Hospital Readmission Through the Emergency Department.

BACKGROUND: Hospital readmission places a high burden on both health care systems and patients. Most readmissions are thought to be related to the quality of the health care system. OBJECTIVES: The aim of this study was to examine the causes and rates of early readmission in emergency department in a Tehran hospital. PATIENTS AND METHODS: A cross-sectional investigation was performed to study readmission of inpatients at a large academic hospital in Tehran, Iran. Patients admitted to hospital from July 1, 2014 to December 30, 2014 via the emergency department were enrolled. Descriptive statistics were used to summarize the distribution demographics in the sample. Data was analyzed by chi2 test using SPSS 20 software. RESULTS: The main cause of readmission was complications related to surgical procedures (31.0%). Discharge from hospital based on patient request at the patient's own risk was a risk factor for emergency readmission in 8.5%, a very small number were readmitted after complete treatment (0.6%). The only direct complication of treatment was infection (17%). CONCLUSIONS: Postoperative complications increase the probability of patients returning to hospital. Physicians, nurses, etc., should focus on these specific patient populations to minimize the risk of postoperative complications. Future studies should assess the relative connections of various types of patient information (e.g., social and psychosocial factors) to readmission risk prediction by comparing the performance of models with and without this information in a specific population.

Atorvastatin therapy is not associated with slowing the progression of aortic stenosis: findings of a randomized controlled trial.

BACKGROUND: Aortic stenosis (AS) is the most common type of valvular cardiac disorders. AS has many risk factors in common with atherosclerosis. Hypercholesterolemia is an important pathomechanism for AS. However, the impact of statin drugs on slowing AS progression has not yet been well established. OBJECTIVE: To investigate the impact of statin therapy on slowing AS progression. METHODS: This was a randomized double-blind placebo-controlled trial in which 75 patients with mild to moderate AS were randomized to receive either simvastatin (20 mg/day) or placebo for a period of one year. Serum lipid profile, C-reactive protein (CRP), and echocardiographic parameters were evaluated at baseline as well as at the end of trial. RESULTS: Treatment with atorvastatin was associated with significant decreases in total cholesterol, triglycerides, and LDL-C and an elevation of HDL-C. None of the lipid profile parameters changed in the placebo group. Serum CRP was not significantly altered in any of the groups. Left ventricular end-systolic volume was significantly increased by the end of trial in the statin group (p = 0.012). In the placebo group, significant increases were observed for aortic valve mean (p = 0.017) and peak (p < 0.001) gradient. Other echocardiographic measures remained statistically unchanged in the statin and placebo groups. The number of patients whose disease progressed into severe stage was comparable between the groups and post-trial echocardiographic assessment did not reveal any significant change in the severity of AS between atorvastatin and placebo (p > 0.05). CONCLUSIONS: The findings of the present randomized trial did not support a beneficial effect of statin therapy (20 mg/day) against AS progression in Iranian patients with mild to moderate disease.

Impact of cardiac rehabilitation on metabolic syndrome in Iranian patients with coronary heart disease: the role of obesity.

BACKGROUND: Due to high prevalence of metabolic syndrome (MetS) and coronary heart disease (CHD) in Iran, and their mutual relationship, we evaluated how comprehensive cardiac rehabilitation (CR) can affect MetS in patients with CHD. METHOD: In this study (1998-2003), we evaluated 547 patients with CHD undergoing comprehensive CR. RESULTS: Cases with MetS decreased from 42.8% to 33.3% after CR program (p < .001). Decrease in high fasting plasma glucose, triglyceridemia, systolic and diastolic blood pressures, and increase in HDL cholesterol, functional capacity, and left ventricular ejection fraction was more prominent in the "MetS but not obese" group. However, total cholesterol, low-density lipoprotein, weight, body mass index, and waist circumference showed a greater decrease in groups with obesity. CONCLUSION: Cardiac rehabilitation is an effective treatment of MetS, particularly in the absence of obesity. This represents an additional argument for the prevention of obesity and the linked insulin resistance.

Coincidence of free-floating thrombus in the aortic arch, severe mitral stenosis, and left atrial appendage clot.

We describe the surgical management of a free-floating thrombus in the aortic arch in a patient with severe mitral stenosis, a left atrial appendage (LAA) clot, and an iliac artery thrombus. A 60-year-old woman complaining of dyspnea and pain in her right leg was referred to our multidisciplinary clinic. After a brief history was taken, an electrocardiography evaluation showed atrial fibrillation. Color Doppler sonography of the lower limb arteries showed decreased blood flow in distal branches of the internal iliac artery of the right leg. Transthoracic and transesophageal echocardiography evaluations revealed severe mitral stenosis, a large LAA clot, and a large mobile mass (2 × 1.5 × 1.5 cm) in the distal aortic arch. Additional investigations with computed tomographic angiography revealed that the thrombus extended from the aortic arch to the subclavian artery. Another bulky thrombus in the right iliac artery was also found. Given this complicated medical situation, emergency cardiac surgery was performed, and the clot was removed. The stenotic mitral valve was replaced with a prosthetic valve, The LAA was closed after clot removal, and the bulky thrombus was extracted from the right iliac artery. Transesophageal echocardiographic data were obtained postoperatively, and the patient's course in the intensive care unit was favorable. She was discharged from the hospital in good condition on warfarin, digoxin, aspirin, and metoprolol.

Knowledge, attitude, and practice of Iranian surgeons about blood-borne diseases.

BACKGROUND: Perhaps more than any other healthcare worker, it is the surgeons who are at an increased risk of exposure to hepatitis B (HB) virus, hepatitis C virus, and human immunodeficiency virus. The aim of this study was to evaluate surgeons' concerns regarding risk awareness and behavioral methods of protection against blood-borne pathogen transmission during surgery. MATERIALS AND METHODS: A 31-item questionnaire with a reliability coefficient of 0.73 was used. Of 575 surgeons invited to participate from three universities and one national annual surgical society between May and July 2007, 430 (75%) returned completed forms. RESULTS: Concern about being infected with blood-borne diseases was more than 70 (from a total score of 100). Only 12.9% of surgeons always used double gloves. Complete vaccination against HB was done in about 76% of surgeons and only 56.8% had checked their HB surface antibody (anti-HBs) level. Older surgeons never used double gloves (P = 0.001). CONCLUSION: Iranian surgeons are not aware of the correct percentage of infected patients with and seroconversion rate of blood-borne diseases, do not use double gloves adequately, do not report their needlestick injuries, vaccinate against HB, and check anti-HBs after vaccination. Educational meetings, pamphlets, and facilities must be provided to health care workers, informing them of hazards, prevention, and postexposure prophylaxis to needlestick injuries, vaccination efficacy, and wearing double gloves.

Gender differences in risk factors and outcomes after cardiac rehabilitation.

OBJECTIVE: We compared the baseline characteristics, cardiovascular risk factors and outcomes between men and women in an Iranian cardiac rehabilitation programme after adjusting for age, body mass index and waist-to-hip ratio. METHODS: In a self-controlled descriptive study performed between 1996 and 2006, we evaluated 547 patients with documented coronary heart disease before and after a 24-session cardiac rehabilitation programme. RESULTS: Women were older, more likely to be obese, anxious, depressed, and had more traditional coronary heart disease risk factors than men. At baseline, exercise capacity was lower (P < 0.001), but total cholesterol (P < 0.001), high-density lipoprotein cholesterol (P = 0.007), low-density lipoprotein cholesterol (P = 0.001), fasting blood sugar (P = 0.002), left ventricular ejection fraction (P < 0.001), systolic blood pressure (P < 0.001), diastolic blood pressure (P < 0.001), and heart rate (P = 0.016) were higher in women.Although there was significant improvement in most of the variables and risk factors after cardiac rehabilitation, changes were not statistically significant between men and women except for significantly more improvement in exercise capacity (P < 0.001) and less reduction in body mass index (P = 0.04) in men. CONCLUSION: Following a short-term cardiac rehabilitation programme, modification in cardiac risk factors and quality of life occurs. Both genders benefit alike in most aspects from this programme.