Underlying factors and challenges of implementing the urban family physician program in Iran

Background The family physician program was launched in 2005 in rural areas of Iran and then piloted in 2012 in the cities of Fars and Mazandaran provinces due to insufficient health coverage in these cities. However, despite its pivotal role in the health system, this program has not progressed according to the policies. This study aimed to explain the underlying factors and challenges of implementing the urban family physician program in Iran. Methods This qualitative study was conducted on 44 policy-makers and managers at national and provincial levels selected via snowball and purposive sampling with maximum variation. The data were managed in MAXQDA 2020 and analyzed by directed content analysis. A triangulation method was adopted for this purpose. Results A total of 10 categories, 18 sub-categories, and 29 codes were formed. Most challenges related to underlying factors included precipitancy, economic sanctions, belief in traditional medicine, belief in the expertise of previous physicians, and global ranking of countries. For program implementation, most challenges included a diversity of insurance organizations, budget allocation, referral system, electronic file, educational system, and culture building. Conclusions The major challenges pertaining to underlying factors included international pressure for reforms and precipitancy in program implementation due to management changes. The challenges associated with program implementation included budget provision and interaction with insurance organizations. Therefore, to expand this program to other provinces in Iran, the identified factors should be carefully considered so that sufficient confidence and commitment can be guaranteed for all stakeholders.

Development and Evaluation of Local Area Network Based Archiving System

The goal of this study was to create the Local Area Network Based Archiving System, a cross-platform development system for electronic information storage, security, preservation, and retention. The system incorporates capabilities such as data storage for long-term preservation and retrieval, file searching and retrieval, security features such as user account information system and account access privilege levels, and an email-like messaging system. The researchers developed the Local Area Network Based Archiving System using the Agile Software Development Methodology to keep up with the stakeholders' ever-changing needs. After each iteration of the work cycle, this methodology employs a process of frequent feedback. Features are added or refined in each iteration to ensure that the study meets its goals and expectations. The developed system received an overall average weighted mean of 4.53 in the evaluation summary, which is considered excellent. The strongest point of the system, according to the respondents' responses, was its content, which received the highest average mean among the five major categories in the system evaluation. The system's mobile responsiveness was a huge plus, as it considerably aided accessibility. The system should also be deployed, according to the respondents, because it will provide a powerful answer to the ongoing challenges with storing, managing, securing, and retrieving electronic files. As a result, the researchers concluded that a Local Area Network Based Archiving System is required for the efficient operation of an electronic file storage system. Having centralized electronic file storage and retrieval system not only saves time and money in the long run but also allows for disaster recovery and business continuity.

Tacrolimus Dose-Conversion Ratios Based on Switching of Formulations for Patients with Solid Organ Transplants

Background: Tacrolimus may be administered during hospitalization as an IV formulation or oral suspension. However, literature suggesting appropriate ratios for conversion from these formulations to capsules is limited. Objective: To evaluate conversion ratios after a switch in formulation of tacrolimus for solid-organ transplant recipients. Methods: This single-centre observational longitudinal study involved hospitalized patients who underwent a switch in formulation of tacrolimus according to 1 of 3 possible scenarios: IV to oral suspension, IV to capsule, or oral suspension to capsule. Data were collected from the earliest accessible electronic file (January 2009) to January 1, 2019. Conversion ratios were calculated for each of the 3 groups using data for blood concentrations and doses before and after the switch. The calculated ratios were then compared with recommended conversion ratios: 1:5 (i.e., 1 mg of IV tacrolimus is converted to 5 mg of oral tacrolimus, expressed as “5”) for either of the switches involving an IV formulation and 1:1 (i.e., same amount, expressed as “1”) for the switch from oral formulation to capsules. Results: For the group who underwent switching from the IV formulation to oral suspension, the mean calculated conversion ratio was 3.04, which was significantly different from the recommended ratio of 5. For the group who underwent switching from the IV formulation to capsules, the calculated conversion ratio was 5.18, which was not significantly different from the recommended ratio of 5. For the group who underwent switching from oral suspension to capsules, the calculated conversion ratio was 1.17, which was not significantly different from the recommended ratio of 1. Conclusion: In this small retrospective study of tacrolimus therapy, the calculated conversion ratio was significantly different from the recommended ratio for patients who were switched from IV administration to oral suspension, but not for those switched from IV administration or oral suspension to capsules. Therapeutic drug monitoring therefore appears indispensable, regardless of conversion ratios. RÉSUMÉ Contexte : Le tacrolimus peut être administré par IV ou sous forme de suspension orale pendant une hospitalisation. Cependant, il existe peu de documents qui proposent des ratios appropriés pour convertir ces formulations en capsules. Objectif : Évaluer les ratios de conversion après un changement de formulation du tacrolimus pour les bénéficiaires de greffes d’organes solides. Méthodes : Cette étude observationnelle longitudinale unicentrique impliquait des patients hospitalisés, pour qui la formulation de tacrolimus changeait en fonction de chacun des trois scénarios possibles : passage de l’administration par IV à la suspension orale, passage de l’administration par IV aux capsules ou passage de l’administration par suspension aux capsules. Le recueil des données a été effectué à partir du plus ancien dossier électronique accessible (janvier 2009) jusqu’au 1er janvier 2019. Les ratios de conversion ont été calculés pour chacun des trois groupes à l’aide de données pour les concentrations de sang et des doses avant et après le changement. Les ratios calculés ont ensuite été comparés avec les ratios de conversion recommandés : 1:5 (c.-à-d., 1 mg de tacrolimus administré par IV est converti en 5 mg de tacrolimus par voie orale, conversion exprimée par le nombre « 5 ») pour chacun des changements impliquant une formulation IV et 1:1 (c.-à-d. même quantité, conversion exprimée par le nombre « 1 ») pour le passage de la formulation orale aux capsules. Résultats : Dans le groupe dont l’administration par IV est passée à une suspension orale, le ratio de conversion moyen calculé était de 3,04, ce qui était significativement différent par rapport au ratio recommandé de 5. Pour le groupe dont l’administration par IV est passée à des capsules, le ratio de conversion moyen calculé était de 5,18, ce qui n’était pas significativement différent par rapport au ratio recommandé de 5. Pour le groupe dont l’administration est passée de la suspension orale aux capsules, le ratio de conversion moyen calculé était de 1,17, ce qui n’était pas significativement différent par rapport au ratio recommandé de 1. Conclusion : Dans cette petite étude rétrospective de la thérapie à l’aide du tacrolimus, le ratio de conversion calculé était significativement différent du ratio recommandé pour les patients qui passaient d’une administration IV à une suspension orale, mais pas pour ceux qui passaient d’une administration par IV ou d’une suspension orale à des capsules. La surveillance thérapeutique des médicaments semble donc indispensable, quels que soient les ratios de conversion.

Desarrollo de un sistema web para captura de notas post-operatorias entre unidades de salud remotas

The impact of the use of Information and Communication Technologies (ICT) in the Health Sector, as in many other fields, has made it possible to reform the services aimed at improving medical care, you can see the importance and positive, orderly and modern effect with which patient information is managed through standardized systems for the benefit of the population's health care. Doctors who have a technological tool that allows them to generate daily medical notes, add them to an electronic medical record of the patient and consult them later, have a great advantage over doctors who do not have a system where they can analyze a health history, the indications, diagnoses or treatments described in notes of admission, evolution, discharge, post-operative medical note, or notes of outpatient surgeries, leaving not only the doctor at a disadvantage, but also the patient who is treated without having important information for a higher quality care. This study focuses on the factors that must be addressed for an adequate implementation of an Electronic File System (SEE) in medical units that attend to patients in common, in order to contribute to modernizing the current health systems in the locality by connect two remote medical units through a web system for the management of medical information of patients.

Bowon Power: An Integrated of Community Development Mechanism in Nakhon Pathom Province

This research has the objective to study citizenship awareness in community development and urbanization of Nakhon Pathom province. Using the integrated research methodology, namely quantitative research The quantitative data were collected from 375 samples. The data were analyzed by using percentage, mean, standard deviation. And qualitative research 24 in-depth interviews with key informants/person and 12 specific group conversations/person, analyzing data in context and describing. The research found that The community development and urbanization of communities in Nakhon Pathom Province. From the study of the context of community development and urbanization of urban communities in the study area, it can be seen that the mechanism of urbanization is "Power Bowon" with "Community Funds" that are fundamental factors that drive communities to develop. Cooperation from civil society Having visionary leaders wants to see the development of the area in various dimensions. The reliance between community organizations and people, namely the state temple and the communities in which each side performs their duties appropriately. And co-ordinate working together which affects the quality of life of the people in the community who are the direct recipients of urban development Although some community development activities are not initiated by people in the community, but with various sectors being able to coordinate and collaborate And join together to drive development that will benefit the people in the community People are affected by the development activities.Therefore, creating a shared awareness as a force to drive community development activities into urbanization and is an expression of good citizenship by democracy. These instructions give you guidelines for preparing papers for the International conference ICCSE). Use this document as a template if you are using Microsoft Office Word 6.0 or later. Otherwise, use this document as an instruction set. The electronic file of your paper will be formatted further at International Journal of Computer Theory and Engineering. Define all symbols used in the abstract. Do not cite references in the abstract. Do not delete the blank line immediately above the abstract; it sets the footnote at the bottom of this column

An introduction to sewer network design using SWMM

This book is an introductory manual for sewer network design using Storm Water Management Model (SWMM). This manual consists of two files: (i) the introductory document (pdf), and (ii) an additional electronic file containing complementary files with the resources needed to develop SWMM examples

Adaptarea activității de judecată în materie civilă în contextul pandemiei și ulterior acesteia

The SARS-COV2 Pandemic represents a challenge for the Romanian justice system. The traditional approach, where all parties are summoned physically in the court room – and even at the same time –is not sustainable any longer. New procedural rules are necessary. Different hours for different cases is already a reality in many courts and it should become the day-to-day rule. In addition, trials through videoconferences and in written proceedings only should be made possible by the Civil Procedure Code. At the same time, Romania should begin the lengthy process of implementing the electronic file.

Digitization of justice in the context of the COVID-19 pandemic and the implications of digitalization on constitutional rights

The article aims to generate a preliminary radiography on the actual stage of digitalization of justice in Romania, offering a perspective on its evolution both domestically and internationally, a development forced, at least in appearance, by the COVID-19 pandemic and restrictions imposed by it. The electronic file, the usual use of electronic signatures in trials, as well as the multitude of information provided in the virtual environment by public judicial institutions are some essential aspects that define the beginnings of this deeply restructuring process. The most important question, on which no rigorous analysis has been carried out so far, remains the following: how does this process impact the constitutional rights of citizens? In the chase after the alignment to the European approaches, to the evolution and speed of the digital age in which we live, we lose sight of the fact that the Romanian citizens may not be prepared for this process. The human component fades in front of the benefits of artificial intelligence, adaptation at any cost is required by society, and indirectly, by the state, without providing the necessary resources in this regard. We propose a necessary reading from the perspective of affecting some rights guaranteed by the Constitution through digitization, aspects worthy of consideration.