bijan khorasani

Insurance deductions are among the most important causes of hospital resource waste. Insurance deductions cause financial problems for hospitals and create tension between insurance organizations and hospitals. This study, done by the University of Social Welfare and Rehabilitation Sciences, investigates the reasons for deductions of inpatient bills covered by Social Security Insurance in Rofeideh Rehabilitation Hospital

The study was conducted cross-sectionally on 776 cases admitted to Rofeidah Rehabilitation Hospital in 2021. All invoices for inpatient services sent to Social Security Insurance were reviewed using the census method. To collect data, invoices sent to Social Security, inpatient records and checklists, and a 31-question questionnaire of Mohammadkhani et al. were used. The collected data were analyzed by descriptive (frequency and percentage) and analytical statistics (the Spearman correlation coefficient) in SPSS software, version 23.

According to the findings, the highest frequency of inpatient prescriptions was related to November 2021 (7.48%). The most frequent deductions of inpatients’ bills were related to medicine and consumables to the amount of 310815448 Rails and surgeon’s fees in 187728448 Rails. Also, the most common reasons were requesting a surcharge and wrong coding. In this study, there was a significant relationship between the documentation of nurses and doctors and the amount of deductions (P<0.0001).

Multiple causes affect the reduction of insurance deductions. By teaching insurance rules and the book on the relative value of health services to medical and nursing staff groups, electronic documents to Social Security Insurance and creating warning mechanisms in it, continuous interaction with Social Security Insurance to justify the managers of the organization regarding the way of providing services to rehabilitation patients and the reason for the prolonged hospitalization time of such patients could be the potential solutions for preventing patients records deductions and help hospitals achieve financial goals.

Low back pain (LBP) is a common problem with a significant impact on individuals and society, leading to activity limitation and chronic pain. Quadratus lumborum (QL) muscle tightness can trigger symptoms of significant LBP. Muscle energy technique (MET), a gentle manual therapy for restricted motion in the spine and limbs, aims to induce muscle relaxation, reduce pain, and improve range of motion (ROM). The aim of this study was to investigate the effects of MET on pain reduction and ROM improvement in chronic LBP subjects with lateral flexion restriction.

This study was a randomized single-blind clinical trial. One hundred and two participants diagnosed with chronic LBP and lateral flexion restriction were randomly divided into two groups: Control (n=51) and intervention (n=51). The control group received conventional physiotherapy, while the intervention group was provided with a combination of conventional physiotherapy and MET (post-isometric relaxation). Pain and ROM were measured using the visual analogue scale (VAS) and a goniometer, respectively. Both groups were evaluated before and immediately after the treatment.

The results revealed a significant reduction in pain and improvement in ROM in both groups after the treatment. No significant differences were found in the mean pain scores between the two groups (P=0.77). However, the mean scores of ROM in the intervention group showed a significant difference compared to the control group (P≤0.001).

MET combination with conventional physiotherapy significantly improves LBP and ROM of lateral flexion in chronic LBP subjects with lateral flexion restriction.

One of the basic challenges of health care centers is the inflation of the costs of services. Rehabilitation services play a significant role in restoring disabled people's functional ability. Having knowledge of the unit cost of rehabilitation services can be useful in optimal allocation of resources and budget. This study aims to calculate the unit cost of outpatient rehabilitation services provided by the Nezam-Mafi Rehabilitation Center (NMRC) in Tehran, Iran. 

This is a descriptive, retrospective study with a cross-sectional design. The time-driven activity-based costing (TDABC) method was used to determine the unit cost for 9 outpatient rehabilitation services related to speech therapy, occupational therapy, physiotherapy and audiology provided by the NMRC in 2019. In the first step, the sequence of each activity was mapped in one code (service). Then, the resources needed to perform each activity were identified and the source of cost for each activity was specified. In the next step, the cost driver for each specific sources and the amount of their use in each activity were determined. Due to the importance of personnel costs, this stage was done with more attention on the time required to provide each activity. In this regard, the cost of each minute of service compensation  was calculated by considering the annual attendance time of personnel and their salary expenses. Finally, the costs of each unit of the production factor and the total cost for each code (service) were determined.

In the NMRC, the costs of renting (47.9%), consumable materials and supplies (11.6%), and contracted services (10.5%) made up the highest percentage of costs. The costs of outpatient rehabilitation services (except for speech therapy) were higher than official tariffs for these services. The cost of specialized personnel for physiotherapy services and the cost of building in occupational therapy, speech therapy, and audiology services had the highest share in their unit costs. The total cost of staff personnel was estimated at 3.904 Rials per minute (RPM), which was higher than the specialized professional for pediatric occupational therapy (2046 RPM), occupational therapy (1929 RPM), speech therapy (1899 RPM), and audiology (1974 RPM). The high overhead costs of outpatient rehabilitation services (24.5% of the total cost( were one of the primary reasons for the gap between the average costs and tariffs. 

There is a considerable gap between the cost of some services in the NMRC and the related tariffs. Due to the low capacity of service provision in the NMRC, overhead costs have led to the inflation of the cost of services in this center. Therefore, the consolidation of small institutions and improving the referral system for people with disabilities from medical centers can reduce the unit cost of services. Considering that most rehabilitation services are not covered by the social security insurance and are not affordable for patients, a national-level reform should be prepared in the healthcare system. In addition, using the TDABC method in rehabilitation service centers can be a solution to identify the main sources of costs and control price inflation in the health sectors.

The primary purpose of this literature review is to investigate different views of elective surgery management during the COVID-19 pandemic. In other words, the guidelines about diseases prevention and their proper management during performing elective surgeries have been reviewed.

Current articles related to COVID-19 and practicing elective surgeries in different remarkable EndNote X8 database journals in 2020 were retrieved. All articles referring to COVID-19 precaution rules in implementing elective surgeries were integrated into the article’s main goals.

All reviews showed alarming guideline steps that should be taken for validated preventing and managing elective surgeries practiced during the COVID-19 pandemic. Emphasizing qualified elective surgery protocols were quoted in many articles to do elective surgeries with successful results.

Taking effective and evidence-based steps in patients` selection, precautions, and hospitals` safety cares result in protective surgical results. Elective surgeries should be practiced in highly-equipped hospitals with extraordinary quarantine measures during a COVID-19 pandemic. Safety measures are the primary goal for patients, staff, surgeons, and other health providers before surgeons get involved with any elective surgeries during the COVID-19 pandemic. Questions of how different elective surgical operations are planned during the COVID-19 pandemic are essential controversies. As no clear answers are found to questions of how elective surgeries can be practiced during a COVID-19 pandemic, specific rules issued by the world’s most authentic surgical associations have been adopted by surgeons to operate elective surgeries.

Vocal changes are one of the most common consequences of thyroid surgery. These changes can be due to neurological or other factors. With respect to vocal changes after surgery, and the need for determination of details of the vocal problems and related consequences in the patients’ life after thyroidectomy, the aim of this study was determination of some acoustic parameters of their voice after thyroidectomy and the status of subscales of Voice Handicap Index (VHI).

This study is a cross-sectional descriptive analytic and non-interventional. One voice of 32 thyroidectomized patients (23 women and 9 men) with 20-60 years of age analyzed acoustically and they completed VHI questionnaire.

Statistical comparison of mean scores of VHI in two groups of patients with and without vocal problem showed that mean score and standard deviation of total scores of VHI, and the scores of functional, emotional, and physical subscales in patients with voice problems are more than the other group, and the differences were significant (P=0.000). Comparison of acoustic parameters in the two groups of patients showed that F0, jitter, shimmer, and HNR were different, but the differences were not significant. According to our results, amplitude perturbations and harmonic to noise ratio was high in both groups of thyroidectomized patients.

According to the findings of this research, we can conclude that F0, jitter, shimmer, and HNR of voice may be not enough for determination of voice problems, but other acoustic measures, self-perceptual, or self-reported evaluation tools such as VHI maybe more efficient in determination of thyroidectomized patients’ voice problems.

The most common indication for abdominal surgery in elderly (65 & older) is gallstone disease.The elderly are more prone to complication of such surgery due to their other co-morbidity and thus they may benefit mostly from a safer method of surgical procedure. The purpose of this study was to evaluate the safety and outcome of laparoscopic cholecystectomy in elderly compare to the conventional method.Methods & Materials: Via prospective study from June 2005 to March 2008 included all patient older than 60 years of age who underwent cholecystectomy by open (Group A) and laparoscopic (Group B) method in Milad Hospital.The demographic data (sex age), American Society of Anesthesiologists’ (ASA) score, postoperative mortality morbidity, length of stay and operative time were recorded for each patient and were compared between two methods. Data of patient’s analysis by SPSS with chi-square and t test.

The study included 311 elderlies (34% men and 66% women). Hundred fifty-seven patients underwent open cholecystectomy; 154 patients underwent laparoscopic cholecystectomy. The mean age was 7141 years. The outcome in group B (laparoscopic) included: morality 0%, morbidity 2%, postoperative hospital stay 1 days, mean operation time was 40 minutes. In group A(open): mortality and morbidity rate were 21% and 12% respectively with postoperative hospital stay 331 days and similar operation time as group A.

Laparoscopic cholecystectomy is the gold standard treatment and safe procedure in elderly patient and aging is not considered to be a contraindication laparoscopic surgery in such patients.