لیلا کوچکی نژاد ارم ساداتی

Climatic conditions always have a great impact on the quality of driving and consequently the damage, injury and death of traffic accidents, among these conditions, fog due to sudden occurrence and reduced visibility of drivers as dangerous weather conditions need to be investigated and Read more. This study aimed at determining the pattern of accidents in fog and the relationship between driver, road, and accident with injury level in, Guilan from 2014 to 2018.This is a retrospective descriptive-analytical study that investigated all accidents that had occurred in Guilan from 2014 to 2018. All of the data were entered into STATA software. The time-series estimators were used as the multivariate regression model for the presence or absence of any relationship between variables. The likelihood of fatalities in fog decreased with age while it increased when drivers were female (p = 0.001). Most of the accidents in fog condition had occurred in December (p=0.000), February (p=0.001) and November (p=0.012). The number of related injuries at 2 AM (p = 0.032), 3 AM (p = 0.019), and 2 PM (p = 0.02) significantly reduced. Moreover, the rate of mortality at 2 AM (p = 0.005), 9 AM (p = 0.012), 11 AM (p = 0.004), 13 PM (p = 0.008) and 19 PM (p = 0.003) were significantly lower. Due to the fact that the death rate was significantly higher in fog conditions than in other weather conditions, it is necessary to warn and inform the public. Also, in traffic education programs, female drivers and young drivers should be included as the target group of the programs. In addition, preventive interventions should be done mostly in the months of November, January and February and in the cities of Anzali and Rasht.

The present study was conducted with the aim of analyzing the spatial distribution of the most accident-prone points of damage, injury and death of heavy vehicle traffic accidents in Guilan province between 2014 and 2018.

In this descriptive- analytical study, all data related to traffic accidents with heavy vehicle referred to the NAJA traffic police in Guilan province were collected and reviewed, and the cases of damages, injuries and deaths of these accidents in these years were calculated and spatial analysis of accident prone points was calculated and analyzed using ARC GIS software.

Most heavy vehicle traffic accidents in Rudbar with 92.6, at 4 am (1.012), in clear air 4227 (72.33%), on main roads 3212 (54.79%) and direct roads and It was related to the conflict with an unknown device 2373 (40.49%).

traffic Accident-prone points in heavy vehicle traffic accidents were identified, with appropriate interventions, accidents should be prevented in these points and the traffic safety of these vehicles should be increased. The traffic transportation organization, in cooperation with the police, should install traffic signs that indicate the speed limit for more awareness of these drivers when traveling on the main roads and direct geometric conditions and monitor the compliance of driving rules by these drivers.

 The quantitative studies have shown that cyclists around the world have different attitudes and perceptions of safety needs. Therefore, in this study, we want to examine the experiences of injured cyclists about safety needs in a qualitative study.

 The present study was a qualitative study witha  content analysis method. The study population consisted of male or female cyclists over 18 years of age who were injured in a crash or fall while cycling and one or more of their limbs were injured and hospitalized in Poursina Medical Center. Excel details of these clients were obtained from the registration system ofthe  Guilan Road Trauma Research Center. People with various characteristics in terms of age, sex, education, marriage, sex, occupation, length of hospital stay, etc. were included in the study. The number of participants was twenty. Interviews were conducted by medical students with the cooperation and supervision of supervisors.

 Safety factors from the experiences of injured cyclists included nine categories, which were: orderly cycling, holding training courses, supervising cycling, observing the principles of cycling, being equipped with safety equipment, having the right to an exclusive route , Reviewing exclusive routes, creating a sense of security and creating peace in women cyclists.

 Authorities should try to make the factors that were safe in the experiences of these injured as much as possible to give these users a sense of calm and security, thereby encouraging others to ride a bicycle as a clean vehicle for the environment.

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.

The degree of seriousness of the control areas is low in dealing with those who do not follow wearing helmet legislation. The purpose of this study was to explain the proposed solutions to solve the problem of implementing the wearing helmet legislation from the perspective of control areas and motorcyclists.

This is a retrospective study on the pediatric patients whose ages were between one month to 18 years old; and who were admitted to the medical pediatric in - tensive care unit (PICU) of Namazi Hospital in Shiraz, Iran, from 2019 to 2020 (20 months) for whom a central venous catheter was placed in the subclavian vein through a supraclavicular approach. Then complications such as hemorrhage, arterial perforation, pneumothorax, and failure of this method were recorded and examined by reviewing special forms in the medical record .

The experiences of 20 male participants; 9 people from the control areas, 4 univer - sity faculty members, 3 traffic police, and 4 motorcyclists were registered. The results showed that the solutions for implementing the wearing helmet legislation with four categories names: Hard, correction, support, and soft solutions and14 subclasses and 54 codes were formed .

The use of hard solutions such as the diligence and seriousness of the control areas in implementing the wearing helmet legislation and corrective solutions such as drafting new laws and amending existing laws, supporting solutions such as supporting the police and motorcyclists, and finally soft solutions such as education and cultural creation and the use of mass media are effective in implementing these laws .

Trauma is the first cause of mortality due to non-obstetric causes in pregnant women. There is a limited knowledge on mechanisms of trauma in pregnancy. Therefore, this study was performed with aim to determine the frequency, type and outcomes of trauma in pregnancy period in patients referring to the major trauma center in Guilan.

This retrospective cross-sectional study was conducted using the data registered in triage unit of Poursina Teaching center, Guilan from July 2017 when the Hospital Information System was being implemented for the first time. Using complete enumeration, all mothers with trauma histories until July 2018 (n=138) were entered into the study. They were then interviewed via telephone about the maternal and fetal outcomes after discharge, and 77 mothers answered. Data were analyzed using SPSS software (Version 21).

The mean of maternal age was 29.24±5.25 years and mean gestational age was 20.92±10.12 weeks. The most common mechanism of trauma was falling (35.5%) and then traffic accidents (31.9%), other mechanisms (sharp objects penetrating in the limbs, falling of the object on the person, dog bite, etc.) (21%), violence (10.9%) and self-immolation (0.7%). In terms of frequency, the most reported fetal outcomes were without outcome (87%), preterm birth (7.8%) and abortion (5.2%), respectively; the most common maternal outcomes were reported as uncomplicated (67.5%), bleeding (11.7%), bone fractures (11.7%), uterine contractions and cervical dilatation (9.1%).

The most common type of trauma during pregnancy was falling. Preterm birth and abortion were the fetal outcomes and vaginal bleeding, bone fracture, uterine contraction, and cervical opening were dangerous maternal outcomes which are reported. Future programs should prioritize trauma prevention in pregnancy and follow-up of maternal outcomes after discharge from trauma center.

: In the last two decades, the lack of facilities has been one of the reasons that has increased the average triage time. This delay prolongs the patient’s waiting time and increases the likelihood of errors and mortality. Limited studies have been conducted on the type of facilities required for a fast triage. The purpose of this study is to express the opinions of physicians and nurses regarding the necessary facilities for a rapid triage in Poursina Hospital, Rasht, Iran, in 2021.

This was a qualitative study using conventional content analysismethod, which was performed on the opinions of twenty people in the fields of emergencymedicine, generalmedicine, and nursing. The four Guba and Lincoln criteria were used for strengthening the data.

The opinions of 20 participants resulted in 4 categories and 17 subcategories under the titles: providing human resources, empowering human resources, improvement of triage process, and provision of physical necessities.

Human resources is a valuable component in triage. Careful planning is needed for the growth and development of this valuable asset. By providing the required staff and upgrading their capabilities through training and experience, the speed of triage can be increased. Giving employees a proper understanding of triage is also effective in accelerating the triage process. The provision of physical resources has also been identified as a facilitator, and those in charge should seek solutions for providing them.

It is predicted that injuries due to traffic accidents will be the fifth cause of death by 2030 compared to the ninth place in 2004.
To determine the burden of rural traffic accidents and analyzing the related factors, their severity and rate
This study was performed in guilan province during four years (2009-2012). the study population included all dead cases due to accident in rural areas of guilan
Overall, 3478 leading-to-death accidentsoccurred, 80% of which were recorded in suburban and rural regions. during four years of study, death rate due to traffic accident was 4.5 times more in men than women. years of life lost(YLL in 1000 population) varied from 11.9 to 15.8 in the same period in both sexes.
Couclusion: For effective intervention programs, young adult men in rural areas should be trained. health network staff should make people aware of the dangers of passing cattle (horse, dog, cow, etc.) in the roads in the evening and At night time when drivers have insufficientvision.roadsides residentsshould also become aware of appropriate clothingfor more visiblity at night when crossing the rural roads

Traumatic brain injury (TBI) is one of the most common causes of seizure and about 10% of patients with severe and moderate trauma develop seizure. Phenytoin is an anti-seizure medicine which is widely prescribed to prevent seizure in TBI patients. Even it has non-linear pharmacokinetics in therapeutic concentrations, the prescription of which necessitates continuous evaluation of plasmatic level of medicine and regulating the dosage.

This study aimed at surveying the variability of Phenytoin serum level in TBI patients in Poursina Teaching Hospital to determine the dosage of medicine more precisely to reach the Prophylactic level.

In a descriptive longitudinal study, 90 patients of Trauma Ward of Poursina Hospital were studied. Phenytoin serum level was estimated in first, second, and seventh day after hospitalization by using RAN DOX kits, the results were then analyzed by SPSS software (ver16). Exact Test, Fisher, and Pearson T-test were utilized to analyze the data.

Out of 90 studied patients, 79 (87.7%) were men and 11(12.3%) women. Mean age was estimated 36.3±15.6 for men and 41.7±16 for women. There was no significant difference between the Phenytoin level in first and third day in two groups. The Phenytoin serum level in 24 first hrs didn’t reach therapeutic level in 75.6% of patients. The average of Phenytoin serum level was in therapeutic level in third day and Phenytoin serum level didn’t reach therapeutic level only in 5% of patients (p≥0.05). This average figure was 20-30 mg/dl in more than half of the patients on seventh day, during which all patients reached therapeutic level (p≥0.05). A significant relationship was observed between age and Phenytoin serum level in all three levels (p<0.05).

Phenytoin is considered as an anti-seizure medicine which is vastly used in TBI victims. Using Phenytion requires exact monitoring due to its limited therapeutic range and linear pharmacokinetics. Since the changes of medicine dosage can lead to blood poisoning and make the medicine ineffective, its prescription needs much more attention regarding its gender, age, and needed dosage.

Emergency ward of hospitals is usually the first place that patient and his/her family faces with، and aggression towards personnel is the most common reaction that they may do. This study was aimed to determine frequency and characteristics of violence against nurses in emergency wards. This was a cross-sectional study. Our sample included all 138 nurses working in emergency wards of all teaching hospitals in Rasht. All of nurses were studied in 2010 by census method using a researcher made questionnaire. Our questionnaire had two sections، one including 7 questions about personal information of nurses and another including 10 questions about number and characteristics of violence. Data was analyzed by SPSS v. 16 software، using descriptive and analytical statistics. Findings showed that 102 persons (74. 6%) of 138 nurses had experience of verbal violence. Violence had no significant correlation with age، work experience، marital status، education level، work shift، holidays and transferred patient (P<0. 0. 5). However، it had a significant correlation with nurse''s worries (P=0. 015)، male gender (P=0. 042)، night shift (P=0. 001)، male relatives of patient (P=0. 01)، patient''s consciousness (P=0. 01)، referring to hospital at night (P= 0. 01) and their discontent from some wards (P= 0. 01). The findings suggested a high rate of violence in emergency wards and several factors may play a role in causing violence. So، paying attention to the underlying causes of violence and holding classes and workshops in teaching hospitals can be effective in reducing hospital violence.