Epidemiological Pattern of Injuries in Iran; a Nationwide Review of Seven Million Emergency Department Admissions

Introduction: Globally, it is estimated that around 5.8 million people die annually as result of injuries, which causes 10% of all deaths and 16% of disability adjusted life years lost worldwide. This study aimed to determine the epidemiology of injuries in emergency departments in Iran.Method: This cross sectional study was carried out using national injury surveillance data registry from 21 March 2009 to 20 March 2014.Results: 7,176,344 patients with the mean age of 27.5 ± 17.8 years were registered to 657 EDs (70.6% male). Road Traffic Crash (RTC) was the most common cause of injury (31.0%) followed by hit (28.2%) and fall (10.1%). While roads were the commonest place of injuries, 34.0% of patients have been injured at home. More than 90% of injuries were unintentional. Assault and suicide attempt were causes of injury in 5.6% and 3.9% of patients, respectively.Conclusion:This paper addresses where prevention measures are most urgently needed and offers insights which could be useful for injury prevention programs in Iran and other developing countries

The Prognostic Value of Echocardiographic Findings in Prediction of In-Hospital Mortality of COVID-19 Patients

Introduction: The correlation between echocardiographic findings and the outcome of COVID-19 patients is still under debate. Objective: In the present study it has been endeavored to evaluate the cardiovascular condition of COVID-19 patients using echocardiography and to assess the association of these findings with in-hospital mortality. Methods: In this retrospective cohort study, hospitalized COVID-19 patients from February to July 2020 with at least one echocardiogram were included. Data were extracted from patients’ medical records and the association between echocardiographic findings and in-hospital mortality was assessed using a multivariate model. The findings were reported as relative risk (RR) and 95% confidence interval (95% CI). Results: Data from 102 COVID-19 hospitalized patients were encompassed in the present study (63.7±15.7 mean age; 60.8% male). Thirty patients (29.4%) died during hospitalization. Tricuspid regurgitation (89.2%), mitral valve regurgitation (89.2%), left ventricular (LV) diastolic dysfunction (67.6%), pulmonary valve insufficiency (PI) (45.1%) and LV systolic dysfunction (41.2%) were the most common findings on patients’ echocardiogram. The analyses of data showed that LV systolic (p=0.242) and diastolic (p=0.085) dysfunction was not associated with in-hospital mortality of COVID-19 patients, while the presence of PI (RR=1.85; 95% CI: 1.02 to 3.33; p=0.042) and patients’ age (RR=1.03; 95% CI: 1.01 to 1.08; p=0.009) were the two independent prognostic factors of in-hospital mortality. Conclusions: It seems that LV systolic and diastolic dysfunction was not associated with in-hospital mortality of COVID-19 patients. However, presence and PI and old age are possible prognostic factors of COVID-19 in-hospital mortality. Therefore, using echocardiography might be useful in management of COVID-19

Errors Related to Medication Reconciliation: A Prospective Study in Patients Admitted to the Post CCU

Abstract Medication errors are one of the important factors that increase fatal injuries to the patients and burden significant economic costs to the health care. An appropriate medical history could reduce errors related to omission of the previous drugs at the time of hospitalization. The aim of this study, as first one in Iran, was evaluating the discrepancies between medication histories obtained by pharmacists and physicians/nurses and first order of physician. From September 2012 until March 2013, patients admitted to the post CCU of a 550 bed university hospital, were recruited in the study. As a part of medication reconciliation on admission, the physicians/nurses obtained medication history from all admitted patients. For patients included in the study, medication history was obtained by both physician/nurse and a pharmacy student (after training by a faculty clinical pharmacist) during the first 24 h of admission. 250 patients met inclusion criteria. The mean age of patients was 61.19 ± 14.41 years. Comparing pharmacy student drug history with medication lists obtained by nurses/physicians revealed 3036 discrepancies. On average, 12.14 discrepancies, ranged from 0 to 68, were identified per patient. Only in 20 patients (8%) there was 100 % agreement among medication lists obtained by pharmacist and physician/nurse. Comparing the medications by list of drugs ordered by physician at first visit showed 12.1 discrepancies on average ranging 0 to 72. According to the results, omission errors in our setting are higher than other countries. Pharmacybased medication reconciliation could be recommended to decrease this type of error

The relationship between Intima-Media Thickness and Carotid Plaque Characteristics with Incidence and Severity of Premature Coronary Artery Disease

Background: Carotid intima media thickness (CIMT) and carotid plaque can predict premature coronary heart disease (PCAD) in patients hospitalized due to coronary artery disease or undergoing therapeutic interventions. This study aimed to determine the relationship between intima media thickness and carotid plaque characteristics with the incidence and severity of premature coronary artery disease. Materials and Methods: The current study was an analytical cross-sectional study conducted on patients referred to Imam Hossein Hospital in 2021-2022 who underwent coronary angiography. Patients were classified into two groups with coronary artery involvement and the group without evidence of significant coronary involvement. Then the data of patients, such as sex, age, risk factors of cardiovascular diseases, and clinical history of individuals, were collected through interviews and aspects related to carotid intima media thickness and plaque formation through a specialized review of reports. Results: A total of 59 women (%59) and 41 men (%41) participated in this study. The mean age was 51.50±9.54. The results of this study showed that there was a direct (positive) and significant correlation between carotid intima media thickness factors, including right and left carotid intima-media thickness, right and left carotid intima media thickness scores, and the number of carotid plaques with increasing severity of coronary artery involvement (P-values<0.05). There was a statistically significant correlation between carotid plaque number and severity of coronary artery disease (P-value<0.05). Conclusion: CIMT has a significant correlation with PCAD, and in patients at risk of PCAD, measurement of CIMT was a suitable method

A Successful implementation of an idea to a nationally approved plan: Analyzing Iran's National Health Roadmap using the Kingdon model of policymaking

Introduction: Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking. Methods: Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model. Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described. Results: The followings were done to accomplish the goals of each step: collecting experts' viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation). Conclusion: In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran's health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework

COVID-19 related hospitalization costs; assessment of influencing factors

Objective: Our aim is to assess the effective factors on hospitalization costs of COVID-19 patients.&nbsp;Methods: Data related to clinical characteristics and cost of hospitalized COVID-19 patients from February 2020&nbsp;until July 2020, in a public teaching hospital in Tehran, Iran was gathered in a retrospective cohort study. The&nbsp;corresponding factors influencing the diagnostic and therapeutic costs were evaluated, using a generalized linear&nbsp;model.&nbsp;Results: The median COVID-19 related diagnostic and therapeutic costs in a public teaching hospital in Iran,&nbsp;for one hospitalized COVID-19 patient was equal to 271.1 US dollars (USD). In patients who were discharged&nbsp;alive from the hospital, the costs increased with patients’ pregnancy (P&lt;0.001), loss of consciousness during&nbsp;hospitalization (P&lt;0.001), a history of drug abuse (P=0.006), history of chronic renal disease (P&lt;0.001), end&nbsp;stage renal disease (P=0.002), history of brain surgery (P=0.001), history of migraine (P=0.001), cardiomegaly&nbsp;(P=0.033) and occurrence of myocardial infarction during hospitalization (P&lt;0.001). In deceased patients, low&nbsp;age P&lt;0.001), history of congenital disease (P=0.024) and development of cardiac dysrhythmias during hospitalization&nbsp;(P=0.044) were related to increase in therapeutic costs.&nbsp;Conclusion: Median diagnostic and therapeutic costs in COVID-19 patients, hospitalized in a public teaching&nbsp;hospital in Iran were 271.1 USD. Hoteling and medications made upmost of the costs. History of cardiovascular&nbsp;disease and new onset episodes of such complications during hospitalization were the most important factors&nbsp;contributing to the increase of therapeutic costs. Moreover, pregnancy, loss of consciousness, and renal diseases&nbsp;are of other independent factors affecting hospitalization costs in COVID-19 patients

Long-Term Electrocardiogram and Echocardiography Findings of Patients with Severe COVID-19

Background: Coronavirus disease 2019 (COVID-19) was a pandemic that can involve the cardiopulmonary system. Long-term cardiac involvement evaluations were less studied in the literatures. In the present study, we aimed to investigate long-term electrocardiographic and echocardiographic findings of patients with severe COVID-19 after a year of follow-up. Materials and Methods: This retrospective cohort study was performed on patients admitted to one of the university hospitals in Tehran, Iran, from the beginning of February 2021 to February 2022. Echocardiography and electrocardiogram were done for all patients at admission and after one year of discharge. Patients' demographics, medical history, echocardiographic, and electrocardiographic information were recorded and analyzed. Results: Sixty patients were enrolled in the study. The mean age of patients was 53.63±12.50 years, and 58.33% were male. After assessing electrocardiography changes and echocardiography results, it was observed that QRS abnormality and inverted T-wave after one year were significantly more than during hospitalization (P<0.05). The pulmonary arterial pressure had increased after one year (24.30±4.79 mmHg to 26.50±7.69 mmHg, p-value=0.026). Conclusion: New cardiac problems in patients with severe COVID-19 disease may appear after one year, and these patients should be evaluated periodically

Electrocardiographic Findings and In-Hospital Mortality of COVID-19 Patients; a Retrospective Cohort Study

Background: Although current evidence points to the possible prognostic value of electrocardiographic (ECG) findings for in-hospital mortality of COVID-19 patients, most of these studies have been performed on a small sample size. In this study, our aim was to investigate the ECG changes as prognostic indicators of in-hospital mortality. Methods: In a retrospective cohort study, the findings of the first and the second ECGs of COVID-19 patients were extracted and changes in the ECGs were examined. Any abnormal finding in the second ECG that wasn’t present in the initial ECG at the time of admission was defined as an ECG change. ECGs were interpreted by a cardiologist and the prognostic value of abnormal ECG findings for in-hospital mortality of COVID-19 patients was evaluated using multivariate analysis and the report of the relative risk (RR). Results: Data of the ECGs recorded at the time of admission were extracted from the files of 893 patients; likewise, the second ECGs could be extracted from the records of 328 patients who had an initial ECG. The presence of sinus tachycardia (RR = 2.342; p <0.001), supraventricular arrhythmia (RR = 1.688; p = 0.001), ventricular arrhythmia (RR = 1.854; p = 0.011), interventricular conduction delays (RR = 1.608; p = 0.009), and abnormal R wave progression (RR = 1.766; p = 0.001) at the time of admission were independent prognostic factors for in-hospital mortality. In the second ECG, sinus tachycardia (RR = 2.222; p <0.001), supraventricular arrhythmia (RR = 1.632; p <0.001), abnormal R wave progression (RR = 2.151; p = 0.009), and abnormal T wave (RR = 1.590; p = 0.001) were also independent prognostic factors of in-hospital mortality. Moreover, by comparing the first and the second ECGs, it was found that the incidence of supraventricular arrhythmia (RR = 1.973; p = 0.005) and ST segment elevation/depression (RR = 2.296; p <0.001) during hospitalization (ECG novel changes) are two independent prognostic factors of in-hospital mortality in COVID-19 patients. Conclusion: Due to the fact that using electrocardiographic data is easy and accessible and it is easy to continuously monitor patients with this tool, ECGs can be useful in identifying high-risk COVID-19 patients for mortality

Pay for performance in hospital management: A case study

Background: This study aims at exploring the aspects of this newly applied payment mechanism compared with the previous ones. Methods: A mixed qualitative and quantitative study, including a descriptive analysis of P4P aspects compared with non-performance-based payment method and a quantitative comparative analysis of hospital departments’ revenue and employees’ payment, was conducted over a time period of 2013–2015. Results: The desire to provide high-quality services and association between staff reimbursement and some of the features, including performance, patient satisfaction, fulltime participation at work, equity in income distribution among staff in different occupational groups, were among the main characteristics of P4P. But in terms of nonperformance payment system, the quantitative analysis of data affirmed no significant correlation between the quantity of provided services, staff salary and department’s revenue. Conclusion: It is evident that pay for performance can persuade employees to improve the quantity and quality of rendered services with much more emphasis on achieving the health system goals and improving patient health outcomes