Hospital Practices and Research
Volume:4 Issue: 1, Winter 2019

In this review article, we aim to depict how healthcare facilities may look in the near future from an architectural design point of view. For this purpose, we review newly introduced technology and medical advances in the field of healthcare, such as artificial intelligence (AI), robotic surgery, 3D printing, and information technology (IT), and suggest how those advances may affect the architectural design of future healthcare facilities. In future hospitals, less space will be required; there will be no need for waiting areas. Most care will be given far from the hospital. Every human might have a computer chip attached to his body, with all his medical data ready and monitored by AI. In the future, all processes may be done by robots and AI, from reception to detection (radiology, scans, etc.). Nearly all surgery will be done by robots, so the architectural design of operation departments will need to be changed accordingly. AI is faster and better in disease detection than man; thus, there will be no need for laboratories or detection departments as we know them now. 3D printers are able to print almost everything from medical equipment to parts of the human body; thus, space will be needed for scanning and 3D printing in future hospitals. 3D printers might change the pharmaceutical industries, and drugs will be produced for any human individually.

In sub-Saharan Africa (SSA), the trend in the number of patients admitted for maintenance hemodialysis is on the rise. The identification of risk factors for chronic kidney disease (CKD) ensures adequate primary and secondary preventive measures geared at reducing the burden of CKD in low-resource settings. A family history of CKD is an established risk factor for CKD in high-income countries. However, data on family predisposition to CKD is scarce in the literature on SSA. The current study aimed to determine the prevalence and risk factors of CKD in family relatives of a Cameroonian population of hemodialysis patients (HDP) followed-up in a major hemodialysis referral center in Cameroon. The current cross-sectional study was conducted over four months on a consecutive sample of first-degree family relatives of end-stage renal disease patients undergoing maintenance hemodialysis at the hemodialysis unit of the General Hospital of Yaoundé. For each participating family relative, socio-demographic characteristics, clinical data, and biological data including fasting blood glucose, proteinuria, and serum creatinine were collected. A total of 82 first-degree family relatives of HDP were recruited. The prevalence of CKD among the participants was 15.8%. The main identified risk factors for CKD were age (P=0.0015), female gender (P=0.0357), hypertension (P=0.0004), regular intake of herbal remedies (P=0.0214), and diabetes mellitus (P=0.0019). Overall, the current findings suggest an urgent need for population education, routine screening of CKD, and the identification of risk factors in first-degree family relatives of HDP in Cameroon.

Complementary medicine claims that biofeedback affects the reduction of blood glycemia. The current study aimed to determine the effects of biofeedback on decreasing blood glucose levels and tension and increasing the quality of life in diabetic patients. The current retrospective evidence-based study used pretest-posttest accidental sampling to select a group of 30 diabetic patients admitted to Glenview Clinic in the Aghdasiyeh region, Tehran, Iran, as the sample. Participants were divided into two 15-membered groups, the experiment and the control groups, matched by age and gender. Data gathering tools included the Quality of Life questionnaire in diabetic patients by Thomas et al, the Perceived Tension Index by Cohen et al, a glucometer, and the fasting blood glucose test. Data was analyzed using analysis of covariance (ANCOVA). The results showed that biofeedback training was effective in decreasing blood glucose levels in diabetic patients. Biofeedback can reduce tension and improve the quality of life of diabetic patients; thus, it could be used as a complementary service in healthcare centers.

Cognitive errors have been presented as effective factors in the creation and continuation of obsessive–compulsive disorder and social anxiety disorder. Psychological resilience is an important factor in the tolerance of cognitive errors. The present study aimed to compare cognitive errors and the psychological resilience of patients with social anxiety disorder and those with obsessive–compulsive disorder. This cross-sectional study investigated a total of 60 patients, 30 with social anxiety disorder and 30 with obsessive-compulsive disorder (OCD), seen at a hospital in Zanjan city, Iran, in 2017. Participants were aged between 15 and 50 years. Participants were chosen using convenience sampling and on the basis of psychiatrist diagnosis and structured diagnostic interviews (SCID-I, II) according to the inclusion and exclusion criteria. The Cognitive Errors Questionnaire (CET) and the Connor-Davidson Resilience Scale (CD-RISC) were used to assess the variables. A significant difference was observed between the two patient groups in the cognitive errors components (P ≤ 0.05). In patients with OCD, the highest average rate of cognitive errors was related to catastrophizing and splitting error. In patients with SAD, the highest mean rate of cognitive errors was related to catastrophizing. There was no significant difference in psychological resilience between the two groups. Cognitive errors play an important role in OCD and social anxiety disorder (SAD). OCD patients were observed to make more cognitive errors than SAD patients. However, psychological resilience was equal between both groups.

Hospitals, the main providers of healthcare services, are costly centers which account for about 80% of the health sector budget and have a huge share of resources. This study aimed to analyze the economic performance of selected military hospitals in Tehran using hospital indicators and inpatient bed-day costs. This descriptive, cross-sectional, retrospective study conducted in hospitals affiliated with a military medical university. Data was collected with forms completed by referring to the hospitals’ finance and accounting, medical records, staffing, and logistics departments. The extracted data converted to hospital indicators using the appropriate formulas and analyzed using Excel and SPSS software with the T-test. The average bed occupancy rate (BOR) was 71%, the average length of stay (ALOS) was 2.5 days, the average bed turnover (BT) was 31 times, and the average bed turnover interval (BTI) was one day. The comparison of means of all the above-mentioned indicators other than BOR with the national standards was statistically significant (P < 0.05). Inpatient bed-day costs with and without capital costs were calculated to be 3 312 353 IRR and 12 253 775 IRR, respectively. Higher BOR and BT and lower ALOS and BTI indicators were appropriate compared with the national standards, but the cost performance was not appropriate. An unreasonable increase in inpatient bed-day cost revealed that there were unused beds and that hospitals had no monitoring systems for revenues and expenditures. Therefore, serious attention must be given to the scientific criteria and principles of health economics to improve resource productivity.

Hypothyroidism is a common disorder of the endocrine system in which the production of thyroid hormones is inadequate. In addition to various physical manifestations, patients who suffer from hypothyroidism may also present with psychological problems, as described in previous studies. Herein, the reports of 2 patients who suffered from hypothyroidism and experienced improvement in their psychological symptoms after levothyroxine therapy are presented. The patients referred with depressive mood with psychotic features and psychomotor retardation. Treatment simultaneously with psychopharmacotherapy and hormone therapy was considered. Although hypothyroidism and depressive disorders are separate issues, hypothyroidism can induce depression and psychosis, and psychopharmacotherapy plus hormone therapy can be effective and boost treatment.

Burkitt lymphoma is an aggressive subtype of Hodgkin lymphoma with a doubling time of 25 hours. It is characterized by a MYC gene coding alteration which results from a translocation of chromosome 8 on the MYC gene locus and immunoglobulin heavy-chain locus (IGH) on chromosome 14. Even though HIV infection is associated to an increased risk of Burkitt lymphoma, these type of malignancies are EBV-negative cases. Sporadic type Burkitt lymphoma is a rare clinical entity. A 48-year-old female without any past medical history presented with a chief complaint of mild abdominal pain of 6 months duration located at the epigastrium which was not related to food ingestion. Nausea or vomiting were neither reported. She noted an acute increased abdominal pain over the last 4 hours before presentation, with irradiation to the right lower quadrant. She denied any Fever, night sweats and weight loss. She also reported hypermenorrhea in the last 6 months. During the physical examination, a palpable mass with 10 cm in diameter was found on right lower quadrant. Sporadic Burkitt lymphoma is one of the rarest hematologic malignancies. The increased tumor size may be more than enough to show clinical or biochemical abnormalities such as serum lactate dehydrogenase (LDH) increased and tumor lysis.