Clinical Medicine Insights: Endocrinology and Diabetes
Diabetes is a chronic disease that challenges global health issues in many aspects. Diabetic foot... more Diabetes is a chronic disease that challenges global health issues in many aspects. Diabetic foot ulcer (DFU) is one of the most common causes of reduced quality of life and increased hospitalization, amputation, treatment costs, and mortality in patients. Improper patients’ knowledge, unsatisfactory education and training of healthcare workers, and limited facilities are the major cause of delayed referral and downscale management in DFUs. The diabetic foot clinical pathway is pivotal in providing best practices based on the latest standards and patient preferences. In the diabetic foot clinical pathway provided by the Iran Ministry of Health, the common concepts and grading systems are well defined for diabetic foot specialists so that patients can be diagnosed correctly and referred properly. Based on clinical examination guidelines, patients with diabetes are classified into low-risk, moderate-risk, high-risk, and active diabetic foot ulcer groups. One of this Pathway’s main obj...
Background Despite the availability of diagnostic equipment and effective drugs to diagnose and t... more Background Despite the availability of diagnostic equipment and effective drugs to diagnose and treat osteoporosis, only a minority of women are cared. The aim of this study was to investigate of the osteoporosis care gaps among postmenopausal women. Methods This cross-sectional observational study in one the province of Iran, collected data from women aged ≥ 50 years. Initially, participants were surveyed through FRAX. Then, a questionnaire was developed in 3 concepts (socioeconomic, diagnosis and medication initiation). Medication adherence was assessed using the validated OS-MMAS-8 questionnaire. Results A total of 998 women with a mean age of 64.6 ± 10.4 participated in this study. Overall, 346(34.6%) women were at high risk of fragility fractures through FRAX. 130(37.5%) women at high fracture risk underwent BMD, and 109 (31.5%) were diagnosed with osteoporosis. 44 (44.9%) patients adhere to the treatment and 54 (55.1%) patients did not. Overall, 9(20.5%), 35(79.5%) and 0 had l...
Background Considered the most common form of arthritis worldwide, Osteoarthritis (OA) prevalence... more Background Considered the most common form of arthritis worldwide, Osteoarthritis (OA) prevalence has been continually due to the aging population and obesity. Based on the results of the last Global Burden of Disease (GBD) study, the North Africa and Middle East (NAME) was reported to have a high OA prevalence, hence the current study aimed to describe the burden and its attributable risk factors. Methods The OA was classified by kellgren Lawrence grading system. The burden (prevalence, incidence, and Years Lived with Disability (YLDs)) and attributable burden (YLDs) to high body-mass index (BMI) were reported based on GBD 2019 globally and for the 21 countries in the region by age, sex, and socio-demographic index (SDI). Results Globally, the age-standardized prevalence, incidence, and YLDs rates were estimated as 6348.3 (95% uncertainty interval 5776.3–7023.0), 492.2 (438.7-551.5), and 228.0 (115.3-452.7) per 100000, respectively. In the NAME region, the prevalence age-standardiz...
Nurses, as multidisciplinary Diabetic Foot Care (DFC) team members, need to be trained in DF prev... more Nurses, as multidisciplinary Diabetic Foot Care (DFC) team members, need to be trained in DF prevention and management. Regarding the increasing use of e-learning educational courses as the new learning strategy with potential benefits among health care providers, this study attempted to evaluate the educational effects of an e-learning course on DFC compared to that of an interactive workshop in the related knowledge attainment. This was a quasi-experimental study compared two non-randomized groups consisting of nurses who attended an e-learning course (intervention group) and a face-to-face interactive workshop (control group) on DFC using a pre- and post-test design. The eligible nurses enrolled by convenience sampling. All five e-modules on DF prevention and care were the same for both groups. A P value of <0.05 was considered as significant. The study findings indicated that both e-learning course and interactive workshop increased DFC knowledge among nurses. There is a significant difference between the learning level (after training) in the intervention and control groups (P < 0.01). The findings suggest that the e-learning course of DF could be as effective as conventional educational methods. However, considering the time, cost savings and providing an opportunity to learn anytime and anywhere, of the e-learning course, it is recommend for the future and required that more health care providers be trained to use of distance learning.
Background This paper presents the protocol of the 4th round of Iranian Multi-center Osteoporosis... more Background This paper presents the protocol of the 4th round of Iranian Multi-center Osteoporosis Study (IMOS), a national survey with the primary objective of estimating the prevalence of osteoporosis and sarcopenia and their risk factors in a representative sample of urban and rural populations. Methods The target population of the survey is all individuals ≥ 50 years in Iran. A multi-stage random sampling method has been used in the study. We stratified the 31 provinces of the country into 5 strata based on the distribution of their potential risk factors for osteoporosis and randomly selected one or two provinces from each stratum. Then, we invited 2530 people aged ≥ 50 years recruited in the 8th National Survey of None Communicable Diseases (NCD) Risk Factors (STEPs-2021) in the selected provinces to participate in IMOS. Body composition measurements including bone mineral density, muscle mass, and fat mass are measured through Dual-energy X-ray Absorptiometry (DXA) method usin...
BACKGROUND One of the key strategies in improving osteoporosis management is to educate healthcar... more BACKGROUND One of the key strategies in improving osteoporosis management is to educate healthcare providers about the diagnosis and treatment of osteoporosis. OBJECTIVE The aim was to investigate the e-learning courses on osteoporosis around the world in order to develop an online course on osteoporosis management. METHODS A comprehensive search strategy was developed to search the Web of Science, Scopus, PubMed, Embase, and ERIC databases and the Google search engine. After collecting data, the content of eligible studies was analyzed and also the figures were illustrated with R-pack 4.1.1 library software for scientometric information. RESULTS 3 studies and 19 websites were included in this study. The target group of e-learning were health care providers including physicians, nurses and health professionals, pharmacists, general practitioners, researchers, and others in the care team. The educational content provided including bone health, osteoporosis definitions, and pathophysi...
The International Journal of Lower Extremity Wounds
This study aimed to review epidemiology of diabetic foot (DF) amputation and provide a pooled est... more This study aimed to review epidemiology of diabetic foot (DF) amputation and provide a pooled estimation of DF amputation rate in the region. A comprehensive search was performed in Web of Science, PubMed, Scopus and EMBASE databases using appropriate search term. Obtained records were entered endnote software and after removing duplicats were screened by title, abstract and full text. Data was extracted from the remained documents. Random effect meta-analysis was used to pool the estimated prevalence rate due to sever heterogeneity between studies. Finally 17 articles in diabetes, 20 in patients with DFU (diabetic foot ulcer) and two in both remained after screening and included in meta-analysis. Overall pooled amputation rate in diabetes was 2% (95% CI: 1%-3%) which was not significantly different between countries. The pooled prevalence of amputation rate in DFU patients was 33% (24%-43%) and the pooled prevalence in Saudi Arabia was significantly higher than in other countries. ...
Background: Premature birth and postpartum hospitalization can hurt the father-newborn bonding an... more Background: Premature birth and postpartum hospitalization can hurt the father-newborn bonding and self-efficacy.Aim: To investigate the effect of fathers' involvement with premature newborns on paternal-infant bonding and self-efficacy.Methods: his was a nonrandomized clinical trial. Eighty fathers of hospitalized newborns in the neonatal intensive care unit were selected by convenience sampling method and divided into two groups. Fathers were trained on the developmental care of their newborn babies. The training was started through simulations and then at the bedside of the newborn. Newborns who were admitted to one of the Neonatal Intensive Care Unit (NICU) at Arash hospital (Tehran University of Medical Sciences). The study was conducted in 2017. Pre-and post-intervention outcomes were collected using the Parent to Infant Bonding Scale (Originally: Mother to Infant Bonding Scale) and the Perceived Maternal Parenting Self-Efficacy tool. The scale scores range from 0 to 27. A...
International Journal of Endocrinology and Metabolism, 2021
Context: There has been an increasing emphasis on the role of education in diabetes prevention an... more Context: There has been an increasing emphasis on the role of education in diabetes prevention and management, and shedding light on evidence gaps is mandatory for national action plans establishment. Data Sources: This scoping review was part of the Iranian Diabetes Road Map project that used a systematic method based on the Arksey and O'Malley approach. Results: After the screening, 173 articles were included, most of which were published in 2018 and focused on self-management. Most included articles were considered patient-related self-management/care/efficacy, while only a limited number of articles studied healthcare provider education and educational establishment. Additionally, a significant number of included studies were addressed virtual education, an issue as the strength of Iranian studies in diabetes education. Conclusions: Education is an important part of diabetes, and specific needs for Iranian patients should be addressed in future studies. Paying attention to n...
International Journal of Endocrinology and Metabolism, 2021
Context: The important role of physical activity in the prevention and management of diabetes nec... more Context: The important role of physical activity in the prevention and management of diabetes necessitates a review of current research to shed light on gaps in national diabetes guidelines. Evidence Acquisition: This scoping review was part of the Iran Diabetes Research Roadmap (IDRR) study. A systematic search was used based on the Arksey and O'Malley method consisting of six steps. The descriptive analysis was done with SPSS software. Additionally, VOS veiwer software was used to draw the knowledge map of the included studies. Results: There were 169 articles included from the beginning of 2015 to the end of 2019 in Iran. Aerobic and resistance exercises were types of physical activity with more number of articles. Most of the included clinical studies were randomized clinical trials and had a level of evidence two. Also, there was more interest in outcomes such as glycemic control and insulin sensitivity, metabolic syndrome, metabolism, and cardiovascular health. The network...
Iranian Journal of Endocrinology and Metabolism, 2019
Introduction: Peripheral arterial disease (PAD) is common in diabetic patients, and about half of... more Introduction: Peripheral arterial disease (PAD) is common in diabetic patients, and about half of the patients with diabetic foot ulcers (DFU) have concomitant peripheral arterial disease (PAD). The purpose of this study was to select an appropriate and comprehensive clinical guide in the management of DFU. The part of the practical guide that pertains to this is based on three systematic reviews in three sections of diagnosis, prognosis, and treatment for DFU in patients with PAD. Materials and Methods: In this study, the ADAPTE methodology process consiss of the three stages of preparation, acceptance or final adoption and finalization for the localization of an international clinical guide. Results: Results are presented in the form of questions and recommendations in three sections, i.e. diagnosis, 2 questions and 3 recommendations, diagnosis prognosis and treatment. In the diagnosis section, and in the prognosis section (2 questions and 6 recommendations), and in the treatment ...
Clinical Medicine Insights: Endocrinology and Diabetes
Diabetes is a chronic disease that challenges global health issues in many aspects. Diabetic foot... more Diabetes is a chronic disease that challenges global health issues in many aspects. Diabetic foot ulcer (DFU) is one of the most common causes of reduced quality of life and increased hospitalization, amputation, treatment costs, and mortality in patients. Improper patients’ knowledge, unsatisfactory education and training of healthcare workers, and limited facilities are the major cause of delayed referral and downscale management in DFUs. The diabetic foot clinical pathway is pivotal in providing best practices based on the latest standards and patient preferences. In the diabetic foot clinical pathway provided by the Iran Ministry of Health, the common concepts and grading systems are well defined for diabetic foot specialists so that patients can be diagnosed correctly and referred properly. Based on clinical examination guidelines, patients with diabetes are classified into low-risk, moderate-risk, high-risk, and active diabetic foot ulcer groups. One of this Pathway’s main obj...
Background Despite the availability of diagnostic equipment and effective drugs to diagnose and t... more Background Despite the availability of diagnostic equipment and effective drugs to diagnose and treat osteoporosis, only a minority of women are cared. The aim of this study was to investigate of the osteoporosis care gaps among postmenopausal women. Methods This cross-sectional observational study in one the province of Iran, collected data from women aged ≥ 50 years. Initially, participants were surveyed through FRAX. Then, a questionnaire was developed in 3 concepts (socioeconomic, diagnosis and medication initiation). Medication adherence was assessed using the validated OS-MMAS-8 questionnaire. Results A total of 998 women with a mean age of 64.6 ± 10.4 participated in this study. Overall, 346(34.6%) women were at high risk of fragility fractures through FRAX. 130(37.5%) women at high fracture risk underwent BMD, and 109 (31.5%) were diagnosed with osteoporosis. 44 (44.9%) patients adhere to the treatment and 54 (55.1%) patients did not. Overall, 9(20.5%), 35(79.5%) and 0 had l...
Background Considered the most common form of arthritis worldwide, Osteoarthritis (OA) prevalence... more Background Considered the most common form of arthritis worldwide, Osteoarthritis (OA) prevalence has been continually due to the aging population and obesity. Based on the results of the last Global Burden of Disease (GBD) study, the North Africa and Middle East (NAME) was reported to have a high OA prevalence, hence the current study aimed to describe the burden and its attributable risk factors. Methods The OA was classified by kellgren Lawrence grading system. The burden (prevalence, incidence, and Years Lived with Disability (YLDs)) and attributable burden (YLDs) to high body-mass index (BMI) were reported based on GBD 2019 globally and for the 21 countries in the region by age, sex, and socio-demographic index (SDI). Results Globally, the age-standardized prevalence, incidence, and YLDs rates were estimated as 6348.3 (95% uncertainty interval 5776.3–7023.0), 492.2 (438.7-551.5), and 228.0 (115.3-452.7) per 100000, respectively. In the NAME region, the prevalence age-standardiz...
Nurses, as multidisciplinary Diabetic Foot Care (DFC) team members, need to be trained in DF prev... more Nurses, as multidisciplinary Diabetic Foot Care (DFC) team members, need to be trained in DF prevention and management. Regarding the increasing use of e-learning educational courses as the new learning strategy with potential benefits among health care providers, this study attempted to evaluate the educational effects of an e-learning course on DFC compared to that of an interactive workshop in the related knowledge attainment. This was a quasi-experimental study compared two non-randomized groups consisting of nurses who attended an e-learning course (intervention group) and a face-to-face interactive workshop (control group) on DFC using a pre- and post-test design. The eligible nurses enrolled by convenience sampling. All five e-modules on DF prevention and care were the same for both groups. A P value of <0.05 was considered as significant. The study findings indicated that both e-learning course and interactive workshop increased DFC knowledge among nurses. There is a significant difference between the learning level (after training) in the intervention and control groups (P < 0.01). The findings suggest that the e-learning course of DF could be as effective as conventional educational methods. However, considering the time, cost savings and providing an opportunity to learn anytime and anywhere, of the e-learning course, it is recommend for the future and required that more health care providers be trained to use of distance learning.
Background This paper presents the protocol of the 4th round of Iranian Multi-center Osteoporosis... more Background This paper presents the protocol of the 4th round of Iranian Multi-center Osteoporosis Study (IMOS), a national survey with the primary objective of estimating the prevalence of osteoporosis and sarcopenia and their risk factors in a representative sample of urban and rural populations. Methods The target population of the survey is all individuals ≥ 50 years in Iran. A multi-stage random sampling method has been used in the study. We stratified the 31 provinces of the country into 5 strata based on the distribution of their potential risk factors for osteoporosis and randomly selected one or two provinces from each stratum. Then, we invited 2530 people aged ≥ 50 years recruited in the 8th National Survey of None Communicable Diseases (NCD) Risk Factors (STEPs-2021) in the selected provinces to participate in IMOS. Body composition measurements including bone mineral density, muscle mass, and fat mass are measured through Dual-energy X-ray Absorptiometry (DXA) method usin...
BACKGROUND One of the key strategies in improving osteoporosis management is to educate healthcar... more BACKGROUND One of the key strategies in improving osteoporosis management is to educate healthcare providers about the diagnosis and treatment of osteoporosis. OBJECTIVE The aim was to investigate the e-learning courses on osteoporosis around the world in order to develop an online course on osteoporosis management. METHODS A comprehensive search strategy was developed to search the Web of Science, Scopus, PubMed, Embase, and ERIC databases and the Google search engine. After collecting data, the content of eligible studies was analyzed and also the figures were illustrated with R-pack 4.1.1 library software for scientometric information. RESULTS 3 studies and 19 websites were included in this study. The target group of e-learning were health care providers including physicians, nurses and health professionals, pharmacists, general practitioners, researchers, and others in the care team. The educational content provided including bone health, osteoporosis definitions, and pathophysi...
The International Journal of Lower Extremity Wounds
This study aimed to review epidemiology of diabetic foot (DF) amputation and provide a pooled est... more This study aimed to review epidemiology of diabetic foot (DF) amputation and provide a pooled estimation of DF amputation rate in the region. A comprehensive search was performed in Web of Science, PubMed, Scopus and EMBASE databases using appropriate search term. Obtained records were entered endnote software and after removing duplicats were screened by title, abstract and full text. Data was extracted from the remained documents. Random effect meta-analysis was used to pool the estimated prevalence rate due to sever heterogeneity between studies. Finally 17 articles in diabetes, 20 in patients with DFU (diabetic foot ulcer) and two in both remained after screening and included in meta-analysis. Overall pooled amputation rate in diabetes was 2% (95% CI: 1%-3%) which was not significantly different between countries. The pooled prevalence of amputation rate in DFU patients was 33% (24%-43%) and the pooled prevalence in Saudi Arabia was significantly higher than in other countries. ...
Background: Premature birth and postpartum hospitalization can hurt the father-newborn bonding an... more Background: Premature birth and postpartum hospitalization can hurt the father-newborn bonding and self-efficacy.Aim: To investigate the effect of fathers' involvement with premature newborns on paternal-infant bonding and self-efficacy.Methods: his was a nonrandomized clinical trial. Eighty fathers of hospitalized newborns in the neonatal intensive care unit were selected by convenience sampling method and divided into two groups. Fathers were trained on the developmental care of their newborn babies. The training was started through simulations and then at the bedside of the newborn. Newborns who were admitted to one of the Neonatal Intensive Care Unit (NICU) at Arash hospital (Tehran University of Medical Sciences). The study was conducted in 2017. Pre-and post-intervention outcomes were collected using the Parent to Infant Bonding Scale (Originally: Mother to Infant Bonding Scale) and the Perceived Maternal Parenting Self-Efficacy tool. The scale scores range from 0 to 27. A...
International Journal of Endocrinology and Metabolism, 2021
Context: There has been an increasing emphasis on the role of education in diabetes prevention an... more Context: There has been an increasing emphasis on the role of education in diabetes prevention and management, and shedding light on evidence gaps is mandatory for national action plans establishment. Data Sources: This scoping review was part of the Iranian Diabetes Road Map project that used a systematic method based on the Arksey and O'Malley approach. Results: After the screening, 173 articles were included, most of which were published in 2018 and focused on self-management. Most included articles were considered patient-related self-management/care/efficacy, while only a limited number of articles studied healthcare provider education and educational establishment. Additionally, a significant number of included studies were addressed virtual education, an issue as the strength of Iranian studies in diabetes education. Conclusions: Education is an important part of diabetes, and specific needs for Iranian patients should be addressed in future studies. Paying attention to n...
International Journal of Endocrinology and Metabolism, 2021
Context: The important role of physical activity in the prevention and management of diabetes nec... more Context: The important role of physical activity in the prevention and management of diabetes necessitates a review of current research to shed light on gaps in national diabetes guidelines. Evidence Acquisition: This scoping review was part of the Iran Diabetes Research Roadmap (IDRR) study. A systematic search was used based on the Arksey and O'Malley method consisting of six steps. The descriptive analysis was done with SPSS software. Additionally, VOS veiwer software was used to draw the knowledge map of the included studies. Results: There were 169 articles included from the beginning of 2015 to the end of 2019 in Iran. Aerobic and resistance exercises were types of physical activity with more number of articles. Most of the included clinical studies were randomized clinical trials and had a level of evidence two. Also, there was more interest in outcomes such as glycemic control and insulin sensitivity, metabolic syndrome, metabolism, and cardiovascular health. The network...
Iranian Journal of Endocrinology and Metabolism, 2019
Introduction: Peripheral arterial disease (PAD) is common in diabetic patients, and about half of... more Introduction: Peripheral arterial disease (PAD) is common in diabetic patients, and about half of the patients with diabetic foot ulcers (DFU) have concomitant peripheral arterial disease (PAD). The purpose of this study was to select an appropriate and comprehensive clinical guide in the management of DFU. The part of the practical guide that pertains to this is based on three systematic reviews in three sections of diagnosis, prognosis, and treatment for DFU in patients with PAD. Materials and Methods: In this study, the ADAPTE methodology process consiss of the three stages of preparation, acceptance or final adoption and finalization for the localization of an international clinical guide. Results: Results are presented in the form of questions and recommendations in three sections, i.e. diagnosis, 2 questions and 3 recommendations, diagnosis prognosis and treatment. In the diagnosis section, and in the prognosis section (2 questions and 6 recommendations), and in the treatment ...
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Papers by Mahnaz Sanjari