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1.
BEAT-Bulletin of Emergency and Trauma. 2017; 5 (2): 110-115
em Inglês | IMEMR | ID: emr-186857

RESUMO

Objective: To determine the effects of pre-injury consumption of anti-platelet agents on the 30-day outcomes of patients with mild traumatic brain injury [TBI]


Methods: This prospective cohort study was conducted at three general hospitals in Tehran, Iran between July 2013 and July 2014. The study population included all patients with mild TBI aged over 18 years that medicated with aspirin or clopidogrel before occurring trauma. Within hospitalization, all patients were assessed with respect to in-hospital conditions especially complications and adverse events. After discharge, the individuals were followed for 30 days by telephone to assess mortality and disability using the Glasgow outcome scale [GOS]


Results: Of 1140 patients with mild TBI, only 135 had previously received aspirin and/or clopidogrel. The mean age was dramatically higher in those who were taking aspirin or clopidogrel [p<0.001]. The patients with previously use of anti-platelets were more transferred by ambulance when compared to another group [p=0.006]. The patients on anti-platelets had significantly lower GCS on admission when compared to others [p<0.001]. Length of hospitalization was significantly longer in those receiving anti-platelets [p=0.003]. In follow-up, 30- day mortality and disability was revealed in 2.8% of patients that received only aspirin and 7.5% in aspirin with clopidogrel and in 1.6 % of those who did not receive drugs without any significant difference between aspirin and control group [p=0.208] and significant difference in aspirin with clopidogrel group [p<0.001]


Conclusion: The premedication by anti-platelets [aspirin and/or clopidogrel] in patients with mild TBI leads to prolonged hospital stay, and increase rate of disability. Age and on admission GCS are the independent risk factors for predicting the outcome in patients with mild TBI receiving anti-platelet agents

2.
Journal of Medical Council of Islamic Republic of Iran. 2012; 29 (4): 338-346
em Persa | IMEMR | ID: emr-128609

RESUMO

Emergency Departments [ED] are the heart of hospitals and they have unique and essential position in health care systems. In ED, the actions should be fast, high quality and effective. So we decided to evaluate the ED in which the Emergency Medicine attending and residents are working and compare the ED with Ministry of Health standards. in this descriptive cross-sectional study, 7 governmental hospitals in Tehran which had Emergency Medicine residents and specialists system assesed and compared with standards of Ministry of Health. The SPSS software was used for analysis. Frequency tables and bar chart were achieved by this software. Considering the 19 main factors, 91.85% of standards were protected. In one of the hospitals the whole standards were protected and the lower rate of protection was 75 per cent. Three parameters [clerk WC, medical documents and emergency drugs] were perfect in all of hospitals but isolation room and physical architecture gained lower rate. [71.4 and 80.71 per cent respectively]. With regard to Ministry of Health standards, it seems the conditions of EDs are favorable but these standards are not perfect and should be revised. Also application of Emergency Medicine specialty in ED might result in improvement of standards


Assuntos
Emergências , Medicina de Emergência , Estudos Transversais , Hospitais
3.
SQUMJ-Sultan Qaboos University Medical Journal. 2012; 12 (1): 86-92
em Inglês | IMEMR | ID: emr-124454

RESUMO

Concerns about medical errors have recently increased. An understanding of how patients conceptualise medical error would help health care providers to allay safety concerns and increase patient satisfaction. The aim of this study was to evaluate patients' worries about medical errors and their relationship with patient characteristics and satisfaction. This descriptive cross-sectional study was done in the Emergency Department [ED] of a university hospital over a one week period in October 2008. A questionnaire was used to assess patients' worries about medical errors and their satisfaction levels both at an initial interview and by telephone 7 days after discharge. Data were gathered and analysed by chi-square, t-tests and logistic regression. Of 638 patients interviewed, 61.6% declared their satisfaction rate as good to excellent; [93 [14.6%] as poor; 152 [23.8%] as fair; 296 [46.4%] as good; 97 [15.2%] as excellent]. A total of 48.3% of patients [44.5-52%, with confidence interval 95%] were concerned about the occurrence of at least one medical error. There was a clear relationship between the general satisfaction rate and having at least one concern about a medical error [Chi-square, P <0.001]. This study showed that many patients were concerned about medical errors during their emergency care. Due to the stressful situation in EDs, patients' safety and satisfaction could be improved by a better understanding of patient concerns, education of ED staff and an improvement in the patient-doctor relationship


Assuntos
Humanos , Masculino , Feminino , Serviço Hospitalar de Emergência , Pacientes , Estudos Transversais , Inquéritos e Questionários , Satisfação do Paciente
4.
Tanaffos. 2010; 9 (4): 28-33
em Inglês | IMEMR | ID: emr-118046

RESUMO

Magnesium deficiency is a common, yet under-diagnosed problem in the intensive Care Unit [ICU]. Our aim was to determine the prevalence of abnormalities in serum magnesium concentrations in critically ill patients upon admission to the ICU. The association of serum magnesium level with prognosis was also studied. This historical cohort study was conducted in the medical ICU of Hazrat-e-Rasool Hospital and 273 critically ill patients were enrolled in this study during a one-year period. Binary logistic regression analyses were performed to identify significant independent risk factors of mortality in the ICU. The mortality rate was 53.8% in the understudy subjects. One-hundred forty-seven subjects [53.8%] had normal serum magnesium levels, whereas, 126 subjects [46.2%] had abnormal values [hyper- or hypomagnesemia]. Patients with lower total serum magnesium level had longer length of mechanical ventilation and ICU stay. The mortality rate was higher in patients who had abnormal magnesium levels. Age, serum Mg and mechanical ventilation were three risk factors that independently predicted probability of mortality in the ICU patients. Monitoring of serum magnesium levels may have prognostic, and perhaps therapeutic, implications and physicians should be alert to the high incidence of magnesium deficiency in critically ill patients


Assuntos
Humanos , Masculino , Feminino , Magnésio/sangue , Unidades de Terapia Intensiva , Estado Terminal , Estudos de Coortes , Fatores de Risco , Prognóstico
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