Alphabet strategy for diabetes care:A checklist approach in the time of COVID-19 and beyond

Chronic disease management requires achievement of critical individualised targets to mitigate again long-term morbidity and premature mortality associated with diabetes mellitus.The responsibility for this lies with both the patient and health care professionals.Care plans have been introduced in many healthcare settings to provide a patient-centred approach that is both evidence-based to deliver positive clinical outcomes and allow individualised care.The Alphabet strategy(AS) for diabetes is based around such a care plan and has been evidenced to deliver high clinical standards in both well-resourced and underresourced settings.Additional patient educational resources include special care plans for those people with diabetes undertaking fasting during Ramadan,Preconception Care, Prevention and Remission of Diabetes.The Strategy and Care Plan has facilitated evidence-based,cost-efficient multifactorial intervention with an improvement in the National Diabetes Audit targets for blood pressure,cholesterol levels and glycated haemoglobin.Many of these attainments were of the standard seen in intensively treated cohorts of key randomized controlled trials in diabetes care such as the Steno-2 and United Kingdom Prospective Diabetes Study.This is despite working in a relatively under-resourced service within the United Kingdom National Health Service.The AS for diabetes care is a useful tool to consider for planning care, education of people with diabetes and healthcare professional.During the time of the coronavirus disease 2019 pandemic the risk factors for the increased mortality observed have to be addressed aggressively.The AS has the potential to help with this aspiration.

Rationale and protocol for estimating the economic value of a multicomponent quality improvement strategy for diabetes care in South Asia

Background:Economic dimensions of implementing quality improvement for diabetes care are understudied worldwide.We describe the economic evaluation protocol within a randomised controlled trial that tested a multicomponent quality improvement(QI)strategy for individuals with poorly-controlled type 2 diabetes in South Asia.Methods/design:This economic evaluation of the Centre for Cardiometabolic Risk Reduction in South Asia(CARRS)randomised trial involved 1146 people with poorly-controlled type 2 diabetes receiving care at 10 diverse diabetes clinics across India and Pakistan.The economic evaluation comprises both a within-trial cost-effectiveness analysis(mean 2.5 years follow up)and a microsimulation model-based cost-utility analysis(life-time horizon).Effectiveness measures include multiple risk factor control(achieving HbA1c<7%and blood pressure<130/80 mmHg and/or LDL-cholesterol<100 mg/dl),and patient reported outcomes including quality adjusted life years(QALYs)measured by EQ-5D-3 L,hospitalizations,and diabetes related complications at the trial end.Cost measures include direct medical and non-medical costs relevant to outpatient care(consultation fee,medicines,laboratory tests,supplies,food,and escort/accompanying person costs,transport)and inpatient care(hospitalization,transport,and accompanying person costs)of the intervention compared to usual diabetes care.Patient,healthcare system,and societal perspectives will be applied for costing.Both cost and health effects will be discounted at 3%per year for within trial cost-effectiveness analysis over 2.5 years and decision modelling analysis over a lifetime horizon.Outcomes will be reported as the incremental cost-effectiveness ratios(ICER)to achieve multiple risk factor control,avoid diabetes-related complications,or QALYs gained against varying levels of willingness to pay threshold values.Sensitivity analyses will be performed to assess uncertainties around ICER estimates by varying costs(95%CIs)across public vs.private settings and using conservative estimates of effect size(95%CIs)for multiple risk factor control.Costs will be reported in US$2018.Discussion:We hypothesize that the additional upfront costs of delivering the intervention will be counterbalanced by improvements in clinical outcomes and patient-reported outcomes,thereby rendering this multi-component QI intervention cost-effective in resource constrained South Asian settings.Trial registration:ClinicalTrials.gov:NCT01212328.

Evaluation of the Integrated Management Program for Acute Malnutrition in the Douentza Health District, Mopti Region, Mali

Introduction: Malnutrition is a major public health problem in Mali, despite the efforts of the government, its technical and financial partners. The aim of this study was to evaluate the integrated management program for acute malnutrition (IMPAM). Methodology: This was a descriptive cross-sectional study that took place from January to December 2020 in the Douentza health district. The study included anyone with at least one malnourished child aged 6 to 59 months in their care who agreed to take part in the study, community health center staff who had given their consent, and the URENI manager at the Douentza reference health center. Data collected via questionnaires were entered into Excel and then analyzed using Epi-Info version 7 software. Results: A total of 138 acutely malnourished children aged 6 - 59 months, including 71 girls (51.45%), 138 accompanying mothers and 11 health workers, were included in our case study. Among the malnourished, 54.34% were in the 12 - 23 months age group and 69.57% had the severe form. 93% of the mothers interviewed were satisfied with the care provided, and all the health staff interviewed stated that community conflicts had an impact on IMPAM’s activities. Cure rates were 81% in Moderate Outpatient Nutritional Recovery and Education Unit (URENAM), 84% in Severe Ambulatory Nutritional Recovery and Education Unit (URENAS) and 92% in Recovery and Intensive Nutritional Education Unit (URENI). Drop-out rates were 19% in URENAM, 16% in URENAS and 0% in URENI. The death rate was 8% in URENI and 0% in URENAM and URENAS. Conclusion: This study confirms the high prevalence of malnutrition in the district (10.54%). It also reveals that factors such as inter-community conflict and insecurity have seriously affected the IMPAM program.

Advancing critical care recovery:The pivotal role of machine learning in early detection of intensive care unit-acquired weakness

This editorial explores the significant challenge of intensive care unit-acquiredweakness(ICU-AW),a prevalent condition affecting critically ill patients,characterizedby profound muscle weakness and complicating patient recovery.Highlightingthe paradox of modern medical advances,it emphasizes the urgent needfor early identification and intervention to mitigate ICU-AW's impact.Innovatively,the study by Wang et al is showcased for employing a multilayer perceptronneural network model,achieving high accuracy in predicting ICU-AWrisk.This advancement underscores the potential of neural network models inenhancing patient care but also calls for continued research to address limitationsand improve model applicability.The editorial advocates for the developmentand validation of sophisticated predictive tools,aiming for personalized carestrategies to reduce ICU-AW incidence and severity,ultimately improving patientoutcomes in critical care settings.

Caregivers'awareness regarding the care of dementia and the coping strategies among the caregivers of people with dementia:a cross-sectional study in Udupi District,Karnataka

Objectives:To assess the awareness and coping skills of the informal and formal caregivers of people living with dementia(PLWD).Dementia is a condition,which leads to memory loss and gradual deterioration of cognitive abilities in the affected person.The lack of awareness regarding the care of people with dementia and the caregivers'poor coping strategies can negatively impact caregivers'experiences.Methods:A cross-sectional survey was conducted among the 80 caregivers of PLWD from the psychiatric units of the selected hospitals of Udupi district,Karnataka,India.The baseline data were collected by a self-reported sociodemographic questionnaire.The“Dementia Knowledge Assessment Scale”was used to gauge participants'awareness of the care of people with dementia,while the“Brief COPE inventory,”a 28-item questionnaire,was used to gauge carers'coping mechanisms.Descriptive and inferential statistics were used for the data analysis using Jamovi(2.3.24),a graphical user interface for R programming,and Microsoft Excel.Results:Most of the caregivers(n=68,85%)had lesser awareness regarding the care of people with dementia.The mean coping strategies score was 60.9±7.71.There was a positive correlation between the awareness and the coping strategies scores among the caregivers(r=0.659,P<0.05).Conclusions:The caregivers of people with dementia often lack awareness about dementia and hence experience poor coping due to their high workload and stress.The frontline healthcare professionals and nurses need to provide appropriate interventions to the caregivers to improve their awareness about dementia and its care.

Quality indicators for the care of older adults with disabilities in longterm care facilities based on Maslow’s hierarchy of needs

Purpose:This study aimed to develop quality indicators for the care of older adults with disabilities in long-term care facilities(LTCFs)based on Maslow’s hierarchy of needs.Methods:The draft of the quality indicators was drawn up based on a literature review and research group discussion.The quality indicators were finalized by two rounds of expert consultation(involving 15 experts)using the Delphi method.The Analytic Hierarchy Process was applied to calculate the indicators’weight.Results:The response rates of the two rounds of consultation were 100%and 93%,and the expert authority coefficients were 0.86 and 0.87.After two rounds of consultation,the expert opinion coordination coefficients of the first-,second-and third-level indicators were 0.42,0.25,and 0.96,respectively(P<0.05),and the variation coefficient was0.25.The final quality indicators for the care of older adults with disabilities in LTCFs included 7 first-level,19 second-level,and 107 third-level indicators.Conclusion:The quality indicators for the care of older adults with disabilities in LTCFs are reliable,scientific,comprehensive,and practical and specify the content of person-centered care needs.This can provide a reference for evaluating and improving care quality in LTCFs.

Attitude of nursing students towards Internet-based nursing services for the aged

Objective To investigate the attitude,willingness,and motivation of third-year undergraduate nursing students from a university of Chinese medicine toward Internet-based nursing services for the aged(IBNSA),providing a reference for its development and related nursing education.Methods This study was conducted from March to April 2019.Using a self-designed questionnaire,this cross-sectional study comprised 508 third-year undergraduate nursing students from a university of Chinese medicine.The questionnaire was divided into two parts.The first part contained the general information of nursing students.The second part investigated nursing students’attitudes,willingness,and motivation towards IBNSA(a total of seven questions).Results Of the 508 nursing students,314(61.81%)expressed support for the IBNSA,44(8.66%)expressed disapproval.Regarding career choice,279(54.92%)were willing to choose IBNSA,51(10.04%)were unwilling.The top three motivations for choosing IBNSA as a nursing student career were increased income,high autonomy and flexibility,and good job prospects.On the contrary,the top three reasons not to choose this option were safety concerns,lack of time and energy,and unwillingness to undertake elderly care.Experience with community activities or a part-time job,experience with elderly care,willing to choose the nursing profession,willing to engage in nursing care after graduation,and willing to engage in nursing for elderly patients after graduation were significantly associated with the motivation of nursing students to participate in IBNSA(P<0.05).Conclusion The majority of nursing students have a positive attitude towards IBNSA and are willing to choose it as their future career.Nurses’and patients’safety guarantees and salary distribution were critical factors influencing their choice.Nursing schools should pay attention to the concerns of nursing students,constantly improve the management system of IBNSA,strengthen safety education,and provide professional knowledge and skills to improve the quality of personnel training.

Preconception Care Health Education for Female Workers of Reproductive Age in Japan Evaluation up to 6 Months after the Program

Objectives: The aim of this study was to implement a health education program for education of preconception care (PCC) for female workers of reproductive age through a seminar and to evaluate the program based on PCC knowledge and awareness and behaviors before the seminar and at 3 and 6 months after the seminar. Methods: A small group health education seminar was implemented using leaflets for 84 female workers of reproductive age, age 20 to 35 years old, and an intervention by group discussion and feedback was provided. Of these participants, 60 (71%) who provided valid survey responses were included in the analysis. The primary outcome indicators were PCC knowledge, PCC awareness and behaviors, and a food frequency questionnaire, and the secondary outcome indicators were self-efficacy and the health awareness and stress management subscales of the Health-Promotion Lifestyle Profile scale. The survey was conducted three times, before the seminar and at 3 and 6 months after the seminar, and the results were compared. Results: The percentage of individuals with PCC knowledge was significantly increased at 3 months after the seminar as compared with before the seminar, and it remained at this level even at 6 months after the seminar. The percentage of individuals with PCC awareness and behaviors was significantly increased for the items actively eat foods containing folic acid, prevent sexually transmitted diseases, and conduct self-examinations for breast cancer at 3 months after the seminar and for the items eat well-balanced meals, make the mind active, prevent sexually transmitted diseases, and conduct self-examinations for breast cancer at 6 months after the seminar. Furthermore, the score for the health awareness subscale of the Health-Promotion Lifestyle Profile scale was significantly increased at 6 months after the seminar. Conclusion: The health education program established PCC knowledge at 6 months after the seminar and improved some PCC awareness and behaviors. Therefore, it was suggested that the program would be effective for education of PCC for female workers of reproductive age.

Evidence of Care of the Aged in Ghanaian Communities—A Scoping Review

Sub-Saharan Africa population is increasing in age with little acknowledgement on the consequences of the issues of ageing. Aim: To explore and describe evidence in published literature on care given to the aged at home and how they prepare for their ageing. Method: The study applied the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) framework for systematic literature reviews using the population, intervention, comparison and outcome (PICO) method to track the eligibility of research questions. This method was the most appropriate for use in exploring the current position in available literature for that of Ghana. The research was performed using five electronic databases from January to July 2017 taking into consideration the set inclusion and exclusion criteria. Only studies written in English were considered and a total of 18 articles met the study criteria. Reviewers extracted primary studies comprising quantitative, qualitative and critical reviews. Result: The literature review showed shortcomings in care for the aged at home. From the search, six core themes were generated: neglect of aged care;aged care for the younger generation;aged living arrangements;government neglect;preparedness;and care of the aged in Ghana. Conclusion: This review offered significant insight into care for the aged in their homes. The inclusive nature of the rigorous approach used provided a good understanding of underlying issues on the needs of the aged. Challenges for future are broadened in scope for more research and effective awareness for interventional projects, services on care given to the aged.

The Experiences of the Elderly and Caregivers in Respect of Caring for the Elderly in Windhoek and Rehoboth Namibia: An Exploratory and Descriptive Study

In many instances, care for the elderly, especially in long-term care institutions, is provided under minimal supervision by caregivers who are lay people. This can lead to poor quality care or neglect of the elderly. The research question was: “How competent are lay caregivers for the elderly in old age homes, who often lack the opportunity for training to improve their knowledge and skills, in delivering care to the elderly? The aims of the study were to explore and describe the experiences of both the caregivers and the elderly in respect of caring for the elderly in old age homes. The objectives of the study were to explore and describe the experiences of the caregivers and the elderly with respect to caring for the elderly and in respect of nursing care they received. A qualitative, explorative, descriptive, contextual and phenomenology design was used to perform this study. In the situational analysis, the experiences and needs of the caregivers were described. Themes in terms of interpersonal relationships that could be positive or negative regarding the elderly were identified. These included lack of regular in-service training sessions for caregivers. Likewise, sub-themes like communication, support and caring for elderly people were revealed. Inadequate knowledge of caregivers in caring procedures, a shortage of staff, equipment and absence of policies which should support and guide the work of caregivers impacts negatively on the care of the elderly. From the experiences of the elderly and caregivers, the competencies under scrutiny emerged and were measured qualitatively by the perceptions of the elderly, in respect of the caring they were exposed to.

Method to Evaluate the Location of Aged Care Facilitiesin Urban Areas Focusing on the Equity in Terms ofUsers’Accessibility

The present study developed and tested a method to evaluate the location of aged care facilities from the viewpoint of whether they are equitably located for users,using the improved Median Share Ratio(MSR).By evaluating the current location of aged care facilities,it is possible to extract the districts which are short of facilities.The evaluation method was applied to Chofu and Kiyose Cities in Tokyo Metropolis,Japan,and the evaluation result of weighting and that of not weighting by elderly population were compared and discussed.Consequently,adopting the evaluation method with weighting by elderly population,it is possible to adequately examine the districts where new aged care facilities should be constructed.From this evidence,it is significant to evaluate the location of aged care facilities,using the improved MSR with weighting by elderly population in the study.

The Research of Social Organizations Participating in the Urban Community Aged Care＇ s Problems--Base on the City of Shanghai in China

With the deepening of China＇s aging population, the conmmnity aged care gradually become endowment new options. Social organization for its own characteristics, play an important role in participating in community aged care. But the extent to which the current social organizations to participate in the community aged care is still very low, the reason is mainly affected by the community aged care access mechanism. Article in the Shanghai community, for example, starhng fiom the present situation of the current social organizations to participate in the community aged care, analysis of the problems arising fi-om the social organizations in the community aged care, probe into its reasons in access mechanism, put forward the corresponding countermeasures and Suggestions, encourage social organizations play an effective role in the community aged care.

The Construction of the Aged Carers under the Internationa Comparative Perspective

Objective： To explore how to learn from foreign experience to promote the construction of nursing staff in China.Methods：Based on the social background and the problems faced by nursing staffin China, we selected Germany and Japan as the social environment and problems of nursing staffin China. Germany, Japan and Japan to find out how to solve the dilemma of nursing service personnel to meet the pension needs of Germany and Japan to compare whether the strategy adopted by the current development of nursing staff in China, and finally combined with the analysis of China＇s aging care workers How to draw lessons from international experience to promote the construction of nursing staff in China.Conclusion： In drawing on the experience of foreign nursing service personnel, we must first analyze the reasons for such measures, whether our country has the conditions to implement such measures is not able to solve The experience of other countries must be suitable for our country, we must combine the social environment in which our country in contrast, selectivity and targeted research.

Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.

Analysis of Urban Public Building Space Design Strategies in the Digital Age

Urban public building spaces involve various aspects of people’s daily activities and interactions,making the rationality and scientific nature of the design of these spaces crucial.This article first discusses the role and impact of digitization in the design of public building spaces,covering aspects such as digital design methods,visual expression and presentation,augmented reality’s spatial interaction experience,and integrated design and construction.Following that,it analyzes the process of digitized urban public building space design by exploring topics like digital space design and modeling,visual representation of digital spaces,digital performance analysis of spaces,and the integration of digital projects.This article aims to provide insights and references for urban public building space design in the digital era.

Alphabet Strategy for diabetes care: A multi-professional, evidence-based, outcome-directed approach to management

With the rising global prevalence in diabetes, healthcare systems are facing a growing challenge to provide efficient and effective diabetes care management in the face of spiralling treatment costs. Diabetes is a major cause of premature mortality and associated with devastating complications especially if managed poorly. Although diabetes care is improving in England and Wales, recent audit data suggests care remains imperfect with wide geographical variations in quality. Diabetes care is expensive with a sizeable amount of available expenditure used for treating the complications of diabetes. A target driven, long-term, multifactorial intervention in patients with type 2 diabetes has been shown to reduce mortality and morbidity. The alphabet strategy is a novel approach to effective diabetes care provision, aiming to address patient education and empowerment, provide consistent comprehensive care delivered in a timely fashion, and allowing multidisciplinary team work.

Nest-site selection and breeding ecology of Streaked Wren-Babbler(Napothera brevicaudata)in a tropical limestone forest of southern China

Background: The breeding information of most birds in Asian tropical areas,especially in limestone forests,is still poorly known.The Streaked Wren-Babbler(Napothera brevicaudata) is an uncommon tropical limestone bird with a small range.We studied its nest-site selection and breeding ecology,in order to understand the adaptations of birds to the conditions of tropical limestone forest in southern China.Methods: We used methods of systematical searching and parent-following to locate the nests of the Streaked Wren-Babbler.We measured characteristics of nest sites and rock cavities.Data loggers and video cameras were used to monitor the breeding behavior.Results: All the observed nests of the Streaked Wren-Babbler were placed in natural shallow cavities or deep holes in large boulders or limestone cliffs.The great majority(96.6%) of Streaked Wren-Babbler nests had three eggs with an average fresh weight of 3.46-± 0.43 g(n = 36,range 2.52-4.20 g).Most(80.4%) females laid their first eggs between March and April(n = 46).The average incubation and nestling period of the Streaked Wren-Babbler was 10.2 range 9-11 days),respectively.Most(87.9%) nests h± 0.4 days(n = 5,range 1011 days) and 10.5 ± 0.8 days(n = 6,ad at least one nestling fledge between 2011 and 2013(n = 33).Conclusions: Our study suggests that several features of the breeding ecology of the Streaked Wren-Babbler,including building nests in rocky cavities,commencing breeding earlier than most species,and reducing foraging times during the incubation period,are well-adapted to the unique habitat of tropical limestone forest.

Factors Affecting the Utilization of Antenatal Care among Married Women of Reproductive Age in Merca, Lower Shebelle, Somalia

Worldwide more than thousands of women and new born are at the danger of die from pregnancy and child delivery complications. Antenatal care (ANC)/ pregnancy care is the health care where expecting mothers and new born receive medical care or medical attention. The aim of this study is to examine factors affecting the utilization of antenatal care among married women of reproductive age in Merca, lower Shebelle, Somalia. Methodology: This is a descriptive cross-sectional and qualitative study design that was carried out from June to August 2022 and this study was carried out in Merca, district lower Shabelle, Somalia. Data were collected from 325 married women of reproductive age who have at least one child and more than living in Merca district. Result: Our study found that the magnitude of antenatal care uptake was 31.1% during the examined period. Very low utilization of antenatal care in Somali women is worrying in the face of high vulnerability of maternal complications. In terms of age diverse and utilization of antenatal care, women in younger age group 15 - 30 were more to utilize antenatal care services than with women in older age group 31 years above (p-value < 0.007). Our study also identified that there is association between level of education and level of utilization among women about antenatal care services (p-value < 0.001). In terms of level of awareness about antenatal care services, it is significantly associated with the level of utilization antenatal care (p-value < 0.001). Our study identified that the number of complaining complications related previous pregnancy that have no awareness about antenatal care services was higher than number of utilized antennal care awareness about antenatal care (p-value < 0.001). Based on these results, it is recommended to improve women’s awareness about antenatal care services by using health education program.

Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia

BACKGROUND: Hospital emergency department(ED) use by patients from residential aged care facilities(RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home(Hi NH) program.METHODS: RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics.RESULTS: In both hospitals, most RACF residents presenting to EDs were aged between 75–94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio(95%CI): 0.09(0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio(95%CI): 0.22(0.07, 0.66); P=0.007].CONCLUSION: The Hi NH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.

Earthquake planning and crisis management with an emphasis on the facilities, utilities, and services of the health care centers of Tiran and Karvan County, Isfahan Province, Iran: A case study

Objective: To study earthquake planning and crisis management with an emphasis on the facilities, utilities, and services of the health care centers of Tiran and Karvan County, Isfahan Province. Methods: This is a descriptive-analytical survey based on the quantitative and qualitative characteristics of Tiran and Karvan County Health Care Centers(HCCs). Twenty quantitative and qualitative indicators were derived from the studied HCCs and analyzed using the strengths, weaknesses, opportunities and threats analysis technique. The top crisis management strategies were identified and a number of strategies and solutions were proposed. Results: The HCC utilities such as water, electricity, gas, and heating and cooling systems were in average condition, whereas the facilities of the majority of HCCs were in vulnerable-to-average condition. In addition, they sustained relatively high degree of instability which calls for reassessment and effective policies to minimize weaknesses and eliminate threats using strengths and opportunities. Conclusions: It is recommended that the condition of Tiran and Karvan County HCCs be enhanced by distributing new HCCs based on the population density, expanding the road network and creating vast, wide-open spaces to enable field hospital construction in times of crisis.