Evaluation of the risk factors associated with emergency department boarding: A retrospective cross-sectional study / 中华创伤杂志(英文版)

PURPOSE@#Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center.@*METHODS@#All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test.@*RESULTS@#Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age.@*CONCLUSION@#The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.

Protective factors of marital stability in long-term marriage globally: a systematic review / 한국역학회지

OBJECTIVES: In recent decades, due to the high prevalence of divorce in numerous countries and the detrimental aftermath thereof, it has become increasingly important to study the components of marital stability. The current study explored fundamental protective factors in long-term marriage through a systematic review. METHODS: Searches for relevant publications were conducted in Embase, Web of Science, PubMed, Scopus, Science Direct, Magiran, and Scientific Information Database from their inception through January 30, 2019. Through the keyword search, 1,706 articles were found, of which 25 articles remained after screening based on the eligibility criteria. RESULTS: The extracted protective factors associated with marital stability in long-term marriage were classified as interpersonal and intrapersonal. Notable extracted factors included spirituality and religion, commitment, sexual relationship, communication, children, love and attachment, intimacy, and conflict resolution approach. These findings show that some aspects of relationships, such as commitment, act to preserve the pillars of marriage in critical situations, while other aspects, such as intimacy, help to construct marital identity and satisfaction. CONCLUSIONS: The identified components of marital stability are structures that enhance a couple’s identity and sense of togetherness. Identifying the specific aspects of marital relationships that contribute to marital stability may help specialists and researchers to target specific types of marital interaction that may enhance the happiness and longevity of relationships, thereby preventing avoidable divorces.

Protective factors of marital stability in long-term marriage globally: a systematic review / 한국역학회지

OBJECTIVES: In recent decades, due to the high prevalence of divorce in numerous countries and the detrimental aftermath thereof, it has become increasingly important to study the components of marital stability. The current study explored fundamental protective factors in long-term marriage through a systematic review.METHODS: Searches for relevant publications were conducted in Embase, Web of Science, PubMed, Scopus, Science Direct, Magiran, and Scientific Information Database from their inception through January 30, 2019. Through the keyword search, 1,706 articles were found, of which 25 articles remained after screening based on the eligibility criteria.RESULTS: The extracted protective factors associated with marital stability in long-term marriage were classified as interpersonal and intrapersonal. Notable extracted factors included spirituality and religion, commitment, sexual relationship, communication, children, love and attachment, intimacy, and conflict resolution approach. These findings show that some aspects of relationships, such as commitment, act to preserve the pillars of marriage in critical situations, while other aspects, such as intimacy, help to construct marital identity and satisfaction.CONCLUSIONS: The identified components of marital stability are structures that enhance a couple's identity and sense of togetherness. Identifying the specific aspects of marital relationships that contribute to marital stability may help specialists and researchers to target specific types of marital interaction that may enhance the happiness and longevity of relationships, thereby preventing avoidable divorces.

Protective factors of marital stability in long-term marriage globally: a systematic review / 한국역학회지

OBJECTIVES@#In recent decades, due to the high prevalence of divorce in numerous countries and the detrimental aftermath thereof, it has become increasingly important to study the components of marital stability. The current study explored fundamental protective factors in long-term marriage through a systematic review.@*METHODS@#Searches for relevant publications were conducted in Embase, Web of Science, PubMed, Scopus, Science Direct, Magiran, and Scientific Information Database from their inception through January 30, 2019. Through the keyword search, 1,706 articles were found, of which 25 articles remained after screening based on the eligibility criteria.@*RESULTS@#The extracted protective factors associated with marital stability in long-term marriage were classified as interpersonal and intrapersonal. Notable extracted factors included spirituality and religion, commitment, sexual relationship, communication, children, love and attachment, intimacy, and conflict resolution approach. These findings show that some aspects of relationships, such as commitment, act to preserve the pillars of marriage in critical situations, while other aspects, such as intimacy, help to construct marital identity and satisfaction.@*CONCLUSIONS@#The identified components of marital stability are structures that enhance a couple's identity and sense of togetherness. Identifying the specific aspects of marital relationships that contribute to marital stability may help specialists and researchers to target specific types of marital interaction that may enhance the happiness and longevity of relationships, thereby preventing avoidable divorces.

Effects of counter torque and transposition (transfer) of installed implants timing on their integration in dog tibia

PURPOSE: The purpose of this research was to evaluate the amount of reosseointegration after counter torquing (reverse torque) and transposing the installed implants at different times. MATERIALS AND METHODS: This study was done on ten tibiae of five cross-bred dogs. At the first day one implant was installed in each tibia. After one week half of the implants were randomly counter torqued (1WCT) and the other half were explanted and reimplanted in a new juxtaposition site (transposed)(1WT). At the same time three new implants were installed in each dog, one of them was considered as one week control (1WC) and remaining two as 8 week groups (8WCT&8WT). After eight weeks the 1WCT and 1WT implants were loosened by counter torque and the quantity of needed force for liberation was measured with the digital device (BGI). At the same time one implant was installed in each dog as eight week control (8WC) and the same protocol was repeated for 8 week groups after another 8 weeks. RESULTS: All implants were osseointegrated. Mean quantities of osseointegration in case groups indicated better amounts rather than control groups. CONCLUSION: Counter torque or transposition of the installed implants one week or eight weeks after the implantation did lead to osseointegration.

Reliability of the Path of the Sciatic Nerve, Congruence between Patients' History and Medical Imaging Evidence of Disc Herniation and Its Role in Surgical Decision Making

STUDY DESIGN: The prevalence of disc herniation is estimated to be about 100,000 new cases per year in France and disc herniation accounts for 25% to 30% of surgical activity in Departments of Neurosurgery. Classically, sciatica is expected to follow its specific dermatome-L5 or S1-. In clinical practice, we regularly encounter patients showing discrepancy between clinical sciatica and imaging findings. PURPOSE: The aim of this paper is to review the medical concept and management of sciatica pain in patients showing this discrepancy. OVERVIEW OF LITERATURE: To the best of our knowledge, this subject has not yet been discussed in the medical literature. METHODS: The medical records of 241 patients who were operated on for L5 or S1 sciatica caused by disc herniation were reviewed. RESULTS: We found an apparent clinicoradiological discrepancy between sciatica described by patients on one side and magnetic resonance imaging (MRI) finding on the other side in 27 (11.20%) patients. We did not find any other abnormalities in the preoperative and postoperative period. All of these patients underwent lumbar discectomy via posterior interlaminar approach. Three months after surgery, 25 patients (92.59%) had been totally relieved of sciatica pain. Two patients (7.41%) continued to experience sciatica in spite of the surgery. CONCLUSIONS: The discrepancy between clinical sciatica and disc herniation level on MRI is not rare. Management of this discrepancy requires further investigation in order to avoid missing the diagnosis and treatment failure.

Group reality therapy in addicts rehabilitation process to reduce depression, anxiety and stress

Substance abuse is one of the most outstanding socio-psychological hazards that can easily wreck one's personal, family and social life. Reality Therapy is a type of Cognitive rehabilitation [known as psychosocial rehabilitation method], and the application of this method in the treatment of different disorders has recently been the topic of research. The objective of this study was to examine the effectiveness of group reality therapy on the reduction of stress, anxiety and depression in addicts. A quasi-experimental study of pretest-posttest design, with a control group was conducted. The study population consisted of all addicts attending Tehran's 'Neda' Rehab Clinic. First, the DASS-21 questionnaire was administered and then 40 people were selected from those who had scored average and higher. They were randomly assigned to two test and control groups of 20 each. Analysis of co-variance was used to analyze the data, with which pretest scores were controlled, and the effect of the independent variable on posttest scores was evaluated. Following the intervention, there were significant decreases in the mean scores of all three variables, i.e. stress, anxiety and depression in the test group. Psychosocial rehabilitation based on reality therapy can be considered as an effective method for reducing stress, anxiety and depression in addicts and also as an adjunctive therapy in treating other ailments

Mental health status of medical students: a cross sectional study

Background: Mental health of medical students who will be responsible for community health has great importance. This study was designed to determine the prevalence of probable mental disorders during the internship period of medical students

Methods: This descriptive cross sectional study evaluated 404 medical students of Shahid Beheshti University of Medical Sciences, in Tehran, the capital of Iran. The data collecting instrument was a self-rated questionnaire including standard mental health questionnaire SCL-90-R, demographic and socio-economic data. The score 0.7 and above were designated as possible cases of mental disorders. Analysis performed by SPSS software, version 14 [SPSS Inc, Chicago, Il, USA]. p-value<0.05 was considered significant

Results: 53.8% of participants were female, and 79.4% were single. From all participants, 14.1% had Global Severity Index [GSI] score more than 0.7. Mean and standard deviation of GSI score was 0.32 [0.27]. The frequency of probable mental disorder in medical students was 16.3% in somatization; 24.5% in obsessive-compulsive; 15.6% in interpersonal sensitivity; 16.8% in depression; 18.8% in anxiety; 14.6% in hostility; 11.4% in phobic anxiety; 16.8% in paranoid ideation and 13.9% in psychoticism. Students who had no children, lived in dormitory, had good economic status and were satisfied with their private life and studying course had significantly lower GSI scores

Conclusion: Between 11 to 24% of the students had mental disorders in different dimensions and economic status, living place and number of children were related to the disorders

Comparison of manual tools, ultrasonic and erbium-doped yttrium aluminum garnet [er:yag] laser on the debridement effect of the surface of the root of teeth suffering from periodontitis

Periodontal diseases are considered as some of the most common reasons of teeth loss, which occur due to the aggregation of microbial plaque and other precipitations on the dental surfaces. In this study, the scaling effect using manual tools, ultrasonic machine and Erbium-Doped Yttrium Aluminum Garnet [Er:YAG]laser on the connection of the human gums connective tissue cells on the root surface of the teeth suffering from severe periodontitis will be compared. After removal of the big precipitations with manual tools, Er:YAG laser light emission of Photona machine is used with respect to the following characteristics: wavelength: 2940 micro m, each pulse: 100mJ, frequency: 10 pulse/sec, optic fiber with cross section 0.5x1.65mm, fiber tip angle with root surface: 15-20 degrees with non-contact mode, 1.5mm farther than the root surface and pulse duration 230 very short. The gingival fibroblast cellular was incubated as a sample of the human gums connective tissue cells under 37C. These cells were departed from the culture medium after the cellular reproduction in the third passage. On the 3[rd] day after incubation, the gingival fibroblast cells morphology was studied by Scanning Electron Microscopy [SEM]. The results of SEM images in the present study indicated the spread fibroblast cells with philopodia were found in all of 5 groups; untreated healthy group [control], untreated group suffering from periodontitis, the scaling effect using manual tools [Scaled Gracey], ultrasonic machine and Er:YAG laser. There is a meaningful difference among the three treatment groups [P<0.001] in the numbers of the fibroblast cells, while all the four treated groups had a meaningful difference with the positive control group [P < 0.001]. The present study indicated that although various dental surfaces cleaning methods may be different in other aspects, but are similar concerning the fibroblasts morphology. Also in addition to power, laser emission time may also be effective in the cells morphology results.

Identification of sarcocystis species of slaughtered sheep in Gazvin Ziaran slaughterhouse using PCR-RFLP

Sarcocystosis is caused by species of Sarcocystis, an intracellular protozoan parasite in the phylum Apicomplexa. The intermediate hosts are the herbivores eating infected food or water containing sporocysts excreted by the carnivorous final host, and that results in tissue cysts in corpses. The present study was carried out to identify Sarcosystis species of sheep using PCR-RFLP. In the present study 60 specimens from the diaphragm, heart and esophagus muscles of sheep slaughtered in Qazvin Ziaran slaughterhouse were collected. 40 specimens contained macroscopic Sarcocystis cysts and the next 20 contained microscopic Sarcocystis cysts. They were examined by Dob Smear and digestion method. DNA extraction was carried out by a kit. PCR conditions were optimized for 18S rRNA amplification. Meanwhile, a comparative study was done to investigate the specific primers of the Toxoplasma and Neospora along with the Sarcocystis cases. According to the position of restriction sites, restricted enzymes were selected. Results indicated that the primers were completely unique and specific for detecting Sarcocystis. PCR-RFLP analysis showed that macroscopic cysts and microscopic cysts belonged to Sarcocystis gigantea and Sarcocystis arieticanis, respectively. Sarcocystis species of sheep can be recognized through PCR-RFLP technique using the designed specific primers. By this technique applying TaqI enzyme from microscopic cysts as well as TaqI and HincII enzymes for macroscopic cysts were found more efficient than the others

Suicide attempts as the cause of post intubation airway stenosis [PIAS]

The incidence of suicide attempt has been increasing in recent years. Presenting a group of patients who attempted suicide, underwent ventilatory support and developed postintubation airway stenosis [PIAS] may help us in prevention and better understanding of this complication. Among patients who referred to our center for treatment of PIAS, those who had been intubated for suicide attempt were investigated in a prospective study. Information was entered in a questionnaire and regular follow ups were done in a 15-month period [April 2003 to July 2004]. Among 100 patients with PIAS, 19 enrolled in this study including10 females and 9 males [mean [ +/- SD] age, 25.3 [ +/- 9.96] yrs; ranging from 17 to 56 yrs]. Type of disease and reasons of suicide were categorized by a psychologist as follows: Eleven patients with psychosocial stress along with an immature personality back-ground, 7cases of psychological disorders and one with an unknown cause. Direct causes of committing suicide included family problems in 10 cases, lovesick in 2, addiction in 3, depression in 6 and social problems in 2 cases [some patients mentioned two reasons and one refused to mention the reason]. Mean time of intubation was 14.78 days [3-30 days], and the mean length of stenosis was 35.12 mm [20-50 mm], 8 patients underwent tracheostomy. Three patients were treated with bronchoscopic dilation and 16 underwent laryngotracheal resection and reconstruction. There were 8 cases of recurrence after resection among which 4 were treated by second resection, 2 recovered by bronchoscopic dilation and 2 managed by stenting. This group of patients [study group] was compared with a similar group of patients in whom the causes of intubations were different [control group]. Incidence of postsurgical recurrence [p=0.011] and the length of stenosis [p=0.01] were higher in the study group. In our patients, social problems such as unemployment, illiteracy and singleness were the more frequent causes of suicide compared with psychological disorders. Patients who undergo mechanical ventilation due to suicide and develop PIAS could be treated by tracheal resection and reconstruction; although the incidence of post- surgical recurrence is higher in them compared with the other groups of patients with PIAS