Neuro-critical Care Unit Bed Allocation Optimization based on Hybrid Approach: Designing of Experiments and Simulation

سابقه و هدف: واحد مراقبت‌های ویژه مغز و اعصاب به مراقبت از بیماران دچار شرایط بحرانی و تهدید کننده حیات در زمینه بیماری های مغز و اعصاب اختصاص دارد و از آنجایی‌که با محدودیت منابع جهت افزایش تخت های مراقبت های ویژه و همچنین افزایش زمان انتظار بیماران در این بخش رو به رو می باشیم نیازمند دستیابی به بهینه ترین ترکیب ممکن برای تخصیص تخت ها به هر نوع از بیماران و تعداد تخت در بخش مراقبت های ویژه می باشیم. لذا در این مطالعه برای استفاده بهینه از تخت ها و نیز به منظور کاهش متوسط زمان انتظار بیماران در بخش مراقبت‌های ویژه مغز و اعصاب مرکز پزشکی، آموزشی درمانی لقمان حکیم وابسته به دانشگاه علوم پزشکی شهید بهشتی به شبیه سازی بخش مورد نظر پرداخته تا ترکیب بهینه تخت های موجود در این بخش حاصل شود. روش بررسی: در این مطالعه ابتدا ترکیب تخصیص تخت های بخش مراقبت های ویژه مغز و اعصاب بیمارستان لقمان حکیم به هر دسته از بیماری ها مشخص شد و با استفاده از نرم افزار طراحی آزمایشات بهینه ترین ترکیب های ممکن بدست آمد. سپس ترکیب های بدست آمده شبیه سازی شده و دو معیار میانگین زمان انتظار در صف برای بیماران و میزان بهره وری (اشغال تخت) برای هر یک از ترکیب ها محاسبه شد. پس از آن مدل ریاضی شامل اهداف کمینه سازی متوسط ​​زمان انتظار بیماران در صف و همچنین میانگین بهره وری تخت ها با استفاده از روش پاسخ خطی ارائه شد. نتایج: بر اساس نتایج، تعداد بهینه انواع تخت های مورد استفاده در این بخش به ترتیب برابر با شش، دو، سه، سه و دو تخت برآورد شدند که منجر به متوسط زمان انتظار 1.4 ساعتی بیماران و نیز متوسط بهره وری 34.5 درصدی مجموع تخت ها شد. نتیجه‌گیری: نتایج مطالعه حاضر بیانگر این واقعیت است که بهینه سازی تخصیص تخت در بخش مراقبت‌های ویژه مغز و اعصاب با بکارگیری رویکرد ترکیبی شبیه سازی و طراحی آزمایشات ، باعث کاهش متوسط زمان انتظار بیماران و به تبع آن افزایش بهره وری (درصد اشتغال به کار) تخت ها می شود. How to cite this article: Goharani R, Shafagh-sorkh O, Nateghinia S, Hajiesmaeili M, Alibabaei A, Shafigh N. Neuro-critical Care Unit Bed Allocation Optimization based on Hybrid Approach: Designing of Experiments and Simulation. J Saf Promot Inj Prev. 2021; 9(1):9-17.Background & Objectives: Neurological Critical Care Unit is allocated for patients with critical conditions in the field of neurological diseases. ICU beds and their equipment are very expensive and there are some economic constraints for increasing the ICU beds. At the same time, the admission waiting time for patients in this unit is not favorable. Therefore, an initiative for better management of this ward was needed.  The objective of this study was to examine an optimal program for allocating beds to patients, based on their required length of stay in the unit. Methods and Materials: In this study, different categories of patients and their quantity was investigated in the Loghman Hakim hospital. Then, by using the design of experiments technique, optimal combinations were obtained. The obtained combinations were simulated for each of two criteria was calculated; patients' average waiting time and bed occupancy rate. Subsequently, a mathematical model with the objective function of minimizing the average waiting time for patients, as well as the average bed occupancy rate was presented using the linear response method. Results: According to the results of this study, an optimal combination of beds allocation to different categories of patients for the Neurological Critical Care Unit were respectively 6, 2, 3, 3, and 2 beds, and average waiting time was 1.4 hours and an average bed occupancy rate was 34.5%. Conclusion: The present study demonstrated that optimization of bed allocation in ICU by using a combined approach of simulation and design of experiments, resulted in a decrease in average waiting time and increase in bed occupancy rate (bed productivity). How to cite this article: Goharani R, Shafagh-sorkh O, Nateghinia S, Hajiesmaeili M, Alibabaei A, Shafigh N. Neuro-critical Care Unit Bed Allocation Optimization based on Hybrid Approach: Designing of Experiments and Simulation. J Saf Promot Inj Prev. 2021; 9(1):9-17. &nbsp

Comparison of Topical Sucralfate and Silver Sulfadiazine Cream in Second Degree Burns in Rats

Background. The most prevalent topical treatment for partial thickness burns is silver sulfadiazine 1% (SSD). Recent studies have shown that the healing of partial thickness burns is delayed with the use of SSD. One of the potential burn dressings is sucralfate. Objectives. With this study the authors have aimed to analyze comparatively the effects of sucralfate and SSD on second degree burn wounds in rats. Material and Methods. Forty-eight male rats were divided into three equal groups. A burn model was constituted on the back of all rats. The burned areas in the first, second and third groups were covered daily with sucralfate, SSD and cold cream (control), respectively. At the end of the 7th, 14th, 21st and 28th day, the rats were anesthetized and the burned skin tissue samples were collected for histopathological examination. Results. At the end of the study, the epidermis and horny layer was completely formed in the SSD and sucralfate group; however the appendix of skin was just formed in the sucralfate group. Also the percentage of wound healing was calculated at 76%, 91% and 100% respectively in the control, silver sulfadiazine and sucralfate groups. Conclusions. Sucralfate is known to have multiple beneficial effects on wound healing. Using topical sucralfate accelerates the burn wound healing process in comparison with both the control and SSD groups and can be used as an adjunctive or alternative agent in the future (Adv Clin Exp Med 2013, 22, 4, 481–487)

Molnupiravir in Combination with Remdesivir for Severe COVID-19 Patients Admitted to Hospital: a Case Series

Since the start of the COVID-19 pandemic, a large number of trials have examined the efficacy of various medications as potential treatments for COVID-19, but a promising therapeutic option is still missing and under investigation. Molnupiravir is an investigational oral antiviral medication and a nucleoside analogue that suppresses SARS-CoV-2 replication and has been found to be active against common virus variations (including the Delta variant). Several phase 2 and 3 clinical trials have shown high efficacy for direct antiviral activity of molnupiravir as well as its favorable safety and tolerability in mild to moderate Covid-19 patients. The current study was done on five hospitalized, severe COVID-19 patients. It seems that in combination with remdesivir, this novel antiviral could exert a synergistic effect on reducing the severity of symptoms as well as the duration of hospitalization. However, further clinical studies on the use of molnupiravir in the treatment of severe COVID-19 are warranted

تعيين عوامل منجر به عمل هاي مجدد در بخش(تروما) مراقبت هاي ويژه جراحي مغز و اعصاب بيمارستان لقمان به منظور بهبود کيفيت

Background and Objective:  neurosurgery reoperation that occurs for various reasons such as complications of primary surgery, planned reoperation, emergency or unplanned reoperation, and increase the financial burden of the hospital and the patient, poor prognosis, and increase the length of stay in hospital and intensive care unit for the patient. Neurosurgery patients are among the patients in whom reoperations need to be evaluated. Determining the factors leading to reoperations in the Neurosurgery Intensive Care Unit determines the causes and improves the quality of the system to prevent preventable reoperations. Materials and Methods: In this cross-sectional retrospective study, the information of patients undergoing reoperation including the type of disease and initial surgery, reasons for reoperation were identified. The frequency of each of the three variables was examined in pairs. All reoperations and returns to the operating room during 5 consecutive years were reviewed. Information of all patients including demographic information, underlying disease, smoking and alcohol, cause of primary and reoperation surgery, medical history, type of operation, complications of the surgery, postoperative care were examined. Results: In this study, it was found that age, sex, initial diagnosis, the distance between surgery and readmission, underlying disease, ICU admission, were not associated with the occurrence of neurosurgery reoperation. Variables associated with the occurrence of neurosurgery reoperation include open surgery, surgical disease including Cerebrovascular, duration of the first surgery, first emergency surgery, duration of further anesthesia in the first operation, bleeding rate and need for a packed cell, Need to receive FFP, some hospital complications Conclusion: Determining the factors that cause neurosurgery re-operation, prevent such surgeries if possible and reduce costs and hospital load, and also patients suffer fewer complications and mortality.   How to cite this article: Goharani R, Ghasemi AR, Hajiesmaeili MR, Banar S, Alibabaei A, Shojaei SP, Dosara MA, Shafigh N, Nateghinia S. Determining the Factors Leading to Reoperations in the (Trauma) Intensive Care Unit of Neurosurgery of Loghman Hakim Hospital to Improve the Quality. Irtiqa Imini Pishgiri Masdumiyat. 2021;9(2):133-43.سابقه و هدف: جراحی مجدد مغز و اعصاب به دلایل مختلفی از جمله عوارض جراحی اولیه ، جراحی مجدد برنامه ریزی شده ، جراحی مجدد اورژانسی یا برنامه ریزی نشده انجام می شود، سبب افزایش بار مالی بیمارستان و بیمار، پیش آگهی ضعیف و افزایش مدت اقامت در بیمارستان و بخش مراقبت های ویژه برای بیمار می شود. بیماران جراحی مغز و اعصاب از جمله بیمارانی هستند که جراحی مجدد در آنها نیازمند ارزیابی است. تعیین عوامل منجر به جراحی مجدد در بخش مراقبت های ویژه جراحی مغز و اعصاب دلایل  این جراحی های مجدد را تعیین می کند و کیفیت سیستم را برای جلوگیری از جراحی های مجدد قابل پیشگیری بهبود می بخشد. روش بررسي: در این مطالعه مقطعی گذشته نگر، اطلاعات بیماران تحت جراحی مجدد از جمله نوع بیماری، جراحی اولیه و دلایل عمل مجدد مشخص شد سپس فراوانی هر یک از سه متغیر به صورت جفت بررسی شد. کلیه جراحی های مجدد و بازگشت به اتاق عمل طی 5 سال متوالی و همچنین اطلاعات کلیه بیماران از جمله اطلاعات دموگرافیک ، بیماری زمینه ای ، سیگار و الکل ، علت جراحی اولیه و جراحی مجدد ، سابقه پزشکی ، نوع عمل ، عوارض جراحی ، مراقبت های بعد از عمل مورد بررسی قرار گرفت. یافته ها: در این مطالعه مشخص شد که سن ، جنس ، تشخیص اولیه ، فاصله بین جراحی و بستری مجدد ، بیماری زمینه ای ، بستری در ICU  با بروز جراحی مجدد مغز و اعصاب ارتباط ندارد. متغیرهای مرتبط با وقوع جراحی مجدد مغز و اعصاب شامل جراحی باز ، بیماری مغزواعصاب از جمله Cerebrovascular ، مدت زمان جراحی اول ، اولین جراحی اورژانسی ، مدت بیهوشی بیشتر در اولین عمل ، میزان خونریزی و نیاز به packed cell، نیاز به دریافت FFP ، برخی از عوارض بیمارستان بودند. نتیجه گیری: با تعیین عواملی که باعث جراحی مجدد جراحی مغز و اعصاب می شود ، در صورت امکان از چنین جراحی هایی جلوگیری می شود و هزینه ها و بار بیمارستان کاهش می یابد ، همچنین بیماران از عوارض و مرگ و میر کمتری رنج خواهند برد. How to cite this article: Goharani R, Ghasemi AR, Hajiesmaeili MR, Banar S, Alibabaei A, Shojaei SP, Dosara MA, Shafigh N, Nateghinia S. Determining the Factors Leading to Reoperations in the (Trauma) Intensive Care Unit of Neurosurgery of Loghman Hakim Hospital to Improve the Quality. Irtiqa Imini Pishgiri Masdumiyat. 2021;9(2):133-43