Performance Assessment of Hospitals Affiliated to Tehran University of Medical Sciences Using the Pabon Lasso Model: a five- year trend study

Background: The Pabon Lasso model is one of the efficiency assessment methods showing the rate of proper utilization of hospital’s available resources. This study was performed to assess the performance of hospitals affiliated to Tehran University of Medical Sciences during a five year period using the Pabon Lasso model. Methods: This retrospective descriptive research was conducted in 15 hospitals of Tehran University of Medical Sciences using the graphical model of Pabon Lasso during a five- year period (2009-2013). Hospitals’ general and performance indicators were collected and data analysis was done through SPSS19 software package. Results: From the beginning to the end of the five- year period, bed occupancy and bed turn-over indicators increased, but the length of hospital stay decreased. Furthermore, the studied hospitals were in the third region of the Pabon Lasso graphic model at the end of this period that shows their efficient performance. Conclusion: Favorable utilization of the available resources in studied hospitals during the five years of study can be attributed to the hospitals’ efficient management in improving hospitals’ efficiency. Therefore, in policy making programs for more efficient use of the available resources, continuous periodic assessments of all hospitals using the Pabon Lasso model or other models is recommended

Development of High Fidelity Digital Inline Holographic Particle Tracking Velocimetry for 3D Flow Measurements

University of Minnesota Ph.D. dissertation. 2016. Major: Mechanical Engineering. Advisor: Jiarong Hong. 1 computer file (PDF); 106 pages.Three-dimensional non-invasive measurement capability is often a necessity to unravel the physical phenomenon in fluid mechanic problems such as flow field characterization in wall-bounded turbulent flows and microfluidic devices. Among all the 3D optical flow diagnostic techniques, digital inline holographic particle tracking velocimetry (DIH-PTV) provides the highest spatial resolution with low cost, simple and compact optical setups. Despite these advantages, DIH-PIV suffers from major limitations including poor longitudinal resolution, human intervention (i.e. requirement for manually determined tuning parameters during tracer field reconstruction and extraction), limited tracer concentration, small sampling volume and expensive computations. These limitations have prevented this technique from being widely implemented for high resolution 3D flow measurements. In this study, we present our novel high-fidelity DIH-PTV algorithm with the goal of overcoming all the above mentioned limitations. Specifically, the proposed particle extraction method consists of multiple steps including 3D reconstruction, 3D deconvolution, automatic signal-to-noise ratio enhancement and thresholding, particle segmentation and centroid cacluation, and inverse iterative particle extraction. In addition, the processing package is enriched with a multi-pass 3D tracking method and a cross-correlation based longitudinal displacement refinement scheme. The entire method is implemented using GPU-based algorithm to increase the computational speed significantly. Validated with synthetic particle holograms, the proposed method can achieve particle extraction rate above 95% with ghost particles less than 3% and maximum position error below a particle diameter for holograms with particle concentration above 3000 particles/mm3 within sampling volumes of ~1 mm longitudinal length. Such improvements will substantially enhance the implementation of DIH-PTV for 3D flow measurements and enable the potential commercialization of this technique. The applicability of the technique is validated using the experiment of laminar flow in a microchannel and the synthetic tracer flow fields generated using a DNS turbulent channel flow database. In addition, the proposed method is applied to smooth- and rough-wall turbulent channel flows under two different settings of high-resolution near-wall and whole-channel measurements (i.e. sampling volume is extended to the entire depth of the channel). In the first case, using a microscopic objective and local seeding mechanism, DIH-PTV resolves near-wall flow structures within a sampling volume of 1 × 1.5 × 1 mm3 (streamwise × wall-normal × spanwise) with velocity resolution of ~100 μm (vector spacing). In the second case, the measurement volume is extended to the whole-channel depth by seeding the entire channel. Under this setting, the 3D velocity fields are obtained within a sampling volume of 14.7 × 50.0 × 14.4 mm3 with a velocity resolution of ~ <1.3 mm per vector, comparable to other the-state-of-the-art 3D whole-field flow measurement techniques. Overall, the presented DIH-PTV measurements under two different settings highlight the potential of DIH-PTV to obtain 3D characterization of the turbulent structures over a full range of scales, covering both the near wall and the out-layer regions of wall-bounded turbulent flows

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.&nbsp;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.&nbsp;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).&nbsp;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.&nbsp;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

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

The Role of Exercise in the Alleviation of Neuropathic Pain Following Traumatic Spinal Cord Injuries: A Systematic Review and Meta-analysis

OBJECTIVE: The objective of this systematic review and meta-analysis was to assess the efficacy of exercise in neuropathic pain following traumatic spinal cord injuries. METHODS: The search was conducted in MEDLINE, Embase, Scopus, and Web of Science by the end of 2022. Two independent researchers included the articles based on the inclusion and exclusion criteria. A standardized mean difference was calculated for each data and they were pooled to calculate an overall effect size. To assess the heterogeneity between studies, I2 and chi-square tests were utilized. In the case of heterogeneity, meta-regression was performed to identify the potential source. RESULTS: Fifteen preclinical studies were included. Meta-analysis demonstrated that exercise significantly improves mechanical allodynia (standardized mean difference [SMD], -1.59; 95% confidence interval [CI], -2.16 to -1.02; p \u3c 0.001; I2 = 90.37%), thermal hyperalgesia (SMD, 1.95; 95% CI, 0.96-2.94; p \u3c 0.001), and cold allodynia (SMD, -2.92; 95% CI, -4.4 to -1.43; p \u3c 0.001). The improvement in mechanical allodynia is significantly more in animals with a compression model of SCI (meta-regression coefficient, -1.33; 95% CI, -1.84 to -0.57; p \u3c 0.001) and in mild SCI (p \u3c 0.001). Additionally, the improvement was more prominent if the training was started 7 to 8 days postinjury (coefficient, -2.54; 95% CI, -3.85 to -1.23; p \u3c 0.001) and was continued every day (coefficient, -1.99; 95% CI, -3.07 to -0.9; p \u3c 0.001). Likewise, voluntary exercise demonstrated a significantly more effect size (coefficient, -1.45; 95% CI, -2.67 to -0.23; p = 0.02). CONCLUSION: Exercise is effective in the amelioration of neuropathic pain. This effect in mechanical allodynia is more prominent if voluntary, continuous training is initiated in the subacute phase of mild SCI