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Hospital Practices and Research
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  This is an Open Access Journal Open Access journal
ISSN (Print) 2476-390X - ISSN (Online) 2476-3918
Published by Baqiyatallah University of Medical Sciences Homepage  [4 journals]
  • 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: : 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: Background: 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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Heriot-Watt University
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