reza azizkhani

Resilience refers to human ability for adapting to disasters, traumas, pain, and suffering from important troubles and stressors in life.
Regarding the fact that people are continuously exposed to various physical and mental health traumatic stimuli, this study aimed to investigate the resilience correlations in Emergency Medical Services (EMS) workers.
The study was descriptive-correlation which examined 15 individuals for each scale and subscale. Therefore, 150 EMS workers were selected for this study.
All four variables, including resilience, self-control, problem-solving style, and self-compassion, were above average. Resilience had a positive and significant correlation with self-control, problem-solving, creativity, confidence in problem-solving, and tendency (a subscale of problem-solving). Self-control had a positive and significant correlation with self-compassion. The final model was as resilience = 0.454 + 41.317 [15.941+ 0.622 (self-compassion)] + 3.453 (tendency) + 3.255 (creativity).
According to the findings of the present study, it is suggested to strengthen four variables of resilience, self-compassion, self-control, and problem-solving styles in the EMS personnel.

Recognizing and determining severe trauma is essential for choosing the appropriate treatment strategy. The aim of this study was to find the predictive value of the quick sequential organ failure assessment (qSOFA) score for in-hospital mortality in adult trauma patients. This prospective observational study was conducted on adult patients with multiple trauma presenting to the emergency department. The qSOFA score was calculated according to the initially recorded variables. The primary outcome was in-hospital mortality. The predictive value of qSOFA was evaluated using the Area Under Receiver Operating Characteristic (AUC) analysis. Finally, 775 multiple trauma patients with a mean age of 38.68±18.74 were admitted. Of these, 34 people (4.39%) died and 741 subjects were discharged from hospital. The mean qSOFA score was 0.41±0.64, significantly higher in the survived patients than in the non-survived patients (P < 0.001). The AUC of qSOFA score to predict in-hospital mortality was 0.878 (95% confidence interval: 0.853-0.900); thus, qSOFA was a good predictor of in-hospital mortality in multiple trauma patients. The qSOFA score can be considered a simple and rapid screening tool for identifying multiple-trauma patients.

The present study was to compare the professional quality of life (ProQOL) and its association with the emotional well‑being among the physicians and nurses in contact with COVID‑19 patients in Iran and France.

The study was performed on 903 nurses and physicians in contact with COVID‑19 patients in Iran and France.he subjects completed their demographics online and then answered questions addressing their job stress and emotion associated with their contact with COVID‑19 patients and ProQOL. Finally, the collected data were analyzed using the SPSS software (ver. 25).

According to the results of the present study, the degree of contact with COVID‑19 patients had a significant role in compassion satisfaction, burnout, and compassion fatigue, with the coefficient effects of 0.459, 0.688, and 0.433, respectively (P < 0.05). The emotional well‑being had a significant role in increasing compassion satisfaction (B = 0.505, P < 0.05).

According to the results of the present study, factors such as contact with a COVID‑19 patient, emotional well‑being, gender, and marital status had a significant effect on dimensions of ProQOL in both Iran and France. Considering that the entire focus of the physicians and nurses is on the health of COVID‑19 patients and they have no concentration on improving their emotional state, it seems that supporting them in terms of psychological self‑care and considering its indirect impact on the quality of professional performance are of particular significance.

The sudden onset and difficult consequences of COVID-19 pandemic are considered a trauma for healthcare. Despite its devastating consequences and psychological distress, it has also undergone positive changes. The main objective of this study was to explain post-traumatic growth among nurses and physicians during COVID-19 pandemic.

In this study, a descriptive phenomenological approach was utilized and semi-structured interviews were conducted with 17 nurses and physicians who were selected by purposive sampling. The interviews were analyzed using Colizzi’s method.

The findings of the study were summarized into two main themes: distress with four subthemes including corona and loss of life, psychological trauma, ambiguity and confusion about the career path, environmental and interpersonal stress, and growth with four subthemes including alternative ways to overcome trauma, promoting interpersonal relationships, empathy in treatment, and finding meaning.

The results of the present study revealed post-traumatic growth played an important role in maintaining the mental health of nurses and physicians beyond traumatic coronavirus pandemic. It is hoped that this study will encourage further exploration and examination of this subject and interventions for all groups of healthcare.

The present study aimed at evaluating the role of training in improving emotional intelligence (EI) skills and assessing its indirect effect on reducing job stress in emergency medicine residents (EMRs). 

In the present study, 20 EMRs were trained for EI skills while 22 EMRs received no training. Then, all participants’ EI level and job stress were assessed and compared before and after the intervention using the Bar-On Emotional Quotient Inventory(EQ-I) and the Osipow job stress questionnaire, respectively. 

The results of the present study revealed that the EI level in the training group with a mean score of 338.27 ± 27.57 was significantly higher than the control group with a mean score of 320.50 ± 28.50 after training intervention (P = 0.043). In addition, job stress in the training group with a mean score of 170.82 ± 16.11 was significantly lower than the control group with a mean score of 183.30 ± 22.21 (P=0.045). Moreover, in the training group, the relationship between EI and job stress was inverse and significant (r = -0.746, P<0.001), but in the control group it was non-significant (r = 0.017, P=0.938). 

According to the results of the present study, training for EI skills can play a significant role in improving EI and reducing stress in EMRs.

 Healthcare workers (HCWs) are among the highest groups impacted by the COVID-19 pandemic. This study aimed to analyze professional quality of life (ProQOL) and its association with emotional well-being in HCWs during the pandemic. 

 This cross-sectional study was conducted on HCWs being in close contact with COVID-19 patients in Iran. The questionnaires assessing ProQOL, emotional well-being, and demographic and occupational characteristics were recruited via email or social media. The ProQOL was used to measure compassion fatigue (CF), burnout (BO) and compassion satisfaction (CS). 

 Among the respondents, 705 HCWs were enrolled, including a higher proportion of physicians 449 (63.7%), females 452 (64.1%), and married 486 (68.9%). The mean of participants’ work experience was 8.41 ± 8.91 years. Almost all of HCWs showed moderate to high levels of CS (98.3%). Also, most of HCWs showed a moderate level of CF (96.3%), and the majority of them (76.6%) had a moderate level of BO. There were significant differences in the duration of contact with COVID-19 patients for all three components of ProQOL and emotional well-being score. Women had a higher level of BO than men (P=0.003). CS was significantly higher in married HCWs than in singles (P=0.007). Pearson correlation coefficient showed that CS had a negative relationship with CF and BO. However, there was a direct correlation between emotional well-being and the CS. 

 During the COVID-19 pandemic, Iranian HCWs showed to have moderate to high levels of CS, and a moderate level of both CF and BO, and showed that emotional well-being had a direct correlation with CS.

Ketamine has been a safe and effective sedative agent commonly used for painful pediatric procedures in the emergency department (ED). This study aimed to compare the effect of dexmedetomidine (Dex) and propofol when used as co‑administration with ketamine on recovery agitation in children who underwent procedural sedation.

In this prospective, randomized, and double‑blind clinical trial, 93 children aged between 3 and 17 years with American Society of Anesthesiologists Class I and II undergoing short procedures in the ED were enrolled and assigned into three equal groups to receive either ketadex (Dex 0.7 μg/kg and ketamine 1 mg/kg), ketofol (propofol 0.5 mg/kg and ketamine 0.5 mg/kg), or ketamine alone (ketamine1 mg/kg) intravenously. Incidence and severity of recovery agitation were evaluated using the Richmond Agitation‑Sedation Scale and compared between the groups.

There was no statistically significant difference between the three groups with respect to age, gender, and weight (P > 0.05). The incidence of recovery agitation was 3.2% in the ketadex group, 22.6% in the ketofol group, and 22.6% in the ketamine group (P = 0.002, children undergoing short procedures were recruited). There was a less unpleasant recovery reaction (hallucination, crying, and nightmares) in the ketadex group compared with the ketofol and ketamine groups (P < 0.05). There was no difference in the incidence of oxygen desaturation between the groups (P = 0.30).

The co‑administering of Dex to ketamine could significantly reduce the incidence and severity of recovery agitation in children sedated in the ED.

Various methods of analgesia can be used to reduce or prevent procedural pain in emergencydepartment (ED). This study aimed to evaluate the effectiveness of topical lidocaine-diclofenac combinationcompared to lidocaine-prilocaine combination (Xyla-P) in reduction of the pain during central venous catheter(CVC) insertion.

In this randomized clinical trial, 100 adult patients requiring CVC insertion in the EDwere enrolled. These patients were randomly divided into two groups. The site of CVC insertion was coveredwith 2 g of topical Xyla-P cream in the first group, and 2 g of topical lidocaine-diclofenac cream in the secondgroup. The primary outcome was the pain during CVC implantation. The secondary outcomes were physiciansatisfaction and the incidence of side effects.

On the visual analog scale (VAS), the pain score duringCVC insertion was significantly lower in the second group (p = 0.027). However, there was no difference in painscores during lidocaine injection between the two groups (p = 0.386). Also, there was no significant differencein the rate of side effects between the two groups (p = 1.0). The physician’s satisfaction with the first groupwas significantly lower than the second group (p = 0.042).

Although the CVC insertion pain wassignificantly lower in patients who received the topical combination of Lidocaine plus Diclofenac, there wasno clinically important difference between the two groups and both topical anesthetics were effective and safein reducing pain intensity. Also, lidocaine-diclofenac combination cream was more cost-effective than Xyla-Pcream.

Ultrasonography (US) has been suggested as an integral part of resuscitation to identify poten-tially reversible causes of cardiac arrest (CA). This study aimed to evaluate the association between cardiac ac-tivity on ultrasonography during resuscitation and outcome of patients with non-shockable rhythms.

We conducted a prospective, observational study on adult patients presenting with CA or experiencing CA inthe emergency department (ED), and initial non-shockable rhythm. US examination of the sub-xiphoid regionwas performed during the 10-second interval of rhythm and pulse check and the association of US findings andpatients’ outcomes was evaluated.

151 patients with the mean age of 65.32 ± 11.68 years were evaluated(76.2% male). 43 patients (28.5%) demonstrated cardiac activity on the initial US. The rate of asystole in initialrhythm was 58.9% (n=89). Return of spontaneous circulation (ROSC) was achieved in 36 (23.8%) patients, twenty(13.2%) survived to hospital admission and seven (4.6%) survived to hospital discharge. When the cardiac stand-still duration increased to six minutes, no patient survived hospital discharge. Potentially reversible causes weredetected in 15 cases (9.9%), and four of them survived to hospital discharge. Cardiac activity on first scan wasassociated with ROSC (OR: 6.86, 95%CI: 2.92-16.09; p < 0.001), survival to hospital admission (OR: 17.80, 95%CI:3.95–80.17; p < 0.001), and survival to hospital discharge (OR: 17.35, 95%CI: 2.02–148.92; p = 0.001).

Conclusion:

In non-traumatic cardiac arrest patients with non-shockable rhythms, bedside US is of great importancein predicting ROSC. The presence of pulseless electrical activity (PEA) rhythm and cardiac activity on initial USwere associated with ROSC, survival to hospital admission, and hospital discharge. When the cardiac standstillduration increased to six minutes, no patient survived hospital discharge.

In recent years, several scoring systems have been developed to assess the severity of traumaand predict the outcome of trauma patients. This study aimed to compare Rapid Emergency Medicine Score(REMS), Modified Early Warning Score (MEWS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) inpredicting the in-hospital mortality of trauma patients.

This diagnostic accuracy study was done onadult patients admitted to the emergency department (ED) between June 21, 2019, and September 21, 2020,following multiple trauma. Patients were followed as long as they were hospitalized. The REMS, MEWS, GCS,and ISS were calculated after data gathering and comprehensive assessment of injuries. Receiver operatingcharacteristics (ROC) analysis was performed to examine the prognostic performance of the four different tools.

Of the 754 patients, 32 patients (4.2%) died and 722 (95.8%) survived after 24 hours of admission. Themean age of the patients was 38.54 ± 18.58 years (78.9% male). The area under the ROC curves (AUC) of REMS,MEWS, ISS, and GCS score for predicting in-hospital mortality were 0.942 (95% CI [0.923-0.958]), 0.886 (95% CI[0.861-0.908]), 0.866 (95% CI [0.839-0.889]), and 0.851 (95% CI [0.823-0.876]), respectively. The AUC of REMSwas significantly higher than GCS (p=0.035). The sensitivities of GCS≤11, ISS≥13, REMS≥4, and MEWS≥3 scores for in-hospital mortality were 0.56, 0.97, 0.81, and 0.94, respectively. Also, the specificities of GCS, ISS,REMS, and MEWS scores for in-hospital mortality were 0.93, 0.82, 0.81, and 0.85, respectively.

Itseems that REMS is more accurate than GCS, ISS, and MEWS in predicting in-hospital mortality≥24 hours ofmultiple trauma patients.

 Acute pain management is a core ethical commitment to medical practice. However, there is evidence to suggest that sometimes infiltrative lidocaine (IL) is not used prior to thoracentesis and abdominocentesis due to the belief that two needles cause greater pain than one. However, topical anesthetics like lidocaine-prilocaine cream (LPC) are painless, easy to use, and have less systemic side effects. Therefore, LPC can be a suitable substitute for medical procedures.

 This study was designed to compare the analgesic effects of LPC with IL in thoracentesis and abdominocentesis.

 Patients were divided into two study groups, including individuals seeing a physician for a thoracentesis (N = 36) and those seeing a physician for an abdominocentesis (N = 33). Patients were randomly assigned to the IL (N = 35) or LPC (N = 34) groups for diagnostic and/or therapeutic purposes. The IL group received 100 mg of 2% lidocaine 5 minutes prior to their procedure, whereas the LPC group received 2.5 g of lidocaine-prilocaine cream. The cream was spread over a 20 - 25 cm2 area and occluded with dressing plaster for 30 minutes prior to the procedure. In both study groups, the thoracentesis and abdominocentesis were ultrasound-guided.

 The findings suggest a non-significant difference between overall pain perception in LPC and IL groups generally, as well as specifically in abdominocentesis and thoracentesis groups. Furthermore, the result remained the same after controlling for confounding variables. The number of attempts to perform successful abdominocentesis was significantly higher in the LPC than IL (P-value = 0.003) group but was not significant in the thoracentesis group (P-value = 0.131). The level of patient satisfaction in the LPC and IL groups were not significantly different (P-value > 0.05).

 Overall, LPC appears to be an appropriate alternative to IL in reducing pain during thoracentesis and abdominocentesis, but it seemed to increase unsuccessful medical procedure attempts.

Ketamine is a commonly used medicine for reducing pain and stress in patients, including children in emergency department (ED). The intravenous (IV) injection of ketamine is gold standard though difficult in children, but other routes are also possible. 

This study was conducted to compare the effects of the submucosal at different doses versus IV injections of ketamine on sedation with proper consciousness in children candidates for diagnostic-therapeutic procedures in ED. 

This randomized clinical trial was conducted with 4 groups; groups 1, 2 and 3 respectively received 4, 3 and 2 mg/kg of submucosal ketamine and group four 1.5 mg/kg of IV ketamine. Eligible subjects selected from 46 patients of children’s age as the candidates for subcutaneous wound healing were randomly assigned to the four groups and followed up 5, 10, 15 and 30 minutes after the injection. The Ramsay score was obtained by measuring the heart rate, the breathing rate, the time to start affecting and duration of the effect. The data were ultimately analyzed in SPSS and Excel. 

The baseline data were matched and confounding variables eliminated included age, gender, weight and hemodynamics. Compared to other doses of submucosal ketamine, 4 mg/kg was found to exert its effect the fastest (4.08±1.01 minutes) (p<0.05) and for the longest duration (23.09±1.12 minutes) (p<0.05). The Ramsay score in groups 1 and 4, i.e. 5.9, was significantly higher than that in groups 2 and 3 (p<0.05). 

The results showed that 4 mg/kg and 3 mg/kg of submucosal ketamine are appropriate alternatives to IV ketamine. Although the time to start affecting was shorter in the intravenous group compared to in the other groups, the duration of the effect was the longest with 4 mg/kg of submucosal ketamine. Surgeon satisfaction scores were found to be very good and not significantly different between groups 1, 2 and 4. Vomiting was also prevalent with no significant differences between the four groups.

Limb trauma is one the main causes of emergency room (ER) referrals and patients often complain of pain from the very moment of arrival.

We decided to compare the analgesic effect of ketamine nebulizer with intravenous (IV) morphine in trauma patients referred to ER. 

In this clinical trial study trauma patients referred to ER of Alzahra and Kashani hospitals in Isfahan, Iran were selected. All trauma patients older than 18 years with limb pain who had a pain score ≥ 7 based on visual analogue scale (VAS) criteria were included. During pre-hospital management, patients were divided into two groups of receiving ketamine nebulizer with a dose of 1.6 mg/kg and receiving IV morphine with a dose of 0.1 mg/kg. Pain score, vital signs and complications were recorded 5 and 15 minutes after receiving the first dose of drug and also at the time of arrival to ER. 

Finally, the records of 391 patients were analysed. There was no significant difference between the two groups in terms of pain intensity, vital signs before intervention, the first 5 and 15 minutes after and the time of arrival in ER (P>0.05). But the changing of VAS scores in different times was significant in both groups (P<0.001). There was a significant difference between the two groups in complications including nausea and vomiting (P<0.001), and also delirium (P=0.010). 

Using ketamine nebulizer can produce similar analgesic effects as IV morphine in trauma patients referred to ER.

In the past decade, factors such as population growth, increased environmental incidents, and substance abuse have caused patient‑overcrowding in emergency departments (EDs). Our main objective was to assess the effects of a discharge lounge on decreasing the patient waiting time and ED overcrowding by computer simulation.

In this cross‑sectional retrospective study, the statistical population consisted of 39264 persons referred to the ED of Al‑Zahra Hospital. The sample size was calculated as 1275 through systematic random sampling at 99% confidence. To increase research accuracy, the number of patients was increased to 2515. Data were collected by standardized checklists and hospital information systems.

Mean waiting time for level 2 patients who left the ED against medical advice after completing the treatment was declined from 56 min to 44 min and before completing the treatment process from 80 min to 50 min. Average waiting time for level 3 patients for personal satisfaction after completing the treatment process decreased from 15 min to 13 min and before the completion of the treatment process from 67 min to 41 min; the number of discharged patients awaiting discharge was decreased at level 2 from 3 to 2 and at level 3 from 2 to 1. The number of patients waiting for admission at triage stations reduced from 44 to 39%, and the average number of patients discharged from emergency room was increased from 7 to 12.

ED overcrowding is the hallmark of a mismatch between the availability of health care resources and patient demand for emergency care. Among major factors contributing to these situations are hindrances in patient flow and occupation of ED beds by nonurgent patients. The establishment of a discharge unit in the ED could be a practical solution to ED overcrowding

Traumatic long-bone fracture is a common cause of referring to the emergency department (ED). The aim of this study was to compare the efficacy of nebulized ketamine and morphine and intravenous (IV) morphine in reducing pain in these patients. In this clinical trial study, 88 patients with traumatic long-bone fractures referred to the ED were randomly selected and divided into two groups of nebulized ketamine and morphine and IV morphine using block randomization. Changes in pain intensity according to visual analog scale (VAS), patient satisfaction, and clinical features, including oxygen saturation (O2 sat), systolic blood pressure (SBP), respiratory rate, and pulse rate (PR) were assessed at baseline and 15 and 30 min after the intervention and finally, data were analyzed using the SPSS software. Demographic characteristics including sex, age, and site of fracture were similar in the two groups (P > 0.05). In the IV morphine group, O2 sat (P < 0.001), SBP (P = 0.005), and PR (P < 0.001) significantly decreased, but in the nebulized group, SBP (P < 0.001) and PR (P < 0.001) significantly increased, but O2 sat did not significantly decrease (P > 0.05). The VAS results in the IV group were better at 15 min (P < 0.001), but after 30 min, both methods were equally effective in pain reduction (P = 0.508). According to the results of this study, the pain reduction was similar in both groups after 30 min, but regarding other parameters such as patients' satisfaction and fewer side effects, it can be concluded that the long-term effect of nebulized morphine and ketamine would be more beneficial.

Several methods have been used in wound closure for traumatic wounds, but it is not clear that which of these methods has more safety and efficacy. This study aimed to compare scar width due to standard and current treatments in wound repair by suturing and method of wound restoration using wound tape in patients with traumatic ulcers.

This randomized clinical trial was done in ninety patients with wounds in the facial area. They were divided randomly into two groups of 45. The wounds in the first group were sutured, and wound tapes were used to wound closure in the second group. After 2 months, length and width of scar and results of life‑size photography were recorded in a list, especially prepared for this purpose.

The mean age of the patients was 22.7 ± 12.9 years with 46 males (56.1%) and 36 females (43.9%). After 2 months, scars width in suture wound group was 2.9 mm and in wound tape group was 2.5 mm, with no statistically significant difference (P = 0.07). In patients with wound length of >20 mm, scars width was similar between groups and no significant differences was noted (P = 0.27), but in patients with wound length of <20 mm, scars width in wound tape group was significantly less than suture wound group (1.7 vs. 2.5 mm, respectively, P = 0.01). Wound complications were not significantly different between the two groups.

Findings revealed that scar formation in wounds lower than 20 mm treated using wound tape was lower than suture, but for wounds between 20 and 50 mm were similar between wound tape and suture.

The present study was designed to evaluate the effectiveness of magnesium sulfate (MgSO4 ) in procedural sedation and analgesia (PSA) when combined with ketamine in patients with fractures in emergency departments and required short and painful emergency procedures.

In this study, 100 patients with fractures and dislocations who were presented to the emergency departments and required PSA for short and painful emergency procedures were randomly allocated to groups of ketamine plus MgSO4 or ketamine alone. Train of four (TOF) stimulation pattern was assessed using nerve stimulator machine and compared between groups.

The mean age of studied patients was 46.9 ± 9.3 years old. 48% were male and 52% were female. No significant differences were noted between groups in demographic variables. The status of TOF, 2 min after the injection of ketamine (1.5 mg/kg), in both groups was similar. After the injection of the second dose of ketamine (1 mg/kg) the status of TOF in four patients in ketamine plus MgSO4 (0.45 mg/kg) group changed, it was three quarters but in ketamine group, the status of TOF in all patients was four quarters. The difference between groups was not statistically significant (P = 0.12).

The findings revealed that for muscle relaxation during medical procedures in the emergency department, ketamine in combination with MgSO4 with this dose was not effective for muscle relaxation during procedures.

Almost 25% of the world population suffer from early death due to preventable events. Trauma and sudden cardiac death are known as common causes of death. The arrival time to help the patient is known as a very important factor in enhancing survival and reducing side effects.

The aim of the present study was to identify the factors relating to the efficacy of prehospital emergency service (timerelated performance). In addition, it was intended to describe time indices of prehospital services among patients who had internal medical and trauma related problems.

In the present cross-sectional study, all the calls to the emergency medical service (EMS) were monitored. The reasons of these calls were internal medical problems and trauma (March 2009 to March 2013). The frequency of calls were derived from the information bank of EMS in Isfahan, Iran. Demographic features, type of events, time indices of EMS and the outcomes of registered patients were collected and the data were analyzed using descriptive and analytical statistics. Descriptive statistics included frequency, percentage, mean, median, and standard deviation and inferential statistics included t-test, ANOVA, multiple regression and chi-square test.

From a total of 299956 cases who had sought help, 61.9% were men. Also, 48.5% of the cases had internal medical and 51.5% had traumatic injuries. In 61.5% of the cases, the injured persons were transferred to the hospital and 3.2% of the cases resulted in death. The men had a morality rate of 1.6 more than women (P < 0.001). Response times were significantly higher than the standard of 8 minutes (P < 0.001). In 50.6% of the cases, the mean response time was less than 8 minutes.

Considering the increasing trend of traumatic events, especially in active groups of society (age groups of less than 45), equipping and updating ambulances and providing the EMS personnel with better training can help the injured people in reducing aftermath consequences. On the other hand, increasing neurologic problems in these age groups is an alarm for health managers and health workers, so that they can improve public health through revising health guidelines. Increase in the response time in prehospital emergency missions is also an alarm for the managers who must revise the methods of conducting emergency missions

Central venous catheterization (CVC) is a commonly performed procedure in critically ill patients of emergency department. This study was designed to compare the diagnostic accuracy of saline flush with CXR in confirmation of above-the-diaphragm CVC placement.

This prospective cross sectional study was conducted on adult patients in need of CVC placement in emergency department. Placement Confirmation was performedwith saline flush method and CXR, then chest computed tomography (CT) was performed as the gold standard. The screening performance characteristics of the two methods were calculated and compared using SPSS 21 and STATA 11.

103 cases with the mean age of 57.18§9.3 (35 -80) years were studied (52.4% male). The mean duration of procedure was 2.5§1.24 in saline flush and 32.11§5.52 minutes in CXR method (P<0.001(. The area under the ROC curves for saline flush and CXR in confirmation of CVC placement were 0.90 (95%CI: 0.70 - 0.100) and 0.80 (95%CI: 0.55 - 0.100), respectively (p = 0.317). The sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio of saline flush were 80%, 100%, 100, 98.9%, Infinity, and 0.01, respectively. These measures were 60%, 100%, 100%, 98%, Infinity, and 0.02 for CXR, respectively.

It seems that saline flush method could be considered as a safe, rapid, and accurate bedside method for CVC placement confirmation in emergency department.

Burnout is viewed as an affective and passive reaction to chronic occupational stress that occurs as emotional exhaustion, physical fatigue, and cognitive weariness.The medical residency is one of the most challenging periods in the professional life of physicians and requires high psychological and physical energy. The aim of this study was to determine the prevalence of burnout among medical residents.
This cross-sectional study conducted on 104 emergency medicine, internal medicine, and obstetrics and gynecology residents in Isfahan University of Medical Sciences, Isfahan, Iran, using the Maslach Burnout Inventory. Data were analyzed using MANOVA, Cramer’s V, and Pearson correlation coefficient tests.
Findings: 71.15% of residents were burned out. The frequency percentage of burnout among obstetrics and gynecology residents was higher than in the other two groups (non-significant) and among the second- and third-year residents was higher than others (significant). In addition, the frequency percentage of burnout among women was higher than men (non-significant), and among the married residents was more than singles (significant). The mean burnout was not significantly different in various levels of demographic variables namely type of specialty, year of study, gender, and marital status. There was no significant correlation between age and burnout.
Majority of residents were burned out. Given the importance of the consequences of burnout, periodic evaluation of residents’ burnout is necessary and psychological interventions should be prepared for them.

Head trauma is one of the most common reasons for emergency department (ED) care. Over the past decade, initial management strategies in mild and moderate head trauma have become focused on selective computed tomography (CT) use based upon presence or absence of specific aspects of patient history and/or clinical examination which has received more attention following reports of increased cancer risk from CT scans. Recently changes in serum brain natriuretic peptide (BNP) levels following head trauma have been studied. We investigated the changes in serum levels of BNP in patients with mild and moderate head trauma, in whom the first brain CT scanning was normal.

This study is a cross‑sectional, descriptive research. It was performed in patients with mild and moderate head trauma. Forty‑one patients with isolated mild and moderate traumatic brain injury (Glasgow Coma Scale = 9–15) were included. First brain CT scans were obtained during 2 h after ED arrival and the second one after 24 h. Plasma BNP levels were determined using a specific immunoassay system.

Twenty‑three patients were in Group A (with normal first and second brain CT) and 18 patients in Group B (with normal first and abnormal second brain CT). With P = 0.001, serum BNP level = 9.04 was determined for differentiating two groups.

We concluded that serum BNP level is higher in patients with mild and moderate head trauma with delayed pathologic changes in second brain CT relative to patients with mild and moderate head trauma and with normal delayed brain CT.

Nausea and vomiting are the most common complications after minor head trauma that increases the risk of intracranial pressure rising. Therefore, the present study was aimed to compare the antiemetic effects of metoclopramide and ondansetron in the treatment of post-traumatic nausea and vomiting. The study was a controlled, randomized, double blind clinical trial, which was conducted in the first 6 months of 2014 in emergency department Al-Zahra and Kashani Hospitals in Isfahan, Iran. The patients with minor head trauma associated with nausea and vomiting were randomly divided into 2 groups: treatment with metoclopramide (10mg/2ml, slow injection) and treatment with ondansetron (4mg/2ml, slow injection). The comparison between the 2 groups was done regarding antiemetic efficacy and side effects using SPSS 21 statistical software. 120 patients with minor head trauma were distributed and studied into two groups of 60 patients (mean age 35.6±14.1 years; 50.0% male). Administration of both ondansetron and metoclopramide significantly reduced the severity of nausea (P<0.001). Changes in the severity of nausea in both groups before and after the treatment revealed that nausea had been decreased significantly in both groups (P < 0.001). The incidence of fatigue (p=0.44), headache (p=0.58) and dystonia (p=0.06) had no significant difference in the two groups but the incidence of drowsiness and anxiety in the metoclopramide group was significantly higher (P < 0.001). The present study indicated that the treatment effectiveness of ondansetron and metoclopramide are similar. However, incidence of drowsiness and anxiety in the metoclopramide was considerably higher. Since these complications can have adverse effects on the treatment of patients with brain injury, it is suggested that it may be better to use ondansetron in these patients.

FOXP3 gene is an X-linked gene that encodes FOXP3 protein, an essential transcription factor in CD4+CD25+FOXP3+ regulatory T (Treg) cells. We aimed, in the present study, to investigate the association of two FOXP3 polymorphisms, -2383 C/T (rs3761549) and IVS9+459 T/C (rs2280883), with lung cancer. In a case-control study we analyzed genotypes and alleles frequencies at -2383 C/T and IVS9+459 T/C positions in 156 patients with lung cancer and 156 age and sex matched healthy controls in Southern Iranian population, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods. The data were verified by direct automated DNA sequencing. The frequency of -2383 T allele was significantly higher in the patients than in the control group (11.8% versus 5.9%, P-value=0.04, OR=2.13, 95%CI=1.04-4.54). T allele frequency at IVS9+459 T/C position was higher, compared to the controls, in the patients who presented the disease over 55 years old (69.9% versus 59.1%, P-value=0.04, OR=1.61, 95%CI=1.01-2.55) and also in SCLC patients (77.8% versus 59.1%, P-value=0.03, OR=2.42, 95%CI=1.05-5.59). No significant differences were found in the genotypes and haplotypes distributions between the cases and controls. A high degree of linkage disequilibrium was observed between two polymorphisms. As the first study dealing with -2383 C/T and IVS9+459 T/C in lung cancer, our data conclusively suggest the association of -2383 T allele with susceptibility to lung cancer in Iranian population. The association of IVS9+459 T allele with susceptibility to lung cancer in old patients suggests the age-dependent effects of FOXP3 gene on cancer occurrence.

Management of acute and chronic wounds has significantly altered in the last decade but little attention has been paid to the solution used for cleansing the wounds. Therefore, the present study aimed to compare the effects of tap water, distilled water, and normal saline for wound cleansing in emergency department.
This is a double-blind randomized clinical trial with a 10-day follow up. Patients who had superficial wounds were randomly divided into 3 treatment groups: normal saline, distilled water, and tap water. The wounds were cleansed using a 20 - 60 milliliter syringe with an 18 gauge needle. All the patients were discharged with the same antibiotic and were followed 48 hours and 10-day to determine the presence or absence of infection symptoms. The evaluated outcomes were infection incidence in the first 48 hours and 10 days after being discharged.
1200 patients were included in the present study (57% male, average age 25.5 ± 11.0 years). 43 (3.5%) patients showed infection symptoms in the first 48 hours. Ten (2.5%) patients were in normal saline treated group, 15 (3.7%) patients were in distilled water group, and 18 (4.4%) patients were in tap water treated group (p=0.32). 13 (3.2%) patients in normal saline group, 20 (4.9%) patients in distilled water group and 23 (5.6%) in the tap water group did not take their antibiotics. Prevalence of infection were higher in patients who did not take antibiotics (p The results of the present study showed that the prevalence of infection in using the 3 agents (normal saline, distilled water and tap water) for cleansing wounds was similar. Therefore, drinking water could be considered as an alternative for cleansing wounds.

Physicians frequently deal with procedures which require sedation of pediatric patients. Laceration repair is one of them. No study has been performed regarding the comparison between induction of sedation with sodium thiopental and ketamine in laceration repair. Therefore, the present study was aimed to comparison of induced sedation by rectal sodium thiopental and muscular injection of hydrochloride ketamine in pediatric patients need laceration repair. The presented study is a single-blinded clinical trial performed through 2013 to 2014 in Ayatollah Kashani and Alzahra Hospitals, Isfahan, Iran. Patients from 3 months to 14 years, needed sedation for laceration repair, were entered. Patients were sequentially evaluated and randomly categorized in two groups of hydrochloride ketamine with dose of 2-4 milligram per kilogram and sodium thiopental with dose of 25 milligram per kilogram. Demographic data and vital signs before drug administration and after induction of sedation, Ramsey score, time to onset of action, and sedation recovery time were evaluated. Chi-squared, Mann-Whitney, and Non-parametric analysis of covariance tests were used. P<0.05 was considered as a significant level. In this study 60 pediatric patients were entered. 30 patients with mean age of 42.8±18.82 months were received sodium thiopental and the rest with mean age of 30.08±16.88 months given ketamine. Mann-Whitney test was showed that time to onset of action in sodium thiopental group (28.23±5.18 minutes) was significantly higher than ketamine (7.77±4.13 minutes), (p<0.001). The sedation recovery time in ketamine group (29.83±7.70) was higher than sodium thiopental. Depth of sedation had no significant difference between two groups based on Ramsey score (p=0.87). No significant difference was seen between two groups in the respiratory rate (df=1, 58; F=0.002; P=0.96) and heart rate (df=1, 58; F=0.98; P=0.33). However, arterial oxygen saturation level (df=1, 58; F=6.58; P=0.013) was significantly higher in ketamine group. The findings of the present study show that Although the recovery time from sedation by ketamine is more than sodium thiopental, it’s fast-acting function without effecting on the oxygen saturation level causes that ketamine is considered as the better choice for induction of sedation in pediatric patients need laceration repair. In addition, long-term effect of ketamine provides more time for the physician to do the procedure and this issue decreases the need probability to the repeated-dose. However, effectiveness of both drugs to decrease the agitation was equal, based on the Ramsey score.