Showing 18 results for Sadeghi
Y Erfani, R Safdari, A Rasti , Mk Sharifi Yazdi , Sam Jahanmehr , H Yazdanbod , F Sadeghi ,
Volume 1, Issue 1 (9 2007)
Abstract
Background: Septicemia is a life threatening status and needs rapid antibiotic treatment. Enterobacteriacea are one of the most important causes of septicemia. So this study is therefore aimed to evaluate antibiotic susceptibility of enterobacteriacea isolates in blood cultures in Shariati Hospital, Tehran, Iran.
Methods: This retrospective study was performed on 138 patients with positive blood culture in Shariati Hospital, Tehran, Iran in 2004, using disk diffusion and Macfarland standard.
Results: Prevalence of isolated enterobacteriacea was respectively E. coli (n=74, 53.6%), Klebsiella (n=37, 26.8%), Enterobacter (n=21, 15.2%), Citrobacter (n=4, 2.9%), Salmonella paratyphi (n=1, 0.7%) and Proteus mirabilis (n=1, 0.7%). The most antibiotic susceptibility among enterobacteriaceaes was ciprofloxacin (60.4%), cloramphenicol (56.8 %) and gentamycin (49.3%). The most antibiotic resistance were seen among cephalotine (78%), cotrimoxazole (62.3 %) and ceftriaxon (57.5 %).
Conclusions: Due to dissimilarity between antibiotic consumption in laboratories and hospitals, it seems that to reach more proper conclusions and choosing better strategy for antibiotic consumption, cooperation should be between laboratories and physicians, plus synergism between drug prescription and antibiotic discs in laboratories.
H Dargahi, P Hamouzadeh, J Sadeghifar, M Raadabadi, M Roshani, M Salimi, P Soltanzadeh,
Volume 4, Issue 3 (20 2011)
Abstract
Background and Aim: Identifying criteria of expert teacher and efforts to strengthen and use them in teaching by teachers will enhance the learning process. In this way, one of the important methods is taking the views of students. This study was conducted to determine the characteristics of an expert teacher for effective teaching from the viewpoints of allied medical students at Tehran University of Medical Science.
Materials and Methods: In this cross-sectional study, 200 BSc of allied medical students at were included employing simple random sampling method. Data collection was done employing a self administrated questionnaire. Validity and reliability of questionnaire was calculated. Data analysis was carried out by t-test and SPSS software.
Results: Some criterias like dominance in the scientific subjects (86.8%), power of expression and transmission the training materials (86.2%), respect for students(85.6%), good mood(85%) and work with ethic and sense of responsibility (84.4%) are important criteria for expert teacher. Furthermore, no significant relationship was found between gender and field of study and the above-mentioned four domains (p> 0/05).
Conclusion: Teaching ability was the most important factor for teaching process from he view of the students which could be paid attecntion in teachers' assessment program.
Nilufar Masouri, Fateme Sadeghi, Elham Khayyamdar,
Volume 5, Issue 3 (4 2011)
Abstract
Background and Aim: Information is a factor for organizations success and organizations try to stay in this competitive world. In each organization, there are sections that have special role in information aspect in hospitals and healthcare centers, this role is for medical record section which organizes all of the patients' health care information. Paying attention to function quality in this section(medical record) is very important. Since health ministry introduce(EFQM) as an Excellence Model for hospitals, there fore, the role and importance of medical record section in implementation of this model and its criteria is determined.
Materials and Methods: All of the information databases was collected and those which were appropriate were selected. Then according to the article's goal, proper keywords were selected and documented through comparing with MESH. Finally related articles in credible journals were used in two Persian and English languages.
Results: After determining all the concepts and criteria of EFQM and matching them to the medical record section's goals, task's and functions, feasibility study of EFQM implementation in medical record section, is approved. With this comparism, importance of this section's role in signification model scores hospitals quality of performance is determined.
Yaser Joyani, Mehdi Raadabadi , Zahra Kavosi , Jamil Sadeghifar , Khalil Momenei ,
Volume 5, Issue 3 (4 2011)
Abstract
Background and Aim: An Adapting work condition with physical and mental conditions of employees is an essential factor to do the job effectively. This study
was conducted to determine the relationship between employees occupational accidents and absence from work in Shiraz Namazi Hospital.
Materials and Methods: This descriptive-analytical and cross-sectional study was done in Shiraz Namazi Hospital at 2010. One Hundred and sixty employees in
different departments of the hospital with a random stratified sampling were enrolled in this study. Data were collected using the checklist consisting of three
parts: demographic information, types of occupational accidents and three open questions to enumerate other occupational accidents, diseases resulting from
occupational accidents and possible causes of exposure to this accidents. Data were analyzed using the SPSS software and using descriptive statistics and chi square & t tests.
Results: Out of 160, 159 participants responded and returned the questionnaire,out of which 68.9% were females. Cuts with sharp objects (22%) and toxicity
resulting from working with solvents (82%) were the lowest and highest nonexposure in sample's studies, respectively. A statistically significant relationship
between gender, work shift, organizational status and duration of employment with the occurrence of a number of occupational accidents was observed.
Conclusion: According to the results, there was no clear relationship between absences from work and frequency of each occupational accident. We recommend
the hospitals to consider notebooks for recording occupational accidents and theirway of occurrence. Also , training courses for employees shoud be in priority.
Esmaeel Masoudian, Jamil Sadeghifar, Yusef Masoudian, Moslem Salehi, Mojgan Amiriyan Zadeh, Meysam Mousavi,
Volume 6, Issue 5 (13 2013)
Abstract
Background and Aim: Hospital internal evaluation is considered as one of the most important steps in strategic planning. Therefore, besides the recognition of the weaknesses and limitations of the organization, especially affecting issues on the performance, the responsibility of the organization will be defined. This study was performed for the assessment of internal environment of the Gachsaran's Shahid Rajai Hospital based on Weisbord Organizational Diagnosis model.
Materials and Methods: In a cross-sectional study, 123 hospital staff were selected using random sampling formula. Data was collected using Weisbord Questionnaire which consisted of 35 questions in seven areas. Data analysis was conducted using SPSS statistical software and the t-test.
Results: Among six variables studied, variable communication with 3/15 ± 1/25 mean and standard deviation has the best situation and reward mechanism with the mean and standard deviation of 4/59 ± 1/32 was the worst. There was a meaningful difference among all variables except for the leadership variable.
Conclusion: Based on the findings of this study, Gachsaran's Shahid Rajai hospital has strength in the fields of goals, organizational structure, coordination, and internal organizational communication
Marjan Ghazi Saeedi , Reza Safdari, Abdoljalil Kalantar Hormozi , Leila Shahmoradi, Fatemeh Sadeghi,
Volume 8, Issue 1 (5-2014)
Abstract
Background and Aim: The applicability of any technology to enter a certain field is
determined by defining the advantages and disadvantages of the system in that
field. The aim of this study is to show the advantages and limitations of using
speech recognition systems in health care and providing practical solutions to
improve the acceptability of the system in that field.
Materials and
Methods: This is a descriptive
research with a review method that employs library resources and online
databases such as Proquest, Pubmed, Science Direct, Ovid and Scientific
Information databases using key words like speech recognition software, health
care, benefits, barriers, and solutions.
Results: Speech recognition
system has many advantages like increased accuracy of medical documentation,
and reduced documentation time. It is a tool for data entry into electronic
health records. However, there are several limitations in applying the system
in Iran, such as the lack of definition of database system and the high cost of
hardware and software.
Conclusion: Considering the study
results in relation to the benefits and limitations of systems in healthcare
area, solutions such as production of a national integrated database for the
exchange of health information, improving database to increase the accuracy of
word recognition, and training the users of the system can reduce the
limitations of the system to some extent. Also, in the country’s movement
towards the implementation of electronic health records and the users’ need to
enter data into the computer, the software is a good alternative to keyboard
and mouse input.
Farahnaz Sadoughi , Malihe Sadeghi , Mostafa Langarizadeh , Elahe Gozali ,
Volume 8, Issue 4 (11-2014)
Abstract
Background and Aim: Tele pathology is one of the medical subdivisions that has opened a new approach in the telepathology, e specially to organize consultations. In this research, feasibility of Telepathology implementation in teaching hospitals of Tehran University of Medical Science was studied.
Materials and Methods: This study was a cross-sectional and descriptive study. The study population was included 8 hospitals directors and administrator, 20 pathologists, and 8 informatics staffs, in four teaching hospitals of Tehran University of Medical Sciences. A researcher constructed questionnaire was used for data collection . The validity of the questionnaire was confirmed by expert panel and using by Test – retest method confirmed its reliability. The data was collected and analyzed by SPSS software to prepare descriptive findings.
Results: The R esults showed that 65.6% of hospitals had hardware facilities . Procedures based on legal issues related to information security and privacy was 95.71%, while t here was no guideline for telemedicine and telepathology.
Conclusion: I t could be concluded that in line with considrating the importance and benefits of telepathology, it is necessary to provide software requirements and hardware infrastructure. It should be noted that available properties also must be improved in terms of implementation of telepathology. Also, rules to support patients’ and staff’s rights should be developed for better implementation of such new technologies
Mehdi Basakha, Kazem Yavari , Hosein Sadeghi, Alireza Naseri ,
Volume 9, Issue 2 (7-2015)
Abstract
Background and Aim: The recently emerged symptoms of population aging
have raised serious concerns in some developed countries. A recent report by the
United Nations (UN) indicates that aging is more rapidly growing and is even more
serious in developing countries than it is in certain other countries. Therefore, this
study is aimed to determine the impression of aging on non-oil economic growth.
Materials and Methods: A simple economic growth model was built which
would take demographic variables into account. Then, using the country's data for
the years 1967-2011, the researchers tried to estimate autoregressive distributed
lags (ADL). The short- and long-term models, and error correction model were
estimated using Microfit 4.0 software.
Results: The findings show that physical capital, human capital and trade
openness have a significant positive effect on per capita income, both in the long
and in the short run. Similarly, the regression analysis indicates that “Ageing
Index” may have a significant effect on economic growth in Iran’s non-oil sector.
Conclusion: Due to the young makeup of Iran's population, the signs of aging
economy have not raised sensitiveness but predictions indicate that the aging
process in Iran will be intensified in the coming decades and its negative effects
will emerge in near future. Therefore, due to the long-term effects of aging on
economic growth, working structure and retiredness reform policies, it is vital to
stabilize population growth at an optimal rate, and more importantly, pay attention
to capital storage.
Fatemeh Sheikhshoaei, Elham Zohreh Kermani , Arezoo Ghamgosar, Tahereh Sadeghi,
Volume 10, Issue 1 (4-2016)
Abstract
Background and Aim: Considering the elements of knowledge management (availability, creation, and transfer of knowledge) is very important in digital libraries websites and makes the performance better. So this paper aim to identify the knowledge management criteria in Iranian selected digital library's websites and study of observance scale
Materials and Methods: The research method was descriptive survey and from applied research type. Data collecting has been based on check list according with K-ACT model (Knowledge- Access Creation Transfer). The population of this study was 7 digital library websites, including Noor, Payame noor, Islamic Parliament, Tebyan, DID, National Digital Library of Iran and Astan Quds Razavi that were selected based on accessibility.
Results: This research findings showed that use of knowledge management criteria in the selected digital libraries websites is moderate and the access to website criteria is highest and lowest is online participation criteria. Tebyan DL earned first rank among seven libraries with 56 percent compliance with the standards of knowledge management in the digital library's web sites.
Conclusion: Study of knowledge management criteria in the selected digital library websites has shown that these criteria has not been favorably applied that it stems from criteria incompatible with the principles, rules and standards. Due to these problems, designers of digital libraries can be effective in promoting these websites and enhance the quality of digital library services with aware of users’ needs and attention to use of these criteria.
Reza Safdari, Fatemeh Sadeghi , Maryam Mohammadiazar,
Volume 10, Issue 2 (5-2016)
Abstract
Background and Aim: Population aging in most of developed countries should be subjective to more attention, regarding health issues of aging group. Different organizations and institutions have launched several programs related to elderly center. This paper is aimed to compare performance of different programs of active organizations in the field of elderly care in Iran.
Materials and Methods: This overview of research, used library resources and online databases Proquest, Pub med, Science Direct, Ovid and Scientific Information databases using keywords that Aged care services, relevant organizations, and Iran.
Results: There are various classifications of geriatric services. However, these services can be divided into three groups including infrastructure, social services, and health care and preventive services according to concept, level and type of services.
Conclusion: In Iran, agencies and institutions relevant to elderly, take measures to support elderly people given their current tasks and allocated budget. But, these measures do not seem adequate, because solving aging problem, as a problem with evident influences which its impacts will be intensified in future, requires responsibility and cooperation of more agencies and public institutions.
Mina Sadat Hashemiparast, Roya Sadeghi, Mohammadreza Ghaneapur , Kamal Azam , Azar Tol ,
Volume 10, Issue 3 (7-2016)
Abstract
Background and Aim: Effective educational programs, is one of the most basic methods in prevention of Nosocomial infection. This study aimed to compare the effects of E-learning versus lecture-based education in prevention of Nosocomial infections among hospital staffs.
Materials and Methods: A randomized pre and posttest control group design was conducted on 98 hospital staffs in 2013 after allocating into two groups of "lecture-based education" and "E-learning”. Data were collected by a researcher-made questionnaire which its validity and reliability was confirmed by a pilot study. Wilcoxon, Paired and Independent sample T-test was conducted using SPSS, version18.
Results: There was a significant difference for outcomes before and after education based on two approach of lecture-based (p=0.01) and E-learning (p=0.01).The mean and standard deviation of knowledge in lecture-based education and E-learning group were 12.73± 2.76, 11.50 ± 2.64 respectively. The level of knowledge in the lecture group was significantly higher than that of participants in the E-learning group (p=0.02).
Conclusion: Despite the effectiveness of E-learning in learning and raising awareness of the learners, using of this method among health-related organizations need to empower employees, remove the barriers and suitable infrastructure.
Hossein Dargahi, Shiva Toloui Rakhshan , Jamil Sadeghifar,
Volume 10, Issue 3 (7-2016)
Abstract
Background & Aim: One of the most important and useful models for assessing hospital performance is the Pabon Lasso Model, a graphical model that determines the relative performance of hospitals using three indicators: 1. Bed Occupancy Rate (BOR); 2. Bed turnover (BTO); 3 Average Length of Stay (ALS). The aim of this research is to investigate the performance of the hospitals affiliated with Tehran University of Medical Sciences in Iran during the year 2011 based on the Pabon Lasso Model.
Materials & Methods: This descriptive and cross-sectional study conducted in 2011. All the 16 hospitals affiliated to Tehran University of Medical Sciences formed the study population. Data was analyzed by Excel software and Pabon lasso model.
Results: The following average results for each performance indicator were obtained: Average Length of Stay (ALS) = 6.55 days. Bed Occupancy Rate (BOR) = 74.151% and Bed Turnover (BTO) = 70.24 times per year18.75% hospitals were located in the Pabon Lasso Model zone 1.25% hospitals in zone 2.25% of hospitals in zone 3, and 31.25% hospitals in zone 4 of the model.
Conclusion: The study showed that 75% of the studied hospitals were inefficient. Applying Pabon Lasso model compared hospital's performance. Thus, using one of the active ways of problem recognition in hospitals and perceiving the relation of performance indicators will be helpful in establishing new policy and reviewing current policy in order to maximize performance capacity.
Vahid Changizi, Hossein Sadeghi, Maryam Alizadeh, Atefeh Aghaei, Mohsen Yazdanmehr,
Volume 12, Issue 3 (Aug & Sep 2018)
Abstract
Background and Aim: Today, OSL (Optically Stimulated Luminescence) dosimetry system based on optical stimulation, includes systems that can meet many requirements for radiation protection in the field of medicine and space. The Calcium Sulfide (CaS) is one of the earth's alkaline sulfide materials which can be used as a detector in this system. In this research, some of the dosimetry properties of CaS doped with Cerium, (Ce), and Samarium, (Sm) elements were investigated as OSL dosimeter sensor.
Materials and Methods: First, attenuation of x-rays through the sensors were analyzed and the absorbed dose rate was evaluated using MCNP code. After calcium sulfide tablets were fabricated and their concentration optimized, the maximum waiting time prior to readout was obtained. In addition, the repeatability and linear response of the detector were determined as a function of CaS concentration.
Results: Eight minutes after radiation exposure of detectors, the detection output signals became stable. This stability was monitored for at least 30 minutes after irradiation. The repeatability in measurements was observed within the dose ranges of 100 to 860 mGy. The dosimeter response was observed linear over this dose ranges.
Conclusion: According to the above-observed results and statistical evaluations, one can conclude that the CaS:Ce,Sm crystal is a proper sensor for OSL dosimeter systems in medicine and space studies.
Reza Safdari, Ensieh Nasli Esfahani, Sharareh Rostam Niakan Kalhori, Mahsa Mosadeghi Nik,
Volume 12, Issue 4 (Oct & Nov 2018)
Abstract
Background and Aim: Diabetic foot ulcer is one of the most painful complications of Diabetes and affects various aspects of a person's life. Therefore, involvement of the patient in self-care can minimize its complications. The purpose of this study was to identify the effective factors in the Diabetic foot self-management for designing a managed-care based app for people with Diabetes who have risk factors for foot ulcers or wound infections.
Materials and Methods: In this cross-sectional study all physicians and nurses employed at ‘Diabetes and Metabolic Diseases Research Center’ of Tehran University of Medical Sciences who had a history of working with Diabetic patients at various levels of Diabetes and foot ulcers participated. The data collection tool was a questionnaire based on the likert scale that made by researchers, which included demographic and clinical information, education and lifestyle management and capabilities of application for self-management in Diabetic foot patients. Finally, descriptive statistics used to analyze the results in SPSS.
Results: After reviewing the rate of experts’ agreement with the components of the survey, all the cases over 51% approval rate were considered as required components. According to the opinion of the physicians respectively capabilities of application, education and lifestyle management and patient information and according to the opinion of the nurses’ education and lifestyle management, patient information and capabilities of application were important respectively.
Conclusion: Beside proper treatment of the disease, self-management strategies can be effective and useful. Effectiveness of the patients’ self-care by acquiring the necessary skills and involvement in self-care might be achievable.
Mohammad Hossein Sadeghian, Seyed Amirhossein Mahdavi, Farhad Habibi, Masoud Shafiei,
Volume 16, Issue 3 (Aug 2022)
Abstract
Background and Aim: The American Psychiatric Association identifies suicide as the third leading cause of death among people aged 15 to 24. This study was conducted with the aim of investigating factors affecting of the occurrence of suicides leading to death in corpses referred to the Forensic Medicine Organization of Tehran Province from 2010 to 2019.
Materials and Methods: This research was a descriptive and analytical cross-sectional study in 2019 year. The statistical population includes all bodies referred to forensic medicine. The information related to all corpses referred to forensic medicine which was analyzed between 2010 and 2019 were 5471 cases. Descriptive and analytical statistical methods were used to analyze the data. P-value less than 0.05% was considered valid.
Results: The results showed that 50% of suicide deaths were under 32 years old. Sixty-nine point two percent of suicides leading to death are male and the rest are female. The highest frequency in terms of method was related to the hanging method, 39.3%, and in the youth age group, in terms of the level of education in men, high school diploma and diploma in women. The highest frequency of suicide related to singles was 47.1% and 27.4% in the summer season. The most common method of suicide was hanging, with more than 39%, followed by poisoning with poison, with more than 25% of cases. The least used method was drowning.
Conclusion: Based on the results of this study, it seems that factors such as age, sex, level of education, and even geographic and social factors are among the factors that affect suicide, which can help policymakers, managers, psychologists, psychiatrists, and related organizations. Paying attention to educational literacy, employment status and income level of people, special attention of families to adolescent and young boys and girls and especially their marital status can be effective measures to prevent suicide.
Omid Ali Gholami, Jamil Sadeghifar, Bahareh Kabiri, Shabnam Ghasemyani, Sadegh Sarhadi, Reza Jorvand,
Volume 17, Issue 4 (10-2023)
Abstract
Background and Aim: Health literacy is recognized as a key determinant of health and is a central focus of public health policy strategies. The present study aimed to assess the health literacy level and identify the factors influencing it among the clients of comprehensive health service centers in Ilam city.
Materials and Methods: In 2022, a descriptive-analytical study was conducted to examine 429 clients aged 18-65 years who visited comprehensive selected health service centers in Ilam city. For adults the data collection tool used was the Helia health literacy questionnaire. Sampling was conducted in nine clusters, with each cluster consisting of 50 samples. The data was analyzed using SPSS software, which included descriptive statistical tests, Pearson’s correlation coefficient, and one-way analysis of variance, with a significance level set at 0.05.
Results: Based on the results, the average health literacy score was 80.16 ± 16.50. In terms of health literacy, 18.97% of people had inadequate or not very adequate health literacy, while 44.39% of the participants had excellent health literacy. The average health literacy scores across different dimensions are as follows: access to health information 65.74, comprehension of information 81/81, reading information skills 12.74, evaluation of information 05.75, and decision making and behavior based on information 61.92. A significant relationship was observed between job, education, and income variables and various dimensions of average health literacy (p-value≤0.001). However, there was no significant relationship between general health literacy and age, gender, and place of residence (P≤0.05).
Conclusion: The results of the present study demonstrate that vulnerable groups have significantly lower literacy levels. Furthermore, given the impact of education on enhancing people’s health literacy, it is advisable to leverage mass media, social networks, and educational centers to enhance literacy levels as a potential factor in community health.
Mohammad Hossein Sadeghian, Parviz Jahan, Mohammad Aarefi,
Volume 17, Issue 5 (12-2023)
Abstract
Background and Aim: Aluminum phosphide poisoning is one of the fatal poisonings in Asian countries, including Pakistan and India, which requires urgent treatment. Since one of the most important symptoms in patients poisoned with aluminum phosphide is cardiovascular manifestations; it seems that electrocardiogram and echocardiographic changes are one of the important things that need to be measured in patients poisoned with this substance. Therefore, the study was designed to investigate electrocardiogram and echocardiographic changes in patients poisoned with aluminum phosphide.
Materials and Methods: The present study was conducted cross-sectionally 2019-2021 on 107 patients poisoned with aluminum phosphide who referred to the poisoning emergency of Baharloo Hospital in Tehran. All patients were included in the study due to taking tablets, solution or inhalation of aluminum phosphide. Finally, the patients› information was collected based on the variables investigated in this study including age, gender, poisoning dose, time interval between taking pills and admission to the hospital, systolic blood pressure level, electrocardiogram and echocardiography changes.
Results: The mean systolic blood pressure was 107 mmHg at the beginning of the study that changed to 103 mmHg after 24 hours. In addition, the mean diastolic blood pressure was 71.19 mmHg at the beginning of the study that changed to 68.66 mmHg after 24 hours. The blood pH of the patients at the beginning of the study and after 24 hours, was 6.99 and 7.39, respectively (P-value= 0.081). The mean EF was 40.68at the beginning of the study which, on average, changed to 46.57 mmHg after 24 hours (%5.21 increase, P-value= 0.029).
Conclusion: The results of the present study showed that extensive changes in the echocardiography of the heart, especially the left ventricular ejection fraction, as well as the patient›s ECG could indicate the severity of heart poisoning in patients poisoned with aluminum phosphide.
Mehdi Raadabadi, Zahra Tolideh, Zahra Shoara, Zahra Yeganeh, Jamil Sadeghifar, Khalil Momeni,
Volume 18, Issue 1 (3-2024)
Abstract
Background and Aim: There is limited evidence about the effect of the corona disease epidemic on the efficiency of hospitals in Iran. This study was conducted with the aim of investigating the effect of the Covid-19 epidemic on the productivity of public hospitals in Ilam province.
Materials and Methods: This retrospective descriptive research has investigated the performance of 9 hospitals in Ilam province during a four-year period(1397-1400) based on the Pabon Lasso graphic model. The desired data were extracted from the HIS system of the hospitals and the key performance indicators of BOR, BTR and ALOS were calculated. The Pabon Lasso diagram was drawn with Excel software.
Results: The results showed that the bed occupancy percentage in teaching hospitals is significantly higher than non-teaching hospitals (P<0.05). Based on the results, the percentage of bed occupancy and the rate of bed rotation after the covid 19 pandemic has decreased significantly (P<0.05). The average length of the stay of patients also increased after the pandemic (P<0.05). Overall evaluation of hospital efficiency based on the Pabén Lasso model shows that the frequency of hospitals located in Nakara district has decreased from 4 hospitals before the pandemic to 3 hospitals, although hospitals in Kara district have not changed during this period.
Conclusion: Most of the researched hospitals, especially non-teaching hospitals, have low bed occupancy. Weakness in the service delivery chain, especially diagnostic services and specialized and super-specialized services, is one of the main reasons for this situation. Moving towards a change in the way hospitals are managed and having more flexibility in the structure and implementation in the short term and prioritizing large hospitals with a complete chain of services can lead to a way out of the current inefficient situation.
