Leveraging discrete event simulation modeling to evaluate design and process improvements of an emergency department

This study exemplifies the practical application of the Discrete Event Simulation (DES) approach for evaluating the effectiveness of suggested processes and design modifications in improving the existing bottlenecks of an Emergency Department. EDs are under escalating pressure to deliver efficient care while handling considerable challenges, such as overcrowding, delays, length of stay, safety risks, or staffing. Many ED appointments are non-urgent and can be treated in an alternative outpatient setting. Suitable demand-capacity matching and adjusted admission protocols reduce ED patients' Length of Stay (LOS) and improve boarding times. Alternatively, new design suggestions include applying results-pending areas where lower acuity patients wait for their pending lab or imaging results. In this study, DES assesses underlying conditions and existing bottlenecks in an existing ED. The current ED flow involved a "pull-until-full" for exam room boarding and bedside registration after triage fulfillment. Nonetheless, the ED experienced boarding delays for patients waiting to be admitted into the hospital. This study explored two scenarios in DES as potential alternatives for reducing LOS: the implication of a "rapid-admit" protocol and a "results-pending" area. Findings showed that the Rapid-Admit process reduced the admitted patient's LOS by 16%. On average, the results-pending implication reduced the admit LOS by an average of 32% across all ESI levels. These findings suggest the importance of process, staffing, and spatial modifications to achieve ED operational improvements. DES enabled a data-driven approach to evaluate bottlenecks, enhance architect-owner communication, and optimize the system for future design and process improvement alternatives

QT Interval in Pregnant and Non-pregnant Women

Introduction: Prolongation of QT interval might result in dangerous cardiac arrhythmias, including Torsades de Pointes (TdP), consequently leading to syncope or death. A limited number of studies carried out in this respect to date have shown that QT interval might increase during pregnancy. On the other hand, it has been shown that each pregnancy might result in an increase in the risk of cardiac accidents in patients with long QT interval. Therefore, the present study was undertaken to compare QT intervals in pregnant and non-pregnant women. Methods: Pregnant women group consisted of 40 women in the second and third trimesters of pregnancy and the non-pregnant control group consisted of healthy women 18-35 years of age. All the patients underwent standard 12-lead electrocardiogram (ECG). The QT interval was measured for each patient at lead II. The mean corrected QT interval (QTc) and QT dispersions (QTd) were compared between the two groups. Results: Mean heart rates in the pregnant and non-pregnant groups were 98.55±14.09 and 72.53±13.17 beats/minutes (P<0.001). QTd and QTc means were in the normal range in both groups; however, these variables were 49.50±12.80 and 43.03±18.47 milliseconds in the pregnant group and 39.5±9.59 and 40.38±17.20 milliseconds in the control group, respectively (P<0.001). Conclusion: The QT interval was longer in pregnant women compared to non-pregnant women; however, it was in the normal range in both groups. Therefore, it is important to monitor and manage risk factors involved in prolongation of QT interval and prevent concurrence of these factors with pregnancy

Comparison of total antioxidant capacity of saliva in women with gestational diabetes mellitus and non-diabetic pregnant women

Pregnancy is considered a stressful event, results in higher levels of oxidative stress and considerable changes in physiological and metabolic functions such as gestational diabetes mellitus (GDM). Due to the cumulative effect of antioxidants and considering the controversies in this area, this study was undertaken to investigate the total antioxidant capacity (TAC) of saliva in pregnant women whit gestational diabetes in comparison to non-diabetic pregnant women. In this cross-sectional study (2015-16), a total of 31 women with a diagnosis of GDM and 59 non-diabetic pregnant women were included in the diabetic and control groups, respectively. Salivary samples were collected by spitting method. When all samples were collected, total antioxidant capacity (TAC) was measured with the use of a commercial kit following the manufacturer?s instructions. Data were analyzed with descriptive statistics and Mann-Whitney test using SPSS 18. Average TAC level in the saliva of women with gestational diabetes was 0.10 ± 0.14, with 0.04 ± 0.11 in non-diabetic pregnant women. Nonparametric Mann-Whitney test showed that this difference was statistically significant (P=0.024). Under the limitations of the present study it can be concluded that there is an increase in oxidative stresses during pregnancy, followed by an increase in the total levels of salivary antioxidants to counteract such stresses. Therefore, it is expected that determining the salivary antioxidant levels during pregnancy can be an alternative technique for the early diagnosis of diabetes

Associated factors with delayed door to balloon time in STEMI patients

Introduction: The time interval from hospital arrival to the balloon inflation of catheter in coronary arteries is defined as Door to Balloon Time (DBT). Door to balloon time is a marker of primary Percutaneous Coronary Intervention (PCI) timeliness. Door to balloon time duration, associated factors and it’s relation to outcomes are not similar in various centers. Herein we aimed to define these issues in our region. Methods: In this study, 188 patients with ST Elevation Myocardial infarction (STEMI) diagnosis eligible for primary PCI were included. Demographic, clinical and time intervals from arrival in hospital to catheterization data of patients were recorded. Patients were followed for six-month in terms of mortality and admission. Results: After excluding patients with missed data, 174 patients were entered in the study. Mean age of patients were 60.8±11.81 years and 78% of patients were male. Median DBT was 70 minutes (IQR 25-75: 55-97 minute). One hundred and twenty three patients (71%) had timely door to balloon time. Patients with delayed door to balloon time had lower age, lower prevalence of typical chest pain and higher prevalence of PCI on Left Circumflex Artery (LCX) than timely group but these differences were not significant. (p values were 0.068, 0.074 and 0.070 respectively). Delayed DBT was evident in three segments of door to ECG, ECG to code and code to cath times (p values were, < 0.0001, 0.009 and < 0.0001 respectively) but the cath to balloon time was not significantly different between two groups (p value: 0.159). Although in-hospital mortality was higher in delayed group than timely group but the difference was not meaningful. (11.7% vs 4.9%, p value: 0.103) Six-month mortality and admission rate were not different between two groups. Conclusion: Door to balloon time was acceptable in this study and was comparable to developed countries. Albeit there is room for improvement due to modifiable delayed parts

The Use of Intense Pulsed Light (IPL) for the Treatment of Vascular Lesions

 According to the English literature, various lasers and light sources (i,g. argon ion lasers, pulsed KTP lasers, diode lasers and Nd:YAG lasers, pulsed dye laser(PDL), intense pulsed light sources (IPLS) are applicable for the treatment of different vascular lesions. These conditions are the most important indication for laser therapy. This review summarizes the current literature on IPL with regard to the treatment of vascular lesion

Berberis vulgaris: Specifications and traditional uses

The medicinal plants from genus Berberis are particularly important in traditional medicine and the food basket of Iranians. Given various plants from genus Berberis and their economic, nutritional, and medicinal status in Iran, this study seeks to investigate the findings of recent studies on the phytochemical characteristics, specifications, and uses of Berberis vulgaris. In this review article, 350 articles were initially retrieved from reliable scientific databases using relevant search terms. Then, 230 articles were selected and 120 were excluded after a primary analysis. Finally, 98 articles related to the subject under study were meticulously examined and the required data were extracted and classified according to the research purposes. The findings were divided into eight separate sections: Introducing Berberidaceae family, different species of Berberis, pharmaceutical organs, B. vulgaris nutrition facts and minerals, the antioxidants and alkaloids compounds in fruit and other organs, action mechanisms of preventing and treating diseases, traditional uses of B. vulgaris, and its properties reported by recent studies. The results briefly indicate that B. vulgaris contains a large number of phytochemical materials including ascorbic acid, vitamin K, several triterpenoids, more than 10 phenolic compounds and more than 30 alkaloids. Therefore B. vulgaris may have anti-cancer, anti-inflammatory, antioxidant, antidiabetic, antibacterial, analgesic and anti-nociceptive and hepatoprotective effects. Regarding the use of different organs of B. vulgaris in traditional medicine and their confirmed effects in the recent studies, it is possible to use different organs of B. vulgaris, especially fruit, to develop new drug