnaire was completed by the researcher.&#x0D; Results: Overall, 90 patients with a mean age of 30.42 ± 5.30 years were studied. Most patients in the case group had breast cancer (15.6%). In this study, age variables, number of eggs with M1 quality, number of eggs with M2 quality, number of punctured eggs, and duration of ovulation stimulation, number of third day embryos, were not significant between the two groups. Variables such as number of eggs with GV quality and mean number of frozen embryos and number of third day embryos A-C quality, and the mean number of third day embryos were statistically significant between the two groups.&#x0D; Conclusion: According to the results of this study, in many cases, no statistically significant difference was observed between the control and case groups, and ovarian stimulation could provide a good chance for future pregnancy and women with cancer to produce similar eggs and embryos produced by women without cancer.

Evaluation of FLT3-ITD Mutations and MDR1 Gene Expression in AML Patients.

Acute myeloid leukemia (AML) is a hematopoietic malignancy caused by genetic abnormalities. Currently, molecular and genetic factors are routinely used as diagnostic and prognostic markers. FLT-3 is one of the most known diagnostic factors in AML. MDR1 gene belongs to the ATP binding cassette family; it is known as one of the chemotherapy-resistant causes of AML. We aimed to study FLT-3ITD mutations and their association with MDR1 gene expression in AML individuals. For investigation, 80 AML individuals and 20 healthy controls were selected. This study was done in the Cancer molecular Pathology Research Center of Mashhad University of Medical Sciences (MUMS), Iran during 2017-2019. FLT3-ITD mutation was assessed by polymerase chain reaction (PCR); Real-time quantitative PCR was performed to measure the amount of MDR1 gene expression. Bone marrow and blood smears of patients were evaluated in terms of morphology. SPSS 16.0 was used for data analysis. FLT3-ITD mutation and MDR1 overexpression were found in 18.8% and 23.8% of AML patients, respectively. Statistical analysis did not show any relationship or association between these two markers. Cuplike morphology was observed in blast cells in 21.25% of AML cases, which was associated with the presence of FLT3-ITD mutation. FLT-3 and MDR1 function independently. Survival studies to determine the exact role of MDR1 overexpression in drug resistance issues would be suggested.

Ultrasound Changes of Postoperative Adhesion Types Over Time in Children

AbstractPostoperative fibrotic band formation is a common complication that causes bowel obstruction, chronic pain, and especially reoperation problems. We tried to evaluate the ultrasound signs of different adhesions over time in children. This descriptive study was performed in children hospital of Mashhad University of Medical Sciences. Sixty-five children aged 4 months to 15 years (mean age of 7.2 ± 6.5 years) were enrolled in the study. Complete abdominal sonography using 5 to 12 MHz multifrequency probes was performed by a pediatric radiologist. The sonographic findings and data analysis were performed. In first week after surgery, the fibrinous exudates are seen as hypoechoic shadows. It has uneven thickness and usually encases the bowel loops in a circular shape. In second week, they gradually become straighter with uniform thickness. In this period, in 68% of cases, a hyperechoic line is formed in the center of hypoechoic fibrinous exudates, which is usually placed between the bowel loops (interloop fibrosis). The omentum or mesentery entrapment in the fibrinous exudates was occurred in ∼50% and 25% of these cases, respectively. In this state, echogenic omentum or mesentery was seen simultaneously with the hypoechoic fibrinous exudates. After 1 month from surgical procedure, One of the following four sonographic patterns are seen: attachment hyperechoic omentum to retroperitoneum (50%), attachment hyperechoic mesentery to anterior abdominal wall (26%), interloop fibrosis (39%), and severe hypoechoic fibrotic band (30%). Absence of visceral sliding was seen in 65 to 80% of patients. Overall, there are five morphologic patterns of adhesion on ultrasound: fibrinous exudates, interloop fibrosis, fibrotic band, fixed omentum to retroperitoneum, and fixed mesentery to abdominal wall.

Evaluation the Level of Awareness of Patients Referring to Imaging Centers of Mashhad University of Medical Sciences Hospitals about the Ionizing Radiation Risks

Introduction: The undeniable role of medical imaging in the diagnosis and treatment of diseases shows the importance of protection against ionizing radiation used in these methods. Therefore, the aim of the present study is investigating the necessity of increasing patients' awareness of ionizing radiation in minimizing the dose received.&#x0D; Methods: The present study was a cross-sectional analytical study with 159 research-made questionnaires, including demographic information and questions about the level of awareness of patients regarding the dangers of ionizing radiation and protection against these radiations, were completed by the patients referring to the radiology departments of Mashhad University of Medical Sciences in 2019. Data analysis was done using t-test and one-way analysis of variance under SPSS 16 software.&#x0D; Results: The mean knowledge score of the patients was 35.36% ± 26.07%. Moreover, 91/1% of them stated in their answers that they would like physicians to explain the benefits and risks of these radiations, while only 35.2% of patients were informed by their physicians.&#x0D; Conclusion: According to the results of the completed questionnaires, a low percentage of the patients answered the specialized questions correctly, and according to the individuals' statements, 91/2% stated that they would like to receive information in this regard. Therefore, the need to provide appropriate training to the patients in this field, through the preparation of training brochures, and attracting staff cooperation, to inform patients referring to radiology departments about the risks should be a priority.

Automated Lung Segmentation from Computed Tomography Images of Normal and COVID-19 Pneumonia Patients.

Background: Automated image segmentation is an essential step in quantitative image analysis. This study assesses the performance of a deep learning-based model for lung segmentation from computed tomography (CT) images of normal and COVID-19 patients.Methods: A descriptive-analytical study was conducted from December 2020 to April 2021 on the CT images of patients from various educational hospitals affiliated with Mashhad University of Medical Sciences (Mashhad, Iran). Of the selected images and corresponding lung masks of 1,200 confirmed COVID-19 patients, 1,080 were used to train a residual neural network. The performance of the residual network (ResNet) model was evaluated on two distinct external test datasets, namely the remaining 120 COVID-19 and 120 normal patients. Different evaluation metrics such as Dice similarity coefficient (DSC), mean absolute error (MAE), relative mean Hounsfield unit (HU) difference, and relative volume difference were calculated to assess the accuracy of the predicted lung masks. The Mann-Whitney U test was used to assess the difference between the corresponding values in the normal and COVID-19 patients. P<0.05 was considered statistically significant.Results: The ResNet model achieved a DSC of 0.980 and 0.971 and a relative mean HU difference of -2.679% and -4.403% for the normal and COVID-19 patients, respectively. Comparable performance in lung segmentation of normal and COVID-19 patients indicated the model’s accuracy for identifying lung tissue in the presence of COVID-19-associated infections. Although a slightly better performance was observed in normal patients.Conclusion: The ResNet model provides an accurate and reliable automated lung segmentation of COVID-19 infected lung tissue.A preprint version of this article was published on arXiv before formal peer review (https://arxiv.org/abs/2104.02042).

Study protocol for a pilot randomised controlled trial evaluating the effectiveness of oral trehalose on inflammatory factors, oxidative stress, nutritional and clinical status in traumatic head injury patients receiving enteral nutrition

IntroductionIn traumatic brain injury (TBI) patients, inflammatory processes and oxidative stress have been linked to the development of neurodegenerative diseases, disability, increased rate of muscle catabolism, malnutrition, hospital stay and...

Is laser acupuncture effective in controlling gag reflex while taking dental impressions? A randomized double-blinded sham-controlled clinical trial.

The purpose of this study was to investigate the effect of laser acupuncture on controlling gag reflexes by stimulating pericardium 6 (PC6) and conception vessel 24 (CV24) acupuncture points in patients in need of taking dental impressions. In this randomized controlled double-blinded clinical trial study, in 30 patients aged 20-60 years, alginate impressions were taken in the prosthetic and orthodontic clinic at the Dental School of Mashhad University of Medical Sciences, Mashhad, Iran. The participants were randomly divided into 2 groups. The intervention and the control group each included 15 subjects. Both groups were in the exact status of age, gender, and indexes, including the Gagging Severity Index (GSI), Subjective Severity of Gag Reflex (SSGR), Vomiting Number (VN), as well as the Improvement Index, measured. Both groups underwent alginate impressions pre-and postintervention. PC6 and CV24 acupuncture points were irradiated for 4 seconds in contact mode with a laser prob pressure on the skin that was slightly bleached without causing pain for the patient. The laser energy was 0.8 J with an energy density of 2.854 J/cm2 at the surface of the probe (spot size, 0.28 cm2). The total radiation dose was 45.7 J/cm2, and the power density was 714.2 w/cm2. The findings showed that SSGR and VN significantly improved (P ≤ .05) in the intervention group compared to the control group, but GSI was higher in the intervention group. In the intragroups analysis for the comparison between before and after the intervention, it was found that although the average GSI was elevated after the intervention rather than before, the difference was insignificant (P = .083). Also, after the intervention, the average SSGR was significantly reduced (P< .001), and VN was insignificantly lessened (P = .334). Moreover, it was observed after the intervention rather than before that GSI was significantly increased (P< .001), whereas SSGR significantly declined (P< .001), and VN meaningfully decreased (P = .001). The observations demonstrated that the Improvement Index status was significantly better in the intervention group compared to the control group (P = .002). This study found that the application of laser acupuncture on PC6 and CV24 acupuncture points might be effective in reducing the gag reflex and can be used as a noninvasive technique while taking dental impressions.

An Alarming Shift of HIV Infection from Injection Drug to Sexual Transmission in Mashhad, Iran, 1989-2014

Introduction: Iran is facing to a rapid change in the epidemiological pattern of HIV. The trend of annual number of new HIV infections and factors associated with the development of HIV over the last two decades in Iran, were examined.&#x0D; Methods: The data were retrospectively collected from patients who attended the Behavior Diseases Consultation Center of Mashhad University of Medical Sciences in Iran. Individuals were contributed if they were HIV-positive. Baseline factors including demographic, behavioral and clinical characteristics for all participants were examined. Changes in population characteristics were assessed using chi-square test or the Fisher’s exact test.&#x0D; Results: From 1989 to 2014, 584 individuals were eligible for present analysis according to the inclusion criteria. Most patients were men (87%) with most being 36–52 years old, unemployed (58%), married (39.3%), less educated (47.7%) and had a history of imprisonment (83%). The most common modes of HIV transmission were injection drug use (IDU) (51.4%) and IDU along with the sexual relationship (26.5%). These transmission modes varied significantly according to gender (p-value&lt;0.001). Similarly, IDU and sexual relationship were most important transmission modes in males and females, respectively. The number of new HIV infections through sexual-related modes has risen sharply in recent years.&#x0D; Conclusion: In Iran, the pattern of HIV transmission is shifting from unsafe injection drug to unsafe sexual contact for forthcoming years. Also, increasing trend of HIV incidence in women is remarkable. Accordingly, HIV-prevention strategies need to be changed.

Comparison of Sleep Quality in Pregnant Women With Preeclampsia and Control: A Case-Control Study

Background and Aim Preeclampsia is a common complication of the second half of pregnancy. Sleep disorders can cause high blood pressure by causing oxidative stress and endothelial dysfunction. Therefore, the present study was performed to determine the relationship between sleep disorders and preeclampsia. Methods &amp; Materials This is a case-control study that was performed on 240 women referred to the affiliated university hospitals in Mashhad. Sampling was performed in the case group of hospitalized women with a definite diagnosis of preeclampsia (n=90) and in the control group (n=150) among pregnant women without preeclampsia referred to the obstetrics clinic. Data collection tools included demographic information questionnaire and gynecological/obstetric records, Pittsburgh Sleep Quality Questionnaire and clinical evaluation form to determine the symptoms and severity of preeclampsia. Data analysis was performed using SPSS statistical software (version 22) and Mann-Whitney, Chi-square and Fisher tests. A P value of less than 0.05 was considered significant. Ethical Considerations The present paper is the result of a research project approved by the Vice-Chancellor for Research of Mashhad University of Medical Sciences (Code: IR.MUMS.NURSE.REC.1397.042). Results The mean amount of real sleep at night in the group of healthy individuals (8.4±2.3) was significantly higher than patients (8.0±‌2.2) (P‌=‌0.028). In terms of loud snoring, waking up in the middle of the night was most frequent in the affected group (P‌&lt;0.001). There was a statistically significant difference between the two groups in terms of sleep quality score level (P‌&lt;0.001) based on logistic regression test in women with severe sleep problems at risk of preeclampsia (P‌&lt;0.001, 95% CI 2.9-42.2, OR‌: 11‌/‌11) (11/11) was equal compared to healthy women. Conclusion The present study showed that sleep disorders in pregnancy are associated with an increased risk of preeclampsia.

Medical Students' Attitude Toward E-learning During the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) crisis has greatly impressed medical education by shifting traditional educational methods to e-learning. Objectives: This study evaluated the undergraduate medical students' attitudes toward e-learning during the COVID-19 pandemic Methods: This cross-sectional study included undergraduate medical students of Mashhad University of Medical Sciences, Mashhad, Iran, in the academic year 2020 - 21 by census sampling method, whose attitude toward e-learning was evaluated based on the Ghanizadeh et al. scale. Categorical variables were demonstrated with frequency and percentage, and quantitative variables were described using the mean and standard deviation. An independent-sample t test was run to study the hypothesis. Analysis of covariance (ANCOVA) was performed to compare pre-clinical and clinical groups' attitudes toward e-learning after gender control. Statistical analyses were performed by SPSS 23. Results: The study enrolled 528 undergraduate medical students. The findings indicated that 85.4% of the students agreed with the necessity of more effective e-learning in medical education, and 95.5% believed that e-learning should play a complementary role in medical education. It was found that clinical students had a marginally statistically significantly better attitude toward e-learning than pre-clinical students (t = -2.04, df = 526, P = 0.041). Nevertheless, no significant difference was observed between the two groups after gender control (t = 2.87, P = 0.091). It was shown that males had more positive attitudes toward e-learning than females (t = 2.28, df = 526, P = 0.023). Conclusions: The results revealed acceptable attitudes toward e-learning. Although many students declared e-learning's usefulness and confirmed its complementary role in medical education, some announced that it could not replace in-person training.

Type and Number of Errors of the Iranian Electronic Health Record (SEPAS) in Hospitals Affiliated with Mashhad University of Medical Sciences.

This study aims to identify the type and number of errors in the Iranian Electronic Health Record System (SEPAS) in hospitals affiliated with Mashhad University of Medical Sciences (MUMS). A cross-sectional analytical study was conducted to specify the errors done by SEPAS in the first half of 2019, based on the type and number of errors in 26 hospitals affiliated with MUMS that were connected to the SEPAS system. SEPAS system errors were classified into four categories: identity errors, clinical errors, administrative-financial and technical errors. The most important errors that occurred in the SEPAS system included non-authentication errors in Hospital Information System (HIS), non-service records, and invalid national code, respectively. Therefore, hospital administrators and information system developers must make an effort to prevent such errors.

Assessment of knowledge, attitudes and practices toward prevention of hepatitis B virus infection among healthcare workers of Mashhad University of Medical Sciences, Iran

Background: Hepatitis B virus (HBV) infection is regarded as one of the most significant occupational hazards threatening healthcare workers (HCWs). Moreover measuring knowledge, attitudes, and practices among these individuals can be assumed as one of the most important activities to develop the preventive strategies of HBV infection.Methods: This cross-sectional study was conducted in 2017 on HCWs of teaching hospitals affiliated to MUMS. Stratified sampling method was used and the knowledge-attitude-practice questionnaire was reproduced and distributed among nine groups of HCWs based on the proportion of the individuals working in each occupational category. Then knowledge, attitudes, and practices in different sub-groups were compared using independent samples T-test or analysis of variance or even via their non-parametric equivalents.Results: This study was performed on 681 individuals with a mean age of 30.9±6.01 years. The results also showed that 448 HCWs (79.0%) had good levels of knowledge, 389 individuals (69.5%) were endowed with favorable levels of attitudes, and 391 of them (74.9%) had good levels of practices. According to the results of Spearman’s rank-order correlation, there was only a significant but weak correlation between knowledge and attitudes (p=0.00, r=0.16).Conclusions: Based on the findings of this study, it seemed that the levels of knowledge among HCWs of MUMS was good, although about a fifth of these individuals required upgrading their status in terms of their levels of knowledge about HBV. In general, according to the results obtained from the parameters of attitudes and practices, it was assumed that levels of education concerning HBV infection were in need of improvements.

The influence of cold versus room temperature charcoal on reducing nausea of poisoned patients: A randomized clinical trial

Objective: Intoxication is among the most common causes of emergency department (ED) visits. Activated charcoal is one of the useful treatments preventing poison absorption. However, nausea caused by using charcoal has made this substance less acceptable among patients. This study aims at investigating the influence of using cold charcoal on reducing the nausea among poisoned patients. Methods: This clinical experimental trial study approved by the Medical Ethics Committee of Regional School of Medicine of Mashhad University of Medical Sciences with the code 930106. Randomization was provided by Sealed Envelope. Accordingly, the experimental group received cold charcoal (4ᵒC), while the control group received room temperature charcoal (23ᵒC). We used the coding method in order to double blind the study. After half and one hour, nausea was checked in patients by visual numeric scale (VNS). Data were described by using descriptive and analytic test indices including frequency, mean ± standard deviation and suitable charts and tables. Results: The average age of participants was 25.83±7.05. The severity of nausea half an hour after consuming charcoal in cold charcoal group and experimental group was 1.3 and 2.73, respectively (P&lt;0.001). One hour after consuming charcoal, the severity of nausea in cold charcoal group and experimental group was 0.39 and 1.38 (P&lt;0.001). As indicated by the results of the study and after investigating the changing trend of nausea severity, nausea severity decreased in both groups by passing time from half to one hour (P&lt;0.001). Conclusion: Cold charcoal can reduce the rate of nausea and make it more acceptable among patients.

Elaborating the Challenges of Health Insurance Extent of Coverage and Proposing Solutions from Experts Perspectives

Background: The health insurance extent of coverage was decided by the Health Insurance Organization in order to manage costs. In this plan, to determine the extent of payment by each medical center, the performance of the year 2017 was considered the base point. Furthermore, it should not cost more than the performance of the year 2017 or 10 % less. This issue had caused challenges in public hospitals; so, the purpose of this study is to explain the challenges of health insurance extent of coverage from the perspectives of the experts from Mashhad University of Medical Sciences and propose solutions.&#x0D; Methods: This was a qualitative study conducted through content analysis method in 2022. In-depth and semi-structured interviews were used to collect data. The research population included experts such as staff and hospital managers, Medical group managers, and insurance managers and experts. It was done through purposeful sampling. Data collection continued until the codes were completed, and finally 17 people were interviewed. In each phase, data analysis and data collection were performed simultaneously, using content analysis method and MaxQDA10 software.&#x0D; Results: In this study, the 2 main concepts were management challenges (including sub-concepts of motivation, performance evaluation, patient admission, and hospital costs), and planning challenges (including sub-concepts of education, infrastructures, cross-sectional coordination, and foresight).&#x0D; Conclusion: Based on the findings of this study and the challenges expressed, Health Insurance Organization can take steps toward upgrading the plan by considering the necessary prerequisites and providing solutions such as performance monitoring evaluation system, cost management, training the target groups, and appropriate clarification and announcements.