An agent-based simulation combined with group decision-making technique for improving the performance of an emergency department

This study presents an agent-based simulation modeling in an emergency department. In a traditional approach, a supervisor (or a manager) allocates the resources (receptionist, nurses, doctors, etc.) to different sections based on personal experience or by using decision-support tools. In this study, each staff agent took part in the process of allocating resources based on their observation in their respective sections, which gave the system the advantage of utilizing all the available human resources during the workday by being allocated to a different section. In this simulation, unlike previous studies, all staff agents took part in the decision-making process to re-allocate the resources in the emergency department. The simulation modeled the behavior of patients, receptionists, triage nurses, emergency room nurses and doctors. Patients were able to decide whether to stay in the system or leave the department at any stage of treatment. In order to evaluate the performance of this approach, 6 different scenarios were introduced. In each scenario, various key performance indicators were investigated before and after applying the group decision-making. The outputs of each simulation were number of deaths, number of patients who leave the emergency department without being attended, length of stay, waiting time and total number of discharged patients from the emergency department. Applying the self-organizing approach in the simulation showed an average of 12.7 and 14.4% decrease in total waiting time and number of patients who left without being seen, respectively. The results showed an average increase of 11.5% in total number of discharged patients from emergency department.

[Relative frequency and type identification of non-polio enteroviruses isolated from acute flaccid paralysis cases in Iran, 1995-2000]

Iran National Polio Laboratory [NPL] is a member of the World Health Organization [WHO] Polio Laboratories Network. NPL receives stool specimens from acute flaccid paralysis [AFP] cases from all the provinces throughout Iran for poliovirus detection and identification. Furthermore, the NPL also detects non-polio enteroviruses [NPEVs] in these specimens. Recently, NPEVs have come to be believed to be one of the most important causes of AFP following wild poliovirus. This paper reports the prevalence of different types of NPEVs isolated from the specimens of AFP cases between 1995 and 2000. Stool collection, virus detection and serotype identification were performed according to the WHO standard procedures. A total of 2180 stool specimens from AFP cases were received at the National Polio Laboratory. Coxsackie B viruse and echoviruses 6, 11, 7 and 13 had the highest frequency, identified in 23.7%, 14.4%, 12.7%, 11% and 10.2% of the NPEVs isolated from AFP cases, respectively. Four cases of echovirus 20 were identified, in 2 cases the patiets having died and in one the patient having been afflicted with residual paralysis. There have been no reports of death or residual paralysis [paralysis continuing after 60 days] due to echoviruse 20. Considering the upward trend of AFP cases in Iran, even after wild poliovirus eradication, studies are needed to determine the frequency and type identification of NPEVs and the relationship between NPEVs and residual paralysis in the post-eradication era [2000 onwards].

Subjective lactose intolerance in apparently healthy adults in southern Iran: Is it related to irritable bowel syndrome?

BACKGROUND: The main symptoms of lactose intolerance are bloating, abdominal cramps, increased flatus and loose watery stools. These symptoms are similar to those of irritable bowel syndrome (IBS), which is a prevalent entity in the community. OBJECTIVE: As there was no data available on the prevalence of LI and the correlated factors, this study aimed to determine these correlations and their relation to IBS symptoms in an apparently healthy population in Shiraz, southern Iran. MATERIALS AND METHODS: A survey among 1,978 individuals older than 35 years was conducted in Shiraz, southern Iran, using a questionnaire that consisted of items regarding demographic data, life style, subjective gastrointestinal symptoms of LI and IBS symptoms according to ROME II criteria. RESULTS: A total of 562 subjects reported LI (28.41%). The prevalence was significantly higher in females, in subjects taking NSAIDs or acetaminophen and in cases reporting IBS symptoms. Subjects with LI avoided certain foods and drinks; and in order to relieve their symptoms, they used OTC drugs, herbal medicine or visited a physician. On the other hand, no relation was found between LI and age, smoking or the number of meals per day. CONCLUSIONS: Although we found that individuals with IBS had significantly more subjective LI than those without IBS, in the absence of documented lactose malabsorption, it is hard to tell whether the reported symptoms indeed are those of LI or simply those of IBS. So, a period of dairy product avoidance and/ or requesting a test for lactose malabsorption may be beneficial in this area.