Publisher: Baqiyatallah University of Medical Sciences   (Total: 5 journals)   [Sort alphabetically]

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Hospital Practices and Research
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ISSN (Print) 2476-390X - ISSN (Online) 2476-3918
Published by Baqiyatallah University of Medical Sciences Homepage  [5 journals]
  • Assessing the Extent and Causes of Cancellation of Surgeries: An Important
           Issue in Improving the Efficiency of the Hospital

    • Abstract: AbstractBackground and purpose: Canceling surgery imposes the high cost of the healthcare provider system and wasted many energy and time from the patient and the care team. Therefore, this study examined the extent and reasons of canceling of surgeries in one of the hospitals affiliated to Shahid Sadoughi University of Medical Sciences 2020.Method: This was a descriptive-applied study. In order to get the number of operations from April 2018 to March 2020, the hospital used HIS software and then extracted the reasons from the operating room office and the quality improvement office in the hospital. Data were analyzed by SPSS 21 software.Results: Among 8654 planned surgeries, 0.9% were cancelled. The highest frequency of surgical cancellation is associated with general surgery, and the highest rate of surgical cancellation is associated with the ENT specialty. The highest cancellation rate was 1.82% in August 2018 and 2.87% in February 2019. The lack of preparation of patients and patients did not require surgery was the main and worst reason for discontinuing surgery, respectively. Conclusion: The lack of clinical preparation of the patient was the main reason for the cancellation. Therefore, pre-surgery patient evaluation can help solve this problem, make the operating room more effective, and increase patient satisfaction.
       
  • The Association of Atorvastatin Therapy with COVID-19 Outcomes and
           Mortality

    • Abstract: Background: The world is still witnessing a largely ongoing spread of COVID-19, therefore, the scientific findings in this area need to be shared promptly. Objectives: We aimed to assess the usefulness of Atorvastatin treatment in the reduction of COVID-19 mortality in patients with or without Diabetes Mellitus (DM) and to correlate them with C - reactive protein (CRP) levels. Methods: Patients with pneumonia symptoms, positive lung CT scan, and confirmed SARS-CoV-2 on RT-PCR were consecutively enrolled in this study. Outcome was defined as intensive care unit admission and death. Clinical data and history of atorvastatin administration were evaluated. CRP levels were measured at baseline and repeated after one week in all patients. Results: A total of 200 patients were included. Their mean age was 60.5 (SD= 16.5) years, 113 (56.5%) patients were male, 47 (23.5%) with pre-existing diabetes, and 64 (32%) patients were taking atorvastatin routinely. Of all the studied patients, 68 (34%) required ICU admission. No gender differences were found in ICU admission and death. The baseline CRP was not significantly different but the secondary CRP was significantly different between DM and non- DM groups. Secondary CRP also showed a significant reduction in patients who were receiving atorvastatin (p= 0.017). The mortality was the same either in atorvastatin or non-atorvastatin groups (p= 0.715). Conclusions: It seems, taking statin has only some beneficial effects on the improvement of CRP levels in patients with COVID-19. To achieve a reliable result, clinical trials is recommended.  
       
  • Saga of non-COVID patients in COVID times: Our experience in a secondary
           care hospital in a hilly terrain

    • Abstract: Background: The COVID-19 pandemic resulted in the diversion of all the resources, attention, and energy of the medical personnel and administration towards management of COVID patients which resulted in unforeseen difficulties and hazards for non-COVID patients in accessing healthcare professionals and facilities. Objectives: To analyze the impact of the COVID-19 pandemic and repeated lockdowns on the non-COVID patients; to understand the social, psychological, and medical issues faced by them; and propose solutions for difficulties faced by this specific cohort of patients. Methods: We conducted a retrospective observational study on all non-Covid patients reporting for non-COVID illnesses. We conducted the data analysis by comparing the trends for 15 months each in the pre-pandemic (01 Jan 2019 to 31 Mar 2020) and pandemic period (01 Apr 2020 to 30 Jun 2021).Results: There was a 65.92% decrease in Out Patient Department (OPD) attendance, a 56.05% decrease in admissions, and a 90.33 % decrease in elective surgical procedures in non-COVID patients. However, there was a significant increase in emergency surgeries by 62.16%. Conclusion: There has been a significant albeit much-needed diversion of time, energy, and resources to manage COVID-19 patients in recent times. This has led to a paucity of care opportunities for non-COVID patients, which has been further compounded by the frequent lockdowns. We attempt to understand the impact of the pandemic on non-COVID patients, particularly in peripheral hospitals in hilly terrains. We propose the solutions to tackle these issues and describe our experience with them.
       
  • Investigating Fire Protection Condition in Selected Units of Imam Khomeini
           Hospital Affiliated with Tehran University of Medical Science

    • Abstract: Background: Various studies indicate that in many cases, fire has broken out in hospital.Objectives: The main purpose of the present study is to assess fire protection in the selected units of Imam Khomeini hospital located in Tehran in 2020.Methods: In this descriptive-analytic study, first, a researcher-made checklist was developed for the data collection by valid scientific resources (CVI=0.90 and CVR>0.62). After revising and the final confirmation of reliability, the checklist was separately completed by two members of risk management committee in 22 units of Imam Khomeini Hospital affiliated with Tehran University of Medical Science. Cronbach’s weighted Kappa statistical test was calculated. Results: The Domain of Ability and Capability of Fire Prevention was 66.1%, the Domain of Responsiveness was 65.1%, and the Domain of Urgent Evacuation Ability was 27.3%. In the Domain of Responsiveness, the highest scores were related to accessing fire extinguisher cylinder in the units (95.5%) and holding fire extinguishing practice courses and doing seasonal practices with that region’s fire station (90.9% for both). The highest scores in the Domain of Urgent Evacuation Ability were assigned to accessing adequate ambulances to evacuate patients (90.9%) and mapping the units and determining patient evacuation route when a fire breaks out (72.7%). Conclusion: It is necessary to make the essential protection measures come true for improving the hospitals’ fire protection by better access to the exits, increasing the number of the exits and standardizing the emergency exits, increasing the due fire extinguishing practices and hospital evacuation and educating the staff.
       
  • Assessment of Bed utilization indicators of Medicine ward of a tertiary
           level hospital: A cross-sectional study in Eastern India

    • Abstract: Background: Efficient hospital bed utilization is an important function of hospital administrators. Scarcity of beds, overcrowding, flooring is often the picture in tertiary hospitals. Objective: To find out hospital bed utilization indicators like average daily census, bed occupancy rate (BOR), average length of stay (ALS), bed turnover rate (BTR) and bed turnover interval (BTI) in Medicine ward of a tertiary hospital in West Bengal Methods: A descriptive cross-sectional study was conducted in acute male, acute female, chronic male and chronic female ward under Medicine Department of a tertiary hospital in West Bengal from June to August 2018.The record of active beds, patient days, daily admissions and discharge were reviewed for May 2018 by complete enumeration method from admission, discharge and death registers and recorded in a pre-designed pretested checklist. Average daily census, BOR, ALS, BTR and BTI were computed using standard formula. Pabon Lasso model was used to analyse the performance of Medicine ward Results: Average daily census, ALS, BOR, BTR, BTI in medicine ward were 261.81, 8 days, 108.55%, 4.22 and -0.63 respectively. Pabon Lasso graph reflected high BOR and high discharges per bed (productivity) in acute medicine wards reflecting good quantitative performance in contrast to chronic medicine wards with low discharges per bed (productivity or BTR) and higher ALS Conclusions: Medicine ward reflected higher BOR and ALS but lower BTR (productivity) as per the Pabon Lasso graph. Efforts must be taken to reduce ALS in chronic medicine wards.
       
  • Combination Therapy of ReciGen Interferon, Methylprednisolone, and Sovodak
           as a Candidate for Treatment of Patients with Severe COVID-19 in Iran: A
           Case Series

    • Abstract: Introduction: During the current worldwide pandemic of coronavirus disease 2019 (CPVID-19), this disease was first identified in Iran at the end of February. This study was conducted to examine patients with severe COVID-19 disease, who treated with three medications, namely ReciGen, methylprednisolone, and Sovodak.Case summary: We identified 10 patients (3 males and 7 females) with the mean (±SD) age of 55.70±21.48 years, who were admitted to the only referral hospital in Rafsanjan County (Iran) from March to July 2020 with confirmed infections with severe COVID-19. They were treated with the combination therapy of subcutaneous ReciGen interferon every other day, methylprednisolone at a dose of 250 mg every 6 hours for 5 days, and one tablet of Sovodac on a daily basis. conclusion: In the series of cases investigated in this study, general conditions of all patients improved in terms of their clinical parameters after receiving the combination therapy, and all patients were discharged with the blood oxygen level of ≥ 93% and in good general conditions.
       
  • Transfusion-related hemochromatosis involving pituitary gland in a patient
           of beta-thalassemia major

    • Abstract: Introduction: Hemochromatosis of the pituitary gland is a form of iron overload which occurs in different clinical conditions related to multiple blood transfusions. Case report: We present a case of secondary hemochromatosis involving the pituitary gland & choroid plexus in an 8 years old female with imaging findings and a review of the relevant literature. Our patient has had a history of cessation of growth in height for the last 01 year. She was diagnosed as a case of thalassemia major at the age of 06 months. She was on regular blood transfusions since then. Magnetic Resonance Imaging (MRI) revealed evidence of iron deposition in the pituitary gland. Conclusion: This diagnosis should be suspected on clinical presentation and history of multiple blood transfusions. It can be confirmed based on characteristic imaging findings. The patient should be strictly monitored with serum iron levels and a tailored iron chelation therapy should be started.
       
  • COVID-19 Screening in Rheumatologic Diseases Cases; Special Look at
           Chloroquine Derivate Use

    • Abstract: Background: Among suggested medications for the treatment of COVID-19, chloroquine derivates and angiotensin-converting–enzyme inhibitors (ACEIs)/angiotensin II type 1 receptor blockers (ARBs) are the two medications with conflicting effects on the development of the disease. Objectives: The present study aimed to evaluate COVID-19 in patients with rheumatic diseases receiving chloroquine derivate. Methods: Every patient with proven rheumatologic diseases registered in our medical center, Baqiyatallah Hospital, Tehran, Iran was enrolled in the present descriptive cross-sectional study between May and June 2020. At first, the symptoms of COVID-19 were assessed, and if a case had suspicious symptoms, reverse transcription-polymerase chain reaction (RT-PCR) COVID-19 tests were done. Demographic and clinical data are documented for every patient. Then, the patients were grouped once according to their COVID-19 infection status and another time according to their hydroxychloroquine use. Results: 1159 patients enrolled in the study with a mean age of 49.39 years. Frequency of hypertension was 22.17 %, diabetics (9.49%) and 20 (1.7%) patients were positive for COVID-19 testing. The most common symptoms of the COVID-19 positive cases were cough (5.2%) and fever (4%). There was no significant difference in receiving ACEIs/ARBs or other medications between COVID-19 positive or negative patients. Among the patients receiving hydroxychloroquine, 15 patients (1.7%) had proved COVID-19 versus 5 patients (1.7%) who were not receiving these medications (P>0.999). Conclusion: The present study demonstrated that receiving ARBs or ACEIs was not different among patients with or without COVID-19. Moreover, receiving chloroquine derivate was not related to the development of COVID-19 in patients with rheumatologic disorders.
       
  • Racial Variation in the Association between Perceived Discrimination and
           Frequency of Suicidal Thoughts and Behaviors among American Children

    • Abstract: Abstract: Perceived discrimination (PD) is a risk factor of suicidal thoughts and behaviors (STB) for children, youth, and adults. However, it is unknown whether the association between PD and STB frequency differs between African American (AA) and Non-Hispanic White children. Objectives: In this study, we compared AA and non-Latino White children for the association between PD and STB frequency in a national sample of 9-10-year-old American children. Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study, which included 7883 non-Latino White or AA children between the ages of 9 and 10. The predictor variable was frequency of PDs. Race was the moderator. The outcome variable was STB frequency, treated as a count variable, reflecting positive STB items endorsed over the life-course. Covariates included sex, age, marital status, household income, parental education, parental employment, trauma, and economic difficulties. Poisson regression was used for data analysis. Results: Of all the participants, 5994 were non-Latino Whites, and 1889 were AAs. Overall, PD frequency was positively associated with STB frequency. A statistically significant interaction was found between race and PD, suggesting that the association between PD and STB frequency is weaker in AA than non-Latino White children. Conclusion: The observed weaker association between PDs frequency and STB frequency in AA than non-Latino White children suggests that PD may be a less salient risk factor of STB frequency for AA than non-Latino White children. Researchers should explore factors other than PD for suicide prevention of AA children in the US.
       
  • The comparison between the early tracheostomy and orotracheal intubation
           in COVID-19 patients required mechanical ventilation

    • Abstract: Background: Supportive respiratory care and airway management are very important in the treatment of COVID-19 patients with respiratory failure. There are two techniques for supporting patients with respiratory failure.Objectives: The current study aims to evaluate the efficacy and quality of patients care with early tracheostomy in ICU and comparing mortality, hospital stay and outcome between intubation and early tracheostomy.Methods: This study is conducted on total patients with confirmed COVID-19 in the ICU centers of a tertiary hospital. At the beginning of the study, all patients intubated and connected to a mechanical ventilator. Within 3 days, the intensivists performed bedside percutaneous dilational tracheostomy (PDT) for half of the patients, randomly. The early tracheostomy was defined as conducting tracheostomy within at least 3 days from intubation.Results: The total number of 36 patients included in the study and categorized into two groups including 18 patients in the early tracheostomy and 18 patients in orotracheal intubation. In tracheostomy group half of the patients (50%) were recovered from covid-19 respiratory failure and discharged from ICU and hospital. All patients in the intubation group were expired. The length of stay alive in ICU in patients with early tracheostomy was 26.47±3.79 comparing with 7.58±2.36 days in intubated patients.Conclusion: The early tracheostomy compared with orotracheal intubation in respiratory failure patients with COVID-19 can significantly decrease mortality. However, airway management with an early tracheostomy increase the hospitalization stay and can increase the chance for recovery. So, conducting the early tracheostomy is recommended in this study.
       
  • Introducing a Bi-level Linear Programming Model to Simultaneously Reduce
           Patient Payment and Increase Hospital Income

    • Abstract: AbstractBackground: The cost of health care is a large part of every household's budget. On the other hand, the hospital, as an economic entity, is always faced with different aspects of cost and revenue. So, we are dealing with conflicting objectives.Objectives: The main purpose of the research is to help financial management in a specialty hospital. This article provides part of operational research, under the title of bi-level optimization for hospital managers to provide targeted financial planning. The method is based on the fact that in one level, the objective is to maximize the hospital income and in the other level, the objective is to reduce the patient's payment.Methods: The problem of hierarchical and decentralized optimization is written as a bi-level model that minimizes patient costs and maximizes hospital revenues, which is an NP-Hard problem. The optimal solution to this problem is obtained using a genetic algorithm. Then, the performance of the hospital after solving the model is evaluated by the Pabon Lasso diagram and it is shown that the use of this model has a significant effect on the performance of the hospital.Results: Implementation of this model in the studied hospital shows that patient payment costs decreased and hospital income increased (reaching equilibrium point). Conclusion: Hospital performance after model implementation was evaluated by Pabon Lasso diagram and showed that it has an effective role on hospital performance.
       
  • Increased incidence of blood and body fluid exposure and lack of
           transmission evidence during COVID-19 pandemic

    • Abstract: Background: COVID-19 pandemic has been associated with various risks including the exposure of infectious agents. Objective: The study aims at describing the incidence of blood and body fluid (BBF) exposure in a COVID-19 facility so as viral transmission potential through blood. Methods: A descriptive study of BBF exposure notified was carried out in a community hospital of Qatar. Results: In 2020 29 needlestick injuries were reported, which is an important increase in comparison with the year 2019 (6 incidents) and 2018 (5 incidents). No evidence of SARS CoV2 transmission was shown concerning the injury using symptoms monitoring and lab test. Conclusion: The increased risk of BBF exposure during the pandemic provides insight into the need to review the prevention practices of occupational exposure during the pandemics. Additional studies are required to define the risk of COVID-19 related to occupational exposure to BBF.
       
  • Symptomatology, Positivity, And Type Of Care Received By Healthcare
           Workers Tested For COVID-19 Infection In A North-Central State In Nigeria:
           A Retrospective Study

    • Abstract: Background: The health of healthcare workers (HCWs) is an indicator of the quality of health service provision during the COVID-19 pandemic.Objectives: This study aimed to describe the symptomatology and positivity of COVID-19 infection, and type of COVID-19 care received among (HCWs) in a North-Central State in Nigeria.Methods: This was a retrospective review of COVID-19 records of HCW retrieved from the Surveillance Outbreak Response Management System between April, 2020 and March, 2021 in Kwara State, Nigeria.Results: Among the 1,453 HCWs, 831 (57.2%) were above 35 years, 874 (60.2%) were females. Among the 259 HCWs who tested positive for COVID-19, 122 (23.8%) lived in urban areas (ᵡ2 = 13.94, p = <0.001). Also, 83 (30.7%) of symptomatic persons tested positive for COVID-19 (ᵡ2 = 37.766, p = <0.001). Overall, 33 (12.7%) of the 259 positive HCWs received hospital-based COVID-19 care), and 33 (16.1%) who had less than 2 symptoms received hospital-based COVID-19 care (ᵡ2 = 9.962, p = 0.002). HCWs who had cough had three times odds of testing positive of COVID-19 (OR = 3.299, 95% CI = 1.571 – 6.927, p = 0.002). Also, HCWs who manifested loss of taste had three times odds of testing positive for COVID-19 (OR = 3.392, 95%CI = 1.010 – 11.393, p = 0.048).Conclusion: COVID-19 testing should be encouraged among HCWs especially among those with symptoms such as cough and loss of taste.
       
  • Evaluation of Patients Presenting to the Emergency Department with Chronic
           Pain: An Observational Clinical Study

    • Abstract: Background: Overcrowding of emergency departments, which are not suitable places to treat chronic pain and are responsible for managing acute disorders, leads to prolonged waiting times, delays in treating conditions requiring rapid intervention, patient dissatisfaction, and chaos and exhaustion in the emergency department. Objectives: To examine the characteristics of patients who presented to the emergency department with nonmalignant chronic pain, to determine the frequency of use and factors that caused emergency department use. Methods: This cross-sectional study was conducted in an emergency department. Three hundred ninety-two patients with chronic pain were included. Results: The mean age of the patients was 48.1±15.3 years, 62.2% were female and 37.8% were male. Of the patients, 59.2% were married, 42.6% had elementary school education, and 56.1% were unemployed. The most common cause of emergency department admission was low back pain, 32.7% were using non-steroidal anti-inflammatory drugs, 16.3% were using opioid analgesics, 15.8% were using anticonvulsants, and 13.2% were using antidepressant drugs; 22% were not using any medication. The reasons for presenting to the emergency department for chronic pain were as follows: 13.3% for medication prescription, 74.5% to receive analgesics, and 12.2% for a diagnosis. The mean Patient Health Questionnaire-9 scale score of the participants was 12.82±3.98, which indicated moderate depressive symptoms. The mean Generalized Anxiety Disorder-7 scale score was 9.84±3.23, which indicated mild generalized anxiety disorder. Conclusion: Instead of trying to suppress pain, emphasis should be put on informing patients about the methods of coping with pain, increasing their quality of life, and integrating them into social life.
       
  • Impact of Transcranial Direct Current Stimulation on Patients with
           Parkinson’s disease: A Report of 2 Cases

    • Abstract: Introduction: The motor function is associated with the activity of both the motor and prefrontal cortices. The efficacy of transcranial direct current stimulation (tDCS) over specific brain cortices has been examined in many psychiatric and neurologic disorders. The aim of this study is report of the tDCS effects on two female of advanced age, with idiopathic Parkinson’s disease (PD).Case Presentation:  We considered 50-minute sessions of bilateral primary motor cortices as well as left DLPFC anodal stimulation using tDCS with passive stretching exercises simultaneously for a total of 20 sessions in 7 weeks. Clinical signs and Electroencephalography (EEG) waveform were assessed at distinct times. Both of the two patients showed improvement in motor function for a short time. EEG changes to some extents were in relation to clinical states.Conclusion: It seems that tDCS can be an auxiliary treatment for motor dysfunction in Parkinson's disease, however, further studies must be carried out in order to prove the claim.
       
 
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