فهرست مطالب سید مهدی ضیا ضیابری

Spiritual intelligence leads to understanding between people, calmness, and management of changes. The spiritual intelligence of emergency personnel May affects the correct performance of emergency procedures. This type of intelligence exists in all people, but due to the challenging working conditions of medical staff in the emergency department and the need to do the best work at the best time, it Can be more important. The objective of this study was to evaluate the effect of spiritual intelligence on efficacy of health personnel in the emergency department.

This study was a descriptive cross-sectional study that was performed on 83 medical personnel working in the emergency department of Poursina educational, research and therapeutic center, in Rasht, Iran, in 2021. The sampling method was census. The data were collected using a tool that consisted of demographic characteristics and King's questionnaire. Data were analyzed using SPSS24 software and descriptive statistical methods (frequency, percentage, mean and standard deviation) and Kolmogorov-Smirnov, independent T-test, Pearson test and analysis of variance. The significance level was considered P <0.05.

The mean age of the research participants was 29.15±7.39 years and 47 (56.6%) of participants were female. The findings of the present study showed that people with higher spiritual intelligence had better occupational efficiency than others (P<0.001), but there was no statistically significant relationship between spiritual intelligence with age, sex, marital status, and education.

Medical personnel who had higher spiritual intelligence were more efficient than others. Apart from the effect of spiritual intelligence on reducing people's stress, improving the spiritual intelligence of personnel in critical departments such as emergency can increase their efficiency, especially in difficult situations that require management.

Traumatic brain injury is one of the leading causes of death and disability. Traumatic brain injuries have multifactorial injury mechanisms and are often associated with other injuries. A large proportion of patients who suffer from traumatic brain injury also have facial injuries. Due to the anatomical proximity of the face and skull, patients with facial injuries are expected to be at higher risk for brain injuries. The present study was performed with the aim of investigating the relationship between facial and cranial fractures and brain consequence in head trauma patients.

 This is an analytical cross-sectional study. The study population consisted of patients with skull and facial injuries due to head trauma. Fractures of the skull and face were classified into two categories: mandibular and middle part of the face. Brain consequence was considered as intracranial concussion and injury. Age, sex, mechanism of trauma, time and type of fracture, associated clinical symptoms, and level of consciousness of patients were recorded. Data were analyzed using STATA software.

Out of 1625 patients with head injuries, 958 (60%) suffered facial and skull fractures. 700 people (71%) suffered brain injuries following a head injury, of which only 29% had no brain consequences. 50% of brain outcomes following facial and cranial bone fractures together, cranial bone fractures accounted for 29%, and facial fractures accounted for 21% of total brain outcomes. Most patients had brain concussions. Local pain was the most common symptom (75.2%). Overall, 36% of all facial fractures and 88% of skull fractures resulted in brain outcome.

 There is a direct relationship between cranial and facial bone fractures and brain consequences in head trauma patients and concussion was the most common brain outcome in these patients. Urgent and timely measures are required in patients with skull and facial bone fractures to reduce the consequences and brain damage.

Occupational burnout is more likely to be caused in occupation, including medicine, due to their stressful nature and has wide effects on individuals᾽ performance. Despite the high level of burnout among professor and residents of emergency medicine, few studies have compared burnout between the two groups in Iran.So this study with the aim of comparing occupational burnout of professor and residents of emergency medicine in the educational and medical centers of Iran University of Medical Sciences in 2018 has been done.

In this analytical cross-sectional study Maslach 1981 (MBI-22) burnout questionnaires with questions regarding demographic characteristics of subjects were used. The sampling method was cluster random sampling across Iran. Data was analysed by independent t-test, One-way ANOVA and chi-squre using SPSS.

Totally, 81 professors and 95 residents participated in the present study. The mean of the component of depersonalization of the professors was 54.05± 22.80 and the resident was51.73± 24.73, the average component of the emotional exhaustion of the professors was33.40 ± 14.77 and the residents was32.84 ± 13.20 and the average component was the Lack of personal accomplishment‏‏ of the prof 39.41±10.23 and the resident was 9.56± 0.98.There was no significant difference in all three components and prof and Resident were equal. According to the regression model, Residents' job burnout with gender variables (P = 0.02) and Having a child (P = 0.02) and the number of on call per month (P = 0.08) had a significant relationship.

According to the results, the level of burnout among medical emergency professors and residents is high and this affect the quality of caring and educational process of medical emergency and consequently disturb these process. Based on the results on the curriculum of these students, it was necessary to make the necessary corrections to reduce burnout and improve quality of life.

Given the importance of emergency medical technicians' performance in saving lives and considering rapid advancements in medical sciences, there is a need for technicians to gain new specialized knowledge through acquiring the necessary skills and undergoing trainings in these areas. Additionally, making improvements in the quality of services provided by the emerency medical services (EMS) personnel in accidents and emergencies necessitates determining their level of knowledge, attitude, and skill and assessing their educational needs. Therefore, the purpose of this study was to determine the educational needs of operational pre-hospital emergency personnel in Rasht city in 2019-2020.

This study was a descriptive cross-sectional study carried out in 2019-2020. The statistical population of this survay consisted of all the pre-hospital emergency service personnel in Rasht, with Associate, Masters, and higher degrees; all of whom were included. The sampling method was census. The data was collected using a questionnaire that measured the training needs of Rasht Emergency Center staff in five domains of management, communication, evaluation skills, equipment, and operational skills.

Training needs of the pre-hospital emergency operations staff in the five domains of management, communication, evaluation skills, equipment, and operational skills were 41.21±22.27, 41.94±21.1, 48.29±22.69, 40.29±21.48, and 76.87±18.22, respectively.

Overall, the educational needs of the studied pre-hospital emergency personnel were high, and training classes should be designed to meet these training needs.

Pelvic fracture is the second most common cause of death in patients with multiple trauma, after head trauma. The present study was performed with the aim of determining the frequency of genitourinary tract injuries in patients with pelvic fractures referring to Poursina Hospital, Rasht, Iran, so that the initial steps required for treating patients (with pelvic fractures) in the emergency department can be specified.

In this retrospective study, the records of 170 patients with pelvic fractures, who referred to Poursina Hospital in Rasht from the beginning of January 2018 until the beginning of January 2019 were reviewed. Using the prepared checklist and based on the patient's clinical examination by the resident, information including age, sex, level of education, presence or absence of hematuria, type of trauma, and type of pelvic fracture were collected. Data were analyzed using STATA - Se v 13.1 software.

Out of the 170 patients referring to the hospital due to pelvic fracture, 70% were male. The patients’ mean age was 45.02 ± 20.10 years and their mean length of hospital stay was 8.11 ± 7.13 days. Motor vehicle accidents were the most important cause of pelvic fractures and urethral injury. Fifty-five patients (33.4%) with pelvic fractures had a genitourinary tract injury. Hematuria was present in 48 of them, and blood at the tip of the meatus and perineal hematoma were symptoms that were significantly associated with genitourinary tract injury following pelvic fracture.

Considering the relatively high prevalence of genitourinary tract injury in pelvic trauma, it is best to perform a complete examination in all patients who present with high-energy trauma, especially in people with pelvic fractures; and if any of the above-mentioned symptoms are observed, genitourinary tract injuries should be suspected and the location of the injury should be further investigated and treated.

Burn injuries are one of the most important causes of disability and death, which can endanger health and also have severe economic and social consequences in human societies. The aim of this study was to determine the knowledge of pre-hospital emergency personnel in Rasht, Iran, in dealing with burn patients in 2018-2019.

The present study was a cross-sectional-descriptive one, and the study population consisted of all pre-hospital emergency personnel in Rasht in 2018. The sampling method of the study was census and the tool used in the study was a questionnaire, which evaluated the demographic information of the personnel in the first part, and in the second part of the questionnaire, participants' awareness was assessed using 15 questions. Data analysis was performed using descriptive and inferential tests and a significance level of p <0.05 was considered.

The majority of staff had between 10-20 years of work experience (33.7%), and in terms of education, most of them were undergraduates (44.2%). The majority had encountered burn cases (62.1%), and had underwent training in relation to burn injuries (69.1%). In terms of knowledge status, only 3.2% (3 people) had good knowledge (score above 10) and the majority had moderate knowledge (53.7%) or poor knowledge (43.2%).

Due to the fact that the level of knowledge was moderate in the majority of the studied pre-hospital emergency personnel, proper planning should be done to hold training courses.

Having the skill for choosing the proper collar and correctly fastening it is very important for preventing neurovascular injuries in patients with head and neck trauma. Therefore, the present study was designed and carried out with the aim of evaluating the knowledge and practice of medical interns regarding use of neck collar for trauma patients. In this cross-sectional study, the knowledge and practice of medical interns who were admitted to the medical internship program of Guilan University of Medical Sciences in 2009 was assessed in winter of 2017 using a questionnaire, the validity and reliability of which had been approved. 80 medical interns with the mean age of 25.93 ± 1.02 years were studied (76.2% female). Mean knowledge score of the participants was 11.5 ± 2.7 (3 to 19). In addition, their mean practice score was 16.5 ± 2.3 (10 to 20). The highest rate of lack of knowledge was observed regarding factors predicting the rate of damage to neck and spinal cord (98.8%), the importance of injury (95.0%), the maximum time allowed for using neck collar (91.3%) and incorrect measures (91.3%). In addition, the highest rate of error in practice also belonged to leveling external auditory meatus with shoulder after fastening the neck collar in children (98.8%), putting a protective pad behind the rib cage after fastening the collar in children (95%) and employing at least 3 people when fastening the collar and maintaining the immobility of the vertebra before fastening the collar (65.0%), respectively. The score of practice and knowledge had a reversed correlation (p = 0.023, r = -0.225). Based on the findings, the rate of knowledge regarding neck collar usage in more than 70% of the medical interns in the present study was in the intermediate to poor range. In addition, the practice of 60% of them was in the intermediate to poor range. There was no direct correlation between the knowledge and practice of the students in this regard.

Patients with chronic obstructive pulmonary disorder (COPD) are at risk of developing tahcydysrhythmia due to various reasons such as hypoxia, hypercapnia, respiratory acidosis, respiratory and metabolic alkalosis, hypokalemia, ischemic cardiac diseases, and cor-pulmonale as well as using drugs such as theophylline and beta-agonists. The present study was designed with the aim of evaluating the prevalence of various types of tachydysrhythmia in acute exacerbation of COPD.
In this cross-sectional study, patients presenting to emergency department (ED) who were diagnosed with acute COPD exacerbation were evaluated regarding tachydysrhythmia prevalence in their electrocardiogram (ECG) on admission and its distribution based on age, sex, history of underlying illness, history of addiction or smoking, previous hospitalization, and mortality. Data were analyzed using SPSS 21 statistical software and p 292 patients with the mean age of 67.35 ± 12.11 years were evaluated (72.6% male). Prevalence of dysrhythmia was 138 patients (47.3%). Normal sinuous rhythm and sinus tachycardia were the most common underlying rhythms with 52.7% and 35.6% prevalence, respectively. Prevalence of tachydysrhythmia was significantly higher in patients with a history of drug abuse (p = 0.049), smokers (p = 0.011), and those with an underlying disease (p = 0.017). Yet, no difference was detected based on age (p = 0.240), sex (p = 0.062) and previous hospitalization (p = 0.159) in this regard. Finally, 268 (93.7%) patients were discharged from ED and 18 (6.3%) died. Prevalence of tachydysrhythmia in those who died was 77.78% compared with 44.78% in those who were discharged (p = 0.007).
Based on the findings, overall prevalence of tachydysrhythmia in patients with COPD was 47.3% in the current study. The most common tachydysrhythmias were sinuous tachycardia, atrial fibrillation, multifocal atrial tachycardia, and idiojunctional rhythm. The prevalence of tachydysrhythmia was significantly higher in those who died, had a history of smoking and drug abuse, and those with an underlying disease.

Arcuate foramen anomaly is an anatomic variation in the first thoracic vertebrae that forms a space for passing of vertebral artery. Considering the role of this bony bridge in migraine development and its effect on prevalence of various types of pain in head, shoulder, and neck areas, as well as its importance in screw placement on the lateral mass of atlas, the present study evaluated the prevalence of this anomaly among those presented to the emergency department (ED) of Poursina Hospital, Rasht, Iran.
The present study is a cross-sectional one, carried out on patients over 18 years of age that visited ED of Poursina Hospital, Rasht, Iran, in 2015 and underwent lateral neck radiography using census method. Data of the patients were gathered using their medical profile or by asking them on the phone, and recorded in a pre-designed checklist. Data were analyzed with the aid of SPSS version 24 and chi-square and independent t-test statistical tests. P-values less than 0.05 were considered as significant.
1146 patients with the mean age of 37.95 ± 15.88 years were studied (69.2% male). Mean age was 36.05 ± 15.26 years among men and 14.21 ± 16.44 years among women (p 0.05).
Based on the results of the present study, the prevalence of arcuate foramen anomaly was estimated to be 9.6% in Guilan province using lateral neck radiography. Its prevalence rate was 10.34% in men and 7.93% in women. Considering this prevalence rate, presence of this anomaly should be considered as a possibility in patients with complaints of head, shoulder, and neck pain.

Shoulder dislocation is identified as displacement of humerus head from the glenoid cavity of scapula bone, which makes up about 50% of total joint dislocations. Taking into account the importance of the side effects and disabilities caused by this type of dislocation and that it can be prevented, the present study was designed aiming to evaluate the epidemiologic characteristics of the patients with shoulder dislocation. In this retrospective cross-sectional study, all the patients referred to the emergency department (ED) with complaint of shoulder dislocation throughout one year were evaluated. Demographic data and characteristics regarding the type of dislocation, presence of accompanying fractures, mechanism of dislocation, history of dislocation and the method of reduction were extracted from the patients’ profiles and recorded in a checklist designed for this purpose. Data were then statistically analyzed using SPSS version 19. Statistics showed that 120 patients with the mean age of 39.3 ± 21.2 years had been admitted to ED of the studied center in one year (79.2% male). The most common type of dislocation was anterior dislocation (95.8%) and in the right shoulder (52.5%) and the most common cause was falling on open arm (34.2%). Reduction method was non-operative in 93.3% of the cases and surgery in 6.7%. Based on the results of this study, in the studied population, most patients with shoulder dislocation were young men who had an anterior dislocation in their right shoulder because of falling on out stretched hand and treated with close reduction.

Elderly diabetic patients are prone to trauma due to background illnesses or physical disabilities. In the present epidemiologic study,we aimed to evaluate pattern of trauma in elderly diabetic patients referred to the emergency department of Poorsina Hospital, Rasht, Iran, 2011.
This cross-sectional study was performed on the diabetic patients over 60 years old. Demographic data, trauma characteristics, mortality, need for blood transfusion, and the time interval between admission and death, were gathered. Finally, the risk factors of the mortality were evaluated. P268 patients with mean age of 69.94±7.18 years were evaluated (58.6% female). Most common trauma mechanism was same level falling (40.3%); most common location for trauma was urban streets (35.8%); most common anatomic site were extremities (45.6%); and the season with highest trauma occurrence was winter (28%). 14.2% of the patients needed blood transfusion and 6.3% of the patients finally died. Mean hospitalization duration in the department was 3.72±5.14 days (between 6 hours to 53 days). There was a significant correlation between mortality of the elderly diabetic patients and sex(p=0.012), anatomic site of trauma (p=0.047), number of injured site (p=0.030), need for blood transfusion (p100/minute (pThe results of this study, show that the most common trauma mechanism was same level falling, the most common site of trauma was streets and other places in the city, most common anatomic site for trauma were extremities; the s eason with highest trauma occurrence was winter. There was a significant correlation between mortality of patients and sex , anatomic site of trauma , number of injured site , need for blood transfusion , systolic blood pressure 100 /minute.

Emergency department (ED) as the fundamental part of hospital has a specific importance due to admitting the most various and sensitive group of patients. The aim of the ED is presenting services with highest quality in the least time . To reach this goal establishment of an emergency medicine specialist who performs assessment, resuscitation, stabilization, detection, and maintenance of emergency patients is noteworthy. The aim of this study was evaluating the effect of establishing the emergency medicine specialists on the performance of ED in Poursina Hospital, Rasht, Iran.
In t his cross - sectional study files of all patients hospitalized in the ED of Poursina, Rasht, Iran, through 2005 - 2012 were evaluated . Variables such as age, gender, cause of refer and number of hospitalization, number of discharging from department, percentage of bed occupation and daily bed occupation, time of hospitalization, number of dischargin g under six hours, number of transportation to other wards or hospitals, and the rate of bed circulation in the ED were assessed, too. Data was gathered through hospital information system and analyzed using SPSS 20.
Through 2005 to 2012 number of admitted patients in the ED has increased so that the most admitted number was related to 2012 (p=0.0001) . The present of discharged patients under six hours and the rate of direct discharging before the presence of emergency medicine specialists have inc reased from 15.5% and 58.9% to 23.4% and 61.2% in after their presence, respectively (p=0.001) . Transporting to other wards and hospitals were also decreased from 41.1% to 38.8% (p=0.00 0 1). The occupied beds percentage after presenting of emergency medicine specialists has noticeably decreased compared to the past, while bed turnover rate increased. In other words, the bed turnover mean has increased from 354.5±108.4 during 2005 - 2008 to 637.7±30.8 through 2009 - 2012 (p=0.002). Also, during 2005 - 2008 the hospi talization mean of the patient has remarkably decreased from 1.08±0.44 days to 0.35±0.05 days in 2009 - 2012 (p=0.021). The occupied bed mean before and after the presence of emergency medicine specialists were 12173±3453 and 6217±219, respectively, showed a descending trend into the past (p=0.018).
It seems that p resenting of emergency medicine specialists in health system leads to improve the service delivery to patients and decrease the waiting time. Also w ith decreasing the waiting time of pa tients and timely disposition, more prepared beds can be accessible in the ED for future admission.