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The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2+/-13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O3 levels amplifies this risk, while a transient increase in NO2 (p<0.001) and SO2 (p<0.001) levels has the same effect. Long-term changes in PM(10) (p<0.001) and PM(2.5) (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department.
Subject(s)
Humans , Male , Air Pollutants , Air Pollution , Cross-Sectional Studies , Emergency Service, Hospital , Patient Admission , Retrospective Studies , StrokeABSTRACT
The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2+/-13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O3 levels amplifies this risk, while a transient increase in NO2 (p<0.001) and SO2 (p<0.001) levels has the same effect. Long-term changes in PM(10) (p<0.001) and PM(2.5) (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department.
Subject(s)
Humans , Male , Air Pollutants , Air Pollution , Cross-Sectional Studies , Emergency Service, Hospital , Patient Admission , Retrospective Studies , StrokeABSTRACT
Ultrasonography is currently being used as one of the diagnostic modalities in various medical emergencies for screening of trauma patients. The diagnostic value of this modality in detection of traumatic chest injuries has been evaluated by several studies but its diagnostic accuracy in diagnosis of pulmonary contusion is a matter of discussion. Therefore, the present study aimed to determine the diagnostic accuracy of ultrasonography and radiography in detection of pulmonary contusion through a systematic review and meta-analysis. An extended systematic search was performed by two reviewers in databases of Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest. They extracted the data and assessed the quality of the studies. After summarization of data into true positive, false positive, true negative, and false negative meta-analysis was carried out via a mixed-effects binary regression model. Further subgroup analysis was performed due to a significant heterogeneity between the studies. 12 studies were included in this meta-analysis [1681 chest trauma patients, 76% male]. Pooled sensitivity of ultrasonography in detection of pulmonary contusion was 0.92 [95% CI: 0.81-0.96; I2= 95.81, p<0.001] and its pooled specificity was calculated to be 0.89 [95% CI: 0.85-0.93; I2 = 67.29, p<0.001] while these figures for chest radiography were 0.44 [95% CI: 0.32-0.58; I2= 87.52, p<0.001] and 0.98 [95% CI: 0.88-1.0; I2= 95.22, p<0.001], respectively. Subgroup analysis showed that the sources of heterogeneity between the studies were sampling method, operator, frequency of the transducer, and sample size. Ultrasonography was found to be a better screening tool in detection of pulmonary contusion. Moreover, an ultrasonography performed by a radiologist / intensivist with 1-5MHz probe has a higher diagnostic value in identifying pulmonary contusions
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In the previous two parts of educational manuscript series in Emergency, we explained some screening characteristics of diagnostic tests including accuracy, sensitivity, specificity, and positive and negative predicative values [1, 2]. In the 3rd part we aimed to explain positive and negative likelihood ratio [LR] as one of the most reliable performance measures of a diagnostic test [3]. To better understand this characteristic of a test, it is first necessary to fully understand the concept of sensitivity and specificity. So we strongly advise you to review the 1st part of this series again [1, 2]. In short, the likelihood ratios are about the percentage of people with and without a disease but having the same test result [4]. The prevalence of a disease can directly influence screening characteristics of a diagnostic test, especially its sensitivity and specificity. Trying to eliminate this effect, LR was developed. Pre-test probability of a disease multiplied by positive or negative LR can estimate post-test probability. Therefore, LR is the most important characteristic of a test to rule out or rule in a diagnosis. A positive likelihood ratio > 1 means higher probability of the disease to be present in a patient with a positive test. The further from 1, either higher or lower, the stronger the evidence to rule in or rule out the disease, respectively [5]. It is obvious that tests with LR close to one are less practical. On the other hand, LR further from one will have more value for application in medicine. Usually tests with LR < 0.1 or > 10 are considered suitable for implication in routine practice
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Nowadays, many researches in the field of medicine are conducting all around the world and medical journalism is a way to share the results. In fact, dissemination of the related manuscripts can pre-vent the repetitive research or may even lead to conducting a better survey. Therefore high quality medical journals are considered as up-to-date resources for further investigations [1, 2]. Medical journals are propagating their papers in various media including television pro-grams, newspapers, internet websites and different social media. So they can influence the government policy makers, health-care professionals and even public [3-5]. Moreover, most researchers hear about medical discoveries for the first time through medical journals and their related social media. So as well a high quality journal can help to improve medical science, a journal of poor quality can be damaging and distorting. Indeed, popular journals have the power of inventing a "communication storm" to draw attention to a certain topic. Thus they have to respect the accepted international principles to prevent spreading inaccurate and misleading data [6, 7]. This paper aims to review the previous and current situation of medical journalism by focus on field of emergency medicine
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In volume 3, number 2, pages 48-49, we explained some screening characteristics of a diagnostic test in an educational manuscript entitled "Simple definition and calculation of accuracy, sensitivity and specificity" [1]. The present article was aimed to review other screening performance characteristics including positive and negative predictive values [PPV and NPV]. PPV and NPV are true positive and true negative results of a diagnostic test, respectively [2]. In other words, if a subject receives a certain diagnosis by a test, predictive values describe how likely it is for the diagnosis to be correct
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Objective: To determine the correlation between blood gas parameters and central venous pressure [CVP] in patients suffering from septic shock
Methods: Forty adult patients with diagnosis of septic shock who were admitted to the emergency department [ED] of Shohadaye Tajrish Hospital affiliated with Shahid Beheshti University of Medical Sciences, and met inclusion and exclusion criteria were enrolled. For all patients, sampling was done for venous blood gas analysis, serum sodium and chlorine levels. At the time of sampling; blood pressure, pulse rate and CVP were recorded. Correlation between blood gas parameters and hemodynamic indices were
Results: A significant direct correlation between CVP with anion gap [AG] and inversely with base deficit [BD] and bicarbonate. CVP also showed a relative correlation with pH, whereas it was not correlated with BD/ AG ratio and serum chlorine level. There was no significant association between CVP and clinical parameters including shock index [SI] and mean arterial pressure [MAP]
Conclusion: It seems that some of non invasive blood gas parameters could be served as alternative to invasive measures such as CVP in treatment planning of patients referred to an ED with septic shock
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The painful nature of fractures has made it inevitable to use various anesthetic techniques to reduce or immobilize fractured parts. In the present study, axillary nerve block was compared with intravenous midazolam/fentanyl to induce anesthesia for Painless Reduction of Upper Extremity Fractures. The subjects in the present clinical trial consisted of 60 patients with upper extremity fractures. They were randomly divided into two equal groups of intravenous sedation [IVS] with midazolam/fentanyl and axillary nerve block [ANB]. Rate of anesthesia induction, recovery time, and pain intensities at baseline, during the procedure and at the end of the procedure were recorded in both groups. Data was analyzed and compared between the two groups with SPSS 18 statistical software using appropriate tests. Demographic data, vital signs and means of pain intensities at the beginning of the procedure were equal in the two groups. In the IVS group, the overall duration of the procedure was shorter with more rapid onset of anesthesia [P<0.05]. In contrast, the recovery time was much shorter in the ANB group [P<0.001]. No life or organ threatening complications were observed in the two groups. Axillary nerve block can be considered an appropriate substitute for intravenous sedation in painful procedures of the upper extremity
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The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments [ED] are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis [FMEA] method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided into one main system and six subsystems, based on FMEA. The study was divided into two phases. In the first phase, the problems leading to the loss of revenue in each subsystem were identified and weighted into four groups using risk priority number [RPN], and the solutions for fixing them were planned. Then, in the second phase, discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after intervention using the repeated measure ANOVA test. 100 financial records of ED patients were evaluat-ed during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1 +/- 3.65 thousand US dollars/month. 12 types of errors were detected in the predefined subsystems. ED reve-nue rose from 73.1 to 153.1, 207.06, 240, and 320 thousand US dollars/month after solving first, second, third, and fourth priority problems, respectively [337.75% increase in two years] [p<0.001]. 111.0% increase in the ED revenue after solving of first priority problems revealed that they were extremely indispensable in decreasing the revenue [p<0.0001]. The findings of the present study revealed that FMEA could be considered as an efficient model for increasing the revenue of emergency department. According to this model, not recording the services by the nursing unit, and lack of specific identifying code for the patients moving from ED to any other department, were the two first priority problems in decreasing our ED revenue
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Emergency department performance index [EPI] greatly influences the function of other hospital's units and patient satisfaction. Recently, the Iranian Ministry of Health has defined specific national EPI containing five indexes. In the present study the performance indexes of emergency department [ED] in one educational hospital has been assessed before and after establishment of emergency medicine. In the present cross-sectional study the ED of Shohadaye Tajrish Hospital, Tehran, Iran was assessed during one-year period from March 2012 to February 2013. The study was divided into two six-month periods of before and after establishment of emergency medicine. Five performance indexes including: the percentage of patients were disposed during 6-hour, left the ED in a 12-hour, had unsuccessful cardiopulmonary resuscitations [CPR], discharged against medical advice, and the mean time of triage were calculated using data of department of medical records on daily patients' files. Then, Mann-Whitney U test was used to make comparisons at P<0.05. The average triage time decreased from 6.04 minutes in the first six months to 1.5 minutes in the second six months [P=0.06]. The percentage of patients leaving the ED in a 12-hour decreased from 97.3% to 90.4% [P=0.004]. However, the percentage of disposed patients during 6-hour [P=0.2], unsuccessful CPR [P=0.34] and discharged against medical advice [P=0.42] did not differ between the two periods. It seems that establishment of emergency medicine could be able to improve ED performances indexes such as time to triage and leave in a 12-hour period
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Motor vehicle collisions [MVC] comprise a majority cause of referral to the emergency department [ED]. A large proportion of MVC appear to be preventable, if more effective measures against driving after substance abuse can be implemented. This study was aimed to investigate the prevalence of substance abuse among drivers of MVC, following road traffic accidents [RTA]. This case-control research was conducted from July to October 2007. One hundred MVC drivers admitted in the ED were included as the case group and 110 hospitalized patients, due to nontraumatic causes were used as controls. History of substances abused was obtained and urine samples were tested for opium in both groups. Finally the history and laboratory results of the groups were compared using SPSS 18. Of the 100 patients in the case group, 39 [39%] were positive for substance abuse [100% male] On the other hand, 49 [44.5%] patients in the control group had positive history or laboratory findings of substance abuse [73.9% male]. Opioids were the most common agent abused in both groups. There was no significant difference between two groups regarding the prevalence of substance abuse [P = 0.92]. The prevalence of substance abuse is high among victims of road traffic injury but in equal proportion to the control group. Health education and counseling is needed to reduce substance abuse in the general population although it was not significantly related to the cause of RTA
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Thrombocytosis is found to be associated with unfavorable prognosis in esophageal carcinoma. Platelets produce thymidine phosphorylase which is a platelet-derived endothelial cell growth factor with angiogenic activity. Increased platelet count may be translated into enhanced tumor growth. We examined the relation between platelet count and several prognostic variables in patients with esophageal cancer. Patients and Three hundred and eighty-one cases with esophageal cancer that underwent esophagectomy in a referral cancer institute during a 5-year period were studied retrospectively. The relation between preoperative platelet count and patient age, gender, site of tumor, presence of multiple cancers and clinicopathological characteristics including histological type, tumor size, depth of penetration [T], lymph node involvement [N], distant metastasis [M], degree of differentiation, presence of vascular, lymphatic and perineural invasion was examined. Squamous cell carcinoma [SCC] constituted 93% and adenocarcinoma 7% of cases. Most of patients were in stage III, followed by stage II. The mean platelet count was 245 +/- 76 [10[9]/L]. There was no statistically significant correlation between platelet counts with prognostic factors except a weak linear correlation between platelet count and and tumor size [P= 0.03, Pearson correlation coefficient: 0.16]. Patients with adenocarcinoma had a higher platelet count than those with SCC [P= 0.003]. Platelet count does not correlate with prognostic factors in esophageal cancer. However, it is significantly different between SCC and adenocarcinoma of esophagus
Subject(s)
Humans , Male , Female , Platelet Count , Thrombocytosis , Prognosis , Retrospective StudiesABSTRACT
Hemorrhoid is among the most common anorectal diseases and patients with high-grade disease conditions need surgical treatment. Many surgical procedures are available to treat the disease. The aim of this study was to compare the operative time and outcomes, [post-operative pain and complications] of Ligasure hemorrhoidectomy with those of the open conventional method. This randomized single-blind clinical trial included 57 patients [28 in Ligasure and 29 in the open group]. The primary variable was the operative time for the excision of a single hemorrhoidal packet. The other variables were post-operative pain measured by morphine doses administered to control pain, scores of visual analogue scale [VAS] used to measure pain severity, pain during home stay measured by doses of oral ibuprofen and the mean daily VAS scores, early complications including bleeding and urinary retention, longer-term complications and time to return to work. The demographic data were comparatively the same between the two groups. The average time to excise a single packet of hemorrhoid was significantly shorter in the Ligasure group [8.91 min vs. 17.35 min, P<0.001]. Post-operative pain measurements [morphine doses and VAS scores] were lower in the Ligasure group, but the differences were not statistically significant [P=0.055 and 0.077, respectively]. Complications of the two procedures were also comparable. Neither of the groups returned to work in a shorter time. Ligasure hemorrhoidectomy seems to be a safe method and it can reduce the operative time significantly. It may also have a modest effect on post-operative pain
Subject(s)
Humans , Prospective Studies , Pain, Postoperative , Postoperative Complications , Single-Blind Method , Morphine , Pain Measurement , IbuprofenABSTRACT
Fasciotomy may increase the morbidity and mortality in patients with crush-induced acute kidney injury [AKI], by creating an open wound, increasing the risk of bleeding, coagulopathy, and potentially fatal sepsis. This study evaluates the outcomes of fasciotomy in these patients after Bam earthquake in Iran. We reviewed medical records of victims of Bam earthquake complicated with crush-induced AKI. Demographic, biochemical, and clinical data of patients who underwent fasciotomy were evaluated and compared with other patients with AKI. Fasciotomy was performed for 70 of 200 patients with crush-induced AKI [35.0%]. There were no significant differences regarding sex, age, time under the rubble, and muscle enzymes level between these patients and those without fasciotomy. They did not experience higher rates of disseminated intravascular coagulopathy, sepsis, adult respiratory distress syndrome, amputation, and dialysis session. Neither did they have a longer hospitalization period or higher death rate. This study showed that fasciotomy did not have any deteriorating effect on morbidity and mortality of patients with crush-induced AKI after Bam earthquake