Effects of pre-injury anti-platelet agents on short-term outcome of patients with mild traumatic brain injury: a cohort study

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

[Assessment of emergency department with emergency medicine specialists regard to ministry of health standards in Tehran]

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

What are patients' concerns about medical errors in an emergency department?

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

Medical student and patient perspectives on bedside teaching

To evaluate the perspectives of medical students and patients on bedside teaching [BST]. A cross-sectional study was undertaken to elicit patients and learners opinions on BST in Hazrat Rasool Hospital, a university teaching hospital in Tehran, Iran. From June 2008 to September 2008, 100 fourth-year medical students and 100 adult patients admitted to the general medical service of a teaching hospital were chosen randomly. Patients who stayed for a minimum of 48 hours and had at least 2 case presentations in 2 consecutive mornings were included in the study. Patients under 18 years of age, non-Persian speakers, and cognitively impaired were excluded from the study. Their perspectives on BST were assessed with 2 separate questionnaires. The mean age of medical students was 25.2 +/- 2.2 [22-36] years and 35% were male. The mean age of patients was 46.3 +/- 18.7 [17-85] years and 50% were male. Most of medical students believed that BST is an effective way for learning principle of history taking, physical examination, practical skills, data registry, communicating skills, evidence based medicine, and interpretation of para-clinical findings. Fifty-three percent of them believed that the time of BST is not enough, while 40% thought BST is the most effective way of learning clinical skills. Sixty percent of patients were comfortable with BST and 80% of them preferred that case presentation be performed in front of them. Our study suggests that teaching in the presence of patients provides unique and valuable opportunities to integrate the knowledge and skills of medicine for the direct benefit of the patient

Assessment of physician's knowledge about disaster

Physicians have an important role addressing the disasters and most of the times they are the first to attend triage scene and emergency departments. Since Iran is one of the countries in which natural disasters are common self reliance and confidence in disaster management are of special importance. In this descriptive cross-sectional study 100 General physicians and 100 residents working in hospitals in some specialized fields related to Emergency conditions were enrolled randomly. They completed checklists about their disaster management knowledge and confidence building level. Data were analyzed via SPSS11. Knowledge of General physicians and residents was as follows, about disaster [29%], scene triage [21%] hospital disaster teams [12%] and tasks [11%] the enrolled physicians didn't show sufficinet abilities in addressing the disasters and their activities were limited to; study [27%], participation in seminars and congresses [4%], and confidence abilities [6%] in disaster conditions. The majority of them [88%] knew that basic and advanced disaster educational courses are necessary for physicians. Disaster training for physicians in under and postgraduate levels are not enough. Therefore considering the low knowledge and abilities of physicians in Iran it's seems that holding advanced disaster courses should be included in physicians training programs