Development of an easy-to-use tool for the assessment of emergency department physical design

Physical design of the emergency department [ED] has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study, we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed. Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a "Yes or No" question for ease of analysis, meaning that the criterion is either met or not

Familial adenoma to us polyposis: ileo-anal pouch versus ileo-rectal anastomosis

In this study we describe the presentation, treatment, and complications of 27 FAP patients. Treatment of Familial adenomatous polyposis [FAP] is centered on early recognition and curative surgery with either restorative proctocolectomy with ileal-pouch-anal-anastomosis [IPAA] or colectomy with ileo-rectal anastomosis [IRA]. All patients diagnosed with FAP at our center from 2008 to 2012 were included in this case series. Either IPAA or IRA was used for treatment. Complications were recorded for 12 months after the procedure. Overall 27 patients were included, 12 [44.44%] index patients, and 15 [55.55%] relatives diagnosed by screening. Eight Index patients presented with rectal bleeding, two with occult fecal blood and two with abdominal masses found to be desmoid tumors. Nineteen patients were treated by IPAA, 6 with IRA, and 2 were inoperable due to diffuse desmoid tumors. Daytime stool frequency was the most common side effect [70.37%], followed by bowel discomfort episodes [55.56%], requiring dietary restrictions [37.4%], passive incontinence [25.93%], soiling [22.22%], nighttime stool frequency [18.52%], flatus incontinence [16.0%], and anastomosis leakage [3.70%]. On average patients treated by IPAA experienced less complication than those treated by IRA. compared with previous reports, this series had older age of diagnosis, higher rate of adenocarcinoma at diagnosis, and fewer side effects after IPAA than IRA. The latter may reflect technique improvement with experience, and if supported by future studies, will cement IPAA as the treatment of choice in FAP