Iranian Red Crescent Medical Journal
Volume:24 Issue: 9, Sep 2022

Reducing patient length of stay (LOS) in hospitals reduces the high cost of chemotherapy and increases patient satisfaction.

This study aimed to present a combined model based on value engineering and the house of quality (HOQ) to improve the chemotherapy processes of hospitalized adult patients and reduce LOS and costs.

In this study, a cost and time model of the functions was drawn for the current chemotherapy process, and as a result, the duration and costs of a chemotherapy course were obtained. A simulation model corresponding to the process map was developed and the output was validated. Afterward, using the HOQmethod in the pre-study stage and collecting value engineering information, the real needs and wants of patients were transformed into quality characteristics, and by implementing other value engineering steps,5 scenarios were presented to improve the process and were tested on the validated simulation model.

The presented scenarios included the process scenario (17.29% time reduction and $ 537,827 cost reduction), medication delivery scenario (7.3% time reduction and $ 268,231 cost reduction), technology scenario (2% time reduction and $ 59,640 cost reduction), end-of-life scenario (20% reduction in time and no cost savings), home care scenario (14% reduction in time and $ 329,020 cost reduction).

By implementing these scenarios and improving the process, the treatment protocol was changed and caused an increase in the value index of the patient's LOS and a decrease in the waiting list for chemotherapy in the above hospital.

Esophageal cancer is one of the most prevalent types of cancer and causes of death worldwide. As the mainstream treatment, surgical resection is technically demanding and time-consuming.Therefore, the scope of its application is limited in the clinical setting. A new surgical approach is thus needed for an improved surgical effect and the prognosis of esophageal cancer.

This study aimed to investigate the effect of a modified thoracoscopic en-bloc esophagectomy on the removal of patients’ esophageal cancers and itsoutcomes.

In this study, amodified en-bloc esophagectomy was developed to remove esophageal cancer. Patients who underwent the modified en-bloc esophagectomy by right thoracoscopic approach or thoracoscope-assisted small incisional approach to have their esophageal cancers removed in Peking University First Hospital (Beijing, China) between January 2014 and January 2017, were screened and retrospectively studied. Cancer recurrence, overall survival, mortality, as well as intraoperative and postoperative outcomes, were reported.

A total of 31 patients (22 male and 9 female, mean age: 62.9 years) were included in the study. Out of 30 patients with R0 resection, eight patients had cancer recurrences in the neck, lung, liver, and bone; however, none of the recurrences was identified in the mediastinum. Six patients died during the follow-up period. By the end of December 2020, the five-year survival rate of all patients was 58.3%. The median survival time of N0 patients was 52 months, which was significantly longer than that in N1+2 patients (23 months). Additionally, there was no statistically significant difference between the median survival timeof N1 and N2 patients. Moreover, perioperative complications included pneumonia, arrhythmia, hoarseness, and chylous ascites, which were consistent with those reported previously.

The modified en-bloc esophagectomy to remove esophageal cancerby right thoracoscopic approach or thoracoscope-assisted small incisional approach was found safe and reliable due to decreased cancer recurrence, increased overall survivalrate, and prolonged survival time.

Coronavirus will not be the first and the last pandemic in the world. Problem-solving and crisis management methods are determined by the ways in which people, statesmen, and experts treat various fields.

The present qualitative study was conducted pursuing the goal to illustrate COVID-19 epidemicmanagement learned lessons from the perspective of the managers of the educational and medical centers of Mazandaran University of Medical Sciences, Sari, Iran, in 2022.

This qualitative study was conducted based on a content analysis type in Mazandaran University of Medical Sciences and its subdivisions (hospitals and educational centers). The data were collected using semi-structured interviews, and interview coding was performed manually by the researcher. To increase the study accuracy, the methods proposed by Lincoln and Goba (1998) were used with such criteria as validity, reliability, verifiability, and transferability.

In total,15 managers (8 men and 7 women) in the age range of 32-70 years participated in this study and underwentdeep and semi-structured interviews. Initially, 1079 semantic units and 85 subcategories were extracted. After reducing, removing, and integrating being conducted atvarious stages of data analysis, 3 themes and 12 categories were extracted. The present study themes are made up of "Management Challenges", "Personnel Challenges", and "Social Challenges".

One of the factors for promoting quality in planning is benefiting from the prior learned experiences and lessons. Taking advantage of the consulting team, the intra-organizational and extra-organizational coordination, optimally benefitting from the human workforce, paving the ground for virtual training for health system staff, and elevating the quality of public information are critical in theeffective management of COVID-19.

Rumors concerning various aspects of the fight against COVID-19, vaccination, in particular, have become one of the main challenges for managers and policymakers who have to deal with different aspects of the disease. This necessitates the recognition of the factors that influence the prevention and spread of these rumors.

The current study aimed to investigate the link between health literacy among adults and their acceptance of COVID-19 vaccination rumors in Iran.

This cross-sectional study was conducted from November 15 to December 15, 2021, in different provinces of Iran.The study population included Iranian adults, aged 18 years and older, who were selected using the snowball sampling method. The data collection tools involved two questionnaires:the Health Literacy Questionnaire, which consists of 33 items, and the COVID-19 Vaccine Rumor Questionnaire which assesses 17 rumors related to COVID-19 vaccination collected from various news sources.

The number of completed questionnaires was 1158 out of 2163 questionnaire visits (74% response rate). Univariate analysis showed that health literacy had a statistically significant association with sociodemographic variables of gender, marital status, ethnicity, place of residence, and level of education. The results of data analysis also demonstrated a significant correlation between the average of rumors’ acceptance and thesociodemographic variables of gender, marital status, ethnicity, place of residence, and level of education. The results of the Pearson correlation coefficient test showed a significant and negative relationship between health literacy and rumor belief (P= 0.000, r=-0.590), indicating that those with a higher level of health literacy had a lower level of rumor acceptance.

Based on the findings of the present study, health literacy has a significant effect on reducing the credibility of rumors and other misinformation among community members. Macro-level decisions and policies are needed to improve factors such as health literacy and can help individuals identify and track rumors and make decisions based on reliable information on vaccination.

Previous studies have pointed to the major role of viruses in the pathogenesis of cancers, especially lymphoproliferative cancers.

The current study investigated the relationship between recent Human Herpesvirus Type 6 (HHV6) infection and childhood leukemia-lymphoma syndrome.

From January 2011 to December 2012, we entered every new case of acute lymphoblastic leukemia, non-Hodgkin lymphoma, acute myeloblastic leukemia, and Hodgkin lymphoma as the case group (n=48); moreover, 60 patients were randomly selected as controls from hospitalized children withoutinfectious agents and myocarditis in the department of pediatric cardiology in Shiraz, Iran. Immunophenotyping of bone marrow or lymph node biopsy was performed for the case group. The DNA was extracted from all collected samples using a DNA extraction kit (Invitek Company, Germany), and a Real-time quantitative polymerase chain reaction (qPCR)for the U38 gene of HHV-6 was performed for the detection of the HHV-6 genome for both groups.

In the case group, 48 patients with the age range of 0-18 years were assigned to four subgroups: 1-Acute Lymphoblastic Leukemia, 2-Acute Myeloblastic Leukemia, 3-Hodgkin Lymphoma, and 4-non-Hodgkin Lymphoma. In the case group, there were four positive HHV-6 PCR patients: One in Acute Lymphoblastic Leukemia, one in Non-Hodgkin Lymphoma, and two patients in the Hodgkin Lymphoma subgroup. None of the patients with T-cell leukemia-lymphoma had positive PCR. The frequency of HHV6 PCR positive was not significantly different between the case (8.3%) and control (1.6%)groups (P=0.169). No HHV-6 PCR positive was detected in T-cell leukemia/lymphoma patients.

As evidenced by the results of the present study, HHV-6 infection has nosignificant difference in children with T-Cell leukemia-lymphoma and healthy people.

Diffuse axonal injury(DAI)is the most prevalent nerve lesion in brain trauma. Given the known effects of erythropoietin and pentoxifylline on the reduction of cell death following hypoxia.

The current study assessed the possible effects of a combination of erythropoietin, pentoxifylline, and vitamin D on patients' consciousness level.

The present research is a double-blind clinical trial with parallel groups addressing64 DAI patients (average age: 26.5). The intervention group included 32 patients who, apart from the routine treatment, received a combination of erythropoietin, pentoxifylline, and vitamin D3. The control group also encompassed 32 patients who only received routine treatment. The effects of the interventions were assessed based on Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS) scores, and hospitalization duration.

Thefindings of the current research revealed that the GCS scores of the supplement (13.6±0.5) and control groups(12.4±1.6) weresignificantly different (P=0.043), being higher in the supplement group. The supplement group gained a higher GOS score compared to the controls (4.62±0.15 and 3.8±0.16, respectively, P=0.045). Moreover, a significant difference was observed in the hospitalization duration of the supplement (26.5±5.2) and control groups (21.4±3.2) (P=0.020). Nonetheless, the analysis of the extubation time and blood pressure of the two groups exhibited no substantial difference.

In this study, GCS and GOS improved after supplementation. The patients in the supplement group displayed a significantly shorter hospitalization duration. No significant difference was, however, detected when the tube was removed.

As one of the new regional nerve block techniques, the serratus anterior plane block (SAPB) has demonstrated high potential in thoracic surgery.

The present study aimed to analyze the effect of SAPB following thoracic surgery.

Chinese and English databases were retrieved to collect clinical randomized controlled studies (RCTs) on SAPB for postoperative analgesia in thoracic surgery. Both study and control groups were operated under general anesthesia, the SAPB was performed in the study group, and the rest of the postoperative analgesic regimen was the same as that of the control group. The following indicators were evaluated: (1) resting visual analogue scale (VAS) score (4, 12, and 24 h after the surgery), (2) active VAS score (4, 12, and 24 h after the surgery), (3) postoperative nausea and vomiting (PONV), (4) Postoperative Ramsay score (4-6 hours after operation), (5) Number of patient-controlled intravenous analgesia (PCIA) compressions, and (6) Postoperative sufentanil consumption. Stata software (version 15) was used for meta-analysis.

The resting and active VAS scores at 4, 12, and 24 h postoperatively were lower in the study group than in the control group (P< 0.05), and there was no significant difference between the two groups in Ramsay scores at 4-6 h postoperatively (P >0.05). The incidence of PONV was significantly lower in the study group than in the control group (P< 0.05), and the number of postoperative PCIA compressions and sufentanil consumption were significantly less in the study group than in the control group (P< 0.05).

As evidenced by the obtained results, the SAPB can enhance the postoperative analgesic effect in thoracic surgery, reduce the incidence of PONV, and decrease opioid consumption.

 Trauma is one of the most common surgical emergencies. Deep peritoneal lavage (DPL) is an invasive rapid test for detecting intra-abdominal hemorrhage or hollow viscus damage.

 However, there seems to be a defect in the interpretation of DPL in cirrhotic patients.

 The authors reported a 54-year-old male patient who was a known case of cryptogenic liver cirrhosis and was referred due to falling. On the seventh day of admission, due to the persistence of abdominal distention and food intolerance, the medical team decided to conduct DPL to investigate hollow viscera damage. Since the peritoneum fluid analysis expressed a positive finding, the team decided that the patient should undergo explorative laparotomy. Intraoperative findings included cirrhotic liver with ascites without any evidence of bile secretions and intestinal contents. Unfortunately, however, the patient died on the 15th day.

 The present case report is the first study on the false-positive DPL results in cirrhotic patients. It showed that positive DPL findings were untrustworthy in cirrhotic patients, and more powerful diagnostic tools are required for laparotomy decisions.