[Improving emergency department processes using computer simulation]

Introduction: Hospital Emergency Departments [ED] face different problems affecting their performance. Deficiency of inpatient beds, inability to access suitable care, noisy and overcrowded places, etc. lead to prolonged waiting time, increased length of stay and low service quality. The main purpose of this study was to improve patient flow processes in emergency departments

Method: The population of this descriptive- applied study included unlimited number of patients who referred to the ED of the selected hospital. Colored Petri Net was used to model patient flow processes and CPN Tools software was employed to simulate and investigate different improvement scenarios. Input data for the simulation model were obtained through timing during data collection period. Patients' waiting time, length of stay, and resource utilization were defined as performance measures. Four improving scenarios [B, C, D, and E] were defined and their effects were investigated to improve processes

Results: According to simulation outputs, scenario B led to 45% decrease in waiting time for the specialists while the other scenarios had no positive [decreasing] impact on waiting time. Scenario E was the most effective one in decreasing the length of stay for patients at different ESI levels. Scenarios E and D had positive effect on resource utilization

Conclusions: Selection of the best scenario depends on the mission of ED, i.e. to save patients' life. Therefore, a scenario which is the most effective one in saving life must be chosen even if it is expensive. Although it is expensive, scenario E is preferred to scenario D due to its improved outcome. Scenario D is the second best scenario, compared to the other two scenarios, because it is less expensive

[Assessment of occupational exposure to aluminum respirable aerosols among aluminum foundry workers]

Aluminum and in particular its compounds make up a large proportion of the pollutants coming from the aluminum foundry. In several studies conducted on the harmful effects of aluminum in recent decades, it has been identified as a neurotoxic metal. Chronic occupational exposure through inhalation of dust is a common problem in aluminum foundries. Investigation of the exposure of various occupational groups in two aluminum foundry plants to aluminum aerosols. To study the occupational exposure of foundry workers to respirable aerosols of aluminum, personal sampling was conducted from the breathing zone of 63 workers at two foundries in the south of Tehran city following NIOSH method No. 0600. Then samples were treated using NIOSH Institute optimized method No. 7013 and analyzed by high sensitivity graphite atomic absorption.Collected data were analyzed with SPSS V.16 statistical software using an independent sample t-test and ANOVA. The average of aluminum respirable aerosols in A and B factories were 3.21 +/- 2.33 and 3.31 +/- 2.15 mg/m[3] respectively. The one-way ANOVA indicated that occupational exposure among various occupational groups [Similar Exposure Group] in Foundry A had no significant difference [p=0.089], but differences between the exposure of melting and assembling groups in Foundry B are significant [p=0.044]. In general, in exposure frequency to aerosols in aluminum foundries, a significant difference was observed between melting and assembling groups [p=0.005] as well among abrading and assembling groups [p=0.02]. Most of the exposures to aluminum in foundry workers exceeded the current limits given by ACGIH Institute and the Iranian occupational exposure limits. According to the occupational exposure of both foundries and the absence of differences among variables involved in the exposure, the high exposure of melting and abrading groups compared to assembling groups can be attributed to the nature of these units in the production of aluminum aerosols.

Early versus delayed internal urethrotomy for recurrent urethral stricture after urethroplasty in children

Our aim was to evaluate the results of early versus delayed internal urethrotomy for management of recurrent urethral strictures after posterior urethroplasty in children. Twenty boys with proven posterior urethral strictures were treated by perineal posterior urethroplasty. Of these, 12 required internal urethrotomy. Each radiograph demonstrated a patent but irregular urethra with a decrease in diameter at the point of repair [fair results]. Patients were then divided into 2 groups: 6 underwent early [within 6 weeks from urethroplasty], and 6 underwent delayed [after 12 weeks from urethroplasty], internal urethrotomy with the cold knife as a complementary treatment. The groups were comparable in terms of patient age, etiology of the primary urethral stricture, number of recurrences, length and site of the actual stricture, and preoperative maximum flow rate. Mean follow-up was 5 years. Kaplan-Meier analyses showed that the stricture-free rate was 66.6% after early, and 33.3% after delayed, internal urethrotomy [P=.03]. Early internal urethrotomy should be considered in boys with recurrent urethral stricture after urethroplasty

Erectile dysfunction: clinical guidelines [1]

According to a survey, the Massachusetts Male Aging Study, 52% of men beyond 40 years of age may have some degrees of erectile failure, and it is projected to affect 322 million men worldwide by 2025. We present a framework for the evaluation, treatment, and follow-up of the male patient who presents with erectile dysfunction. A comprehensive review of the literature was conducted using the MEDLINE database for all articles from 1975 through 2004 on male sexual dysfunction and the most pertinent articles are discussed. Remarkable progress has been made in the treatment of erectile dysfunction [ED]. Erectile dysfunction is a common condition associated with aging, chronic illnesses and various modifiable risk factors. Erectile dysfunction can be due to vasculogenic, neurogenic, hormonal, and/or psychogenic factors as well as alterations in the nitric oxide/cyclic guanosine monophosphate pathway or other regulatory mechanisms. The number of consultations from new patients presenting with erectile dysfunction and resulting costs for health care systems are increasing. Urologist should be the evaluating physician who supervises the surgical, medical, and hormonal treatment and who refers the patient, as necessary, to other members of the multidisciplinary team. Erectile dysfunction has a significant negative impact on quality of life. Male sexual dysfunction, especially erectile dysfunction, necessitates a comprehensive medical and psychologic evaluation involving both partners. All possible risk factors should be outlined and corrected, when feasible

Erectile dysfunction: clinical guidelines [2]

According to a survey, the Massachusetts Male Aging Study, 52% of men beyond 40 years of age may have some degrees of erectile failure, and it is projected to affect 322 million men worldwide by 2025. We present a framework for the evaluation, treatment, and follow-up of the male patient who presents with erectile dysfunction. A comprehensive review of the literature was conducted using the MEDLINE database for all articles from 1975 through 2004 on male sexual dysfunction and the most pertinent articles are discussed. Remarkable progress has been made in the treatment of erectile dysfunction [ED]. Erectile dysfunction is a common condition associated with aging, chronic illnesses and various modifiable risk factors. Erectile dysfunction can be due to vasculogenic, neurogenic, hormonal, and/or psychogenic factors as well as alterations in the nitric oxide/cyclic guanosine monophosphate pathway or other regulatory mechanisms. The number of consultations from new patients presenting with erectile dysfunction and resulting costs for health care systems are increasing. Urologist should be the evaluating physician who supervises the surgical, medical, and hormonal treatment and who refers the patient, as necessary, to other members of the multidisciplinary team. Erectile dysfunction has a significant negative impact on quality of life. Male sexual dysfunction, especially erectile dysfunction, necessitates a comprehensive medical and psychologic evaluation involving both partners. All possible risk factors should be outlined and corrected, when feasible