shaghayegh rahmani

Patient safety remains a critical concern for healthcare systems, particularly in developed nations. A substantial proportion of patients experience complications and adverse events attributable to healthcare delivery, exacerbating their initial health issues. Many adverse events are likely to go unnoticed, unreported, and consequently unaddressed. This issue largely stems from inadequate surveillance methods that require significant improvement to achieve excellence in delivering safe, high-quality care for emergency patients.

This study aimed to develop an emergency department trigger tool (EDTT) to identify adverse events in the emergency department (ED) to enhance patient safety and quality improvement.

Conducted under the supervision of Mashhad University of Medical Sciences, this study comprised four stages: (1) a systematic review, (2) refinement and automation of empirical triggers, (3) a modified Delphi process to compile a list of validated triggers from experts, and (4) final environmental data collection to determine the most effective triggers.

The study included a systematic review of electronic resources, revealing no prior Persian equivalent of a trigger tool. A total of 502 articles were identified in PubMed, 100 in Google Scholar, and 410 in Scopus. After removing duplicates and adding four articles based on reference searches, 1,016 article titles were initially reviewed. Two independent researchers evaluated the articles on the same day in two locations. In cases of disagreement, a third researcher's opinion was sought. Ultimately, 295 articles were selected, with high inter-rater reliability (0.82). Forty-two articles were included in the final analysis. The developed tool contained 50 triggers organized into six groups. In a review of 100 ED cases, an average of 1.2 triggers was identified per patient file, with 99 (79.8%) of these triggers attributed to medical errors.

This study successfully designed an emergency department trigger tool (EDTT) utilizing a systematic review and the Delphi method. The resulting trigger tool can be employed to assess high-risk situations and potential emergency medical errors. A significant advantage of this tool over previous versions is its focus on high-risk conditions without relying solely on the absence of appropriate actions as indicators of danger.

Integrating artificial intelligence (AI) in healthcare can significantly enhance diagnostic precision, therapeutic effectiveness, and healthcare administration. However, as AI has become more widespread recently, it raises several legal and ethical concerns that require meticulous consideration. A primary concern is determining liability when AI systems commit errors, such as misdiagnosing diseases or prescribing treatments. The legal framework to address this issue is currently unclear, and establishing guidelines for accountability is crucial to ensure patient safety and trust (1).   A critical concern is safeguarding patients' privacy and ensuring their data's security. Maintaining the confidentiality of sensitive medical information and protecting it from unauthorized access or misuse is paramount. This issue involves implementing robust data management protocols, encryption techniques, and access controls to prevent breaches and uphold patients' trust in healthcare providers. Addressing these privacy and security challenges is essential to delivering high-quality, ethical, and responsible patient care. AI systems rely heavily on large datasets for training and decision-making, which raises concerns about unauthorized access or breaches that could compromise patient confidentiality. To effectively address the concerns of patient privacy and data security, healthcare providers must adhere to strict regulations like the Health Insurance Portability and Accountability Act (HIPAA). It ensures that patient data is properly managed and protected from unauthorized access or misuse. Additionally, AI systems used in healthcare must be designed with robust security measures to prevent data breaches and ensure the integrity of patient information (1). AI algorithms are often perceived as unbiased tools, but if trained on biased or incomplete data, they can inadvertently perpetuate discrimination or inequality in healthcare outcomes (2). Addressing algorithmic bias and ensuring fairness of AI systems through ongoing oversight and regulation is essential to mitigate this risk and prevent the perpetuation of health disparities. In emergencies, timely decisions are crucial for saving patients. When AI is involved in high-pressure decision support systems, concerns inevitably arise about liability when mistakes occur (3). The challenge lies in determining who is accountable for AI-driven decisions in healthcare emergencies, which needs clear guidelines and protocols to ensure accountability and patient safety. The integration of artificial intelligence (AI) into the medical field has the potential to significantly improve patient care and healthcare outcomes. However, the legal hurdles associated with AI in medicine are substantial and cannot be ignored. To ensure the responsible and ethical implementation of AI systems in healthcare, it is essential to address legal issues such as liability, data privacy, bias, regulatory compliance, and informed consent. A collaborative approach involving healthcare professionals, policymakers, and legal experts is not just beneficial, but necessary to develop comprehensive legal frameworks that protect patient rights while promoting innovation in this transformative field.

Primary ciliary dyskinesia (PCD) is a rare genetic disease that is estimated to occur in about 1 in 15,000 people. A patient registry is a well-known tool for collecting a sufficient number of patients with a rare disease to evaluate and monitor the patient’s information in a standard and continuous way, as well as to conduct clinical research on the disease, which can be used for early diagnosis. Standard treatment and follow-up of PCD patients will help us. In this study, we developed a PCD registry for the Iranian population.   In this study, for the first time in Iran, the PCD Registry was presented to record demographic information, clinical diagnostic symptoms, diagnosis method, management, and follow-up of patients called IPOLD (Iranian Pediatric Orphan Lung Disease). This PCD Registry can be used in all provinces of Iran, and a network of PCD treatment centers can be established. Two hundred fifty-six patients diagnosed with PCD, regarding demographic information, diagnostic clinical symptoms, disease diagnosis method, imaging, spirometry, and microbiological findings, were referred to university hospitals and clinics covered by the Tehran University of Medical Sciences from April 1401 to April 1402. We used SPSS to analyze data and performed descriptive tests.   In this study, the average age of disease diagnosis was 5.7 years. The most common diagnostic symptom of the patients was chronic cough, with the belief of 94.3%. 56.7% of patients with distress were hospitalized and hospitalized in infancy. Bronchiectasis was seen in CXR or Chest CT in 28 patients (11%), and the severity of bronchiectasis was evaluated using the Bronchiectasis Severity Index (BSI); 13 cases have mild bronchiectasis (46%) and 15 moderate cases (53%). Atelectasis was seen in 47% of patients, with the predominance of RML involvement in 35%. Lung infiltration was reported in 15% of patients. PCD diagnosis method in 46 patients was based on PICADAR clinical diagnosis, 173 patients by nasal nitric oxide test, 31 by genetic test, and six by TEM.  The patients’ information was registered in the registration system, IPOLD, Iran, for children's orphan lung disease.

According to the World Health Organization (2022), severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is liable for more than 572 million cases worldwide and more than six million deaths globally. It has been reported that pregnancy can change the disease manifestations such that gastrointestinal symptoms, which are common in pregnant women, are difficult to distinguish from COVID-19 related complications. Hence, in isolated cases of gastrointestinal or liver forms of COVID-19, diagnosis might be delayed. Previous studies have suggested that serious complications of COVID-19 in pregnancy are associated with a higher body mass index (BMI), gestational diabetes, and older age; thus, this population should be considered as high risk. In this article, we summarized previously published evidence about pregnant women with COVID‐19 and liver dysfunction.

The patient handling time can affect a patient’s access to critical care; also, there is a relationship between patient handling time in the emergency ward and recovery rates. Nurses and staff of emergency wards are essential factors affecting patient flows in emergency wards.  This cross-sectional study focused on the flow of patients referring to the level-1 Academic Traumatic Emergency Ward during 2018-2019. Nurses were divided into two categories of group and small-group training, each receiving two training rounds one month apart. The Revised Form of Timing and Workflow Emergency checklist was used for evaluation.  Evaluating 600 patients showed that the average time from patient entry to level 3 triage up to file creation was 24.8 minutes before interventions, and the same was 19.6 minutes for small groups and 17.6 for group training category (p<0.05), pointing to the fact that the group training category showed a significant reduction in average time from patient entry to triage to file creation. The present study found that the training of nurses is practical for the flow times of patients hospitalized in emergency wards.

Although American Heart Association Guidelines (AHA) are practical and standardized in many aspects of car-diopulmonary resuscitation (CPR) performance, recommendations on when to terminate resuscitation are notfully understood and clear. There is not enough evidence about how long we can continue CPR in shockablerhythms and how many shocks can be delivered to patients, and if there is an end point for it or not. This is-sue is more challenging when we read papers published on survival rates and good functional and neurologicaloutcomes after prolonged CPRs. Here, we demonstrate a case of cardiac arrest receiving CPR in the emergencyroom, for whom it was hard and challenging to make a decision on when to terminate the resuscitation attempts.

As the epidemic spreads, COVID-19 poses a severe threat to the health of communities. Description of epidemiological characteristics of COVID-19 patients helps with the prevention and scientific control of the pandemic. This descriptive study was conducted to describe the clinical, demographic, and epidemiological characteristics of 65 patients suspected of having COVID-19. A researchmade questionnaire was used for data collection. Moreover, the patient’s vital signs were examined. The samples were classified into the two groups of subjects with positive and negative RT-PCR test. Descriptive statistics were used for the analysis of data. The most common manifestations were fever, shortness of breath, and dry cough. Moreover, the lowest proportion belonged to Rh-negative in all ABO blood groups. The patients were mainly male, about 44 years old, and their first and most common manifestations were fever, shortness of breath, and dry cough. In vital signs examination, reduction of blood oxygen saturation was the most important finding. Health centers need to consider these signs in treating COVID-19 patients.

In March 2020, the World Health Organization introduced the Coronavirus disease 2019 (COVID-19) pandemic as a global health concern and predicted that without any changes in the transmission process, the disease would reach its peak in April. Hence, it wasnot unreasonable to expect the referral of pregnant women in all trimesters. Since respiratory illnesses can increase the riskof infectious diseases and maternal mortality, it is justifiable to consider COVID-19-positive cases as high-risk pregnancies.

The present study introduced six pregnant women with COVID-19and discussedthe points to consider in managing these patients.

Pregnant women are at increased risk in all epidemics of infectious diseases due to their physiological and immunological changes. Moreover, the safety of the fetus is another important issueto consider.

Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic.

We report 5 cases that missed triage or received delayed diagnosis because of COVID-19 suspicion. Some cases are life threatening.

Although COVID-19 is the main health concern these days, other critical conditions should be considered. Stabilizing patients before transferring them between hospitals should be the essential goal of emergency department whether the patient is Corona virus infected or not. And before any intervention, the safety of healthcare workers must be ensured.

Regarding the high prevalence of asymptomatic infections, recognition of patients infected with Coronavirus Disease 2019 (COVID-19) has turned into a challenging issue. Therefore, this study aimed to evaluate the prognosis of asymptomatic patients with abnormal CXR indicative of COVID-19 for two weeks. This cross-sectional study included 40 patients who were referred to shahid hashemi nezhad hospital with trauma and underwent CXR. The patients were selected based on the purposive sampling method. The inclusion criteria were asymptomatic patients with trauma who were referred to our hospital and underwent chest CXR indicative of COVID-19. Demographic characteristics of the patients were recorded in a checklist. The real-time reverse transcription-polymerase chain reaction assay was carried out to diagnose the novel COVID-19. Out of 40 patients, 23 cases had positive test results; however, the others did not perform the test. The patients were followed up for 30 days in terms of the progress of their respiratory disease. Furthermore, those in the hospital were controlled daily, and the discharged cases were followed up via telephone. This study included 40 traumatic patients, and the majority of cases (n=29,72.5%,) were male. Upon admission, 37 (92.5%) cases had no signs of common cold, such as cough and fever. However, three (7.5%) patients had an occasional cough, and 10 (25%) cases remembered to have flu-like symptoms in the past two weeks. The mean hospital stay of the patients was estimated at 3.2±1.4 days. It should be noted that no death and respiratory distress syndromes occurred during the follow-up period. A favorable prognosis of asymptomatic patients with CXR indicative of COVID-19 was obtained in this study, and none of the cases developed critical forms of the disease.

Stroke is known to be the third most prominent cause of death in the developing countries and the most common debilitating neurologic disease. This study aimed to investigate the association of platelet count (PC) and mean platelet volume (MPV) index with various stroke types.

This cross-sectional study was carried out on patients over the age of 18 years who presented with signs and symptoms of the first acute stroke. Exclusion criteria were underlying chronic liver or renal disease and the time more than 6 hours from symptom initiation, hematological and infectious disorders in patients. After recording of demographic data, a complete blood cell count (CBC) test was performed.

From 150 patients, who enrolled in the study, 54.7% of patients were males. The initial brain CT scan was normal in 13 (8.7%) patients and showed evidence of brain infarction and intracranial hemorrhage in 84 (56%) and 53 (35.3%) patients respectively. Patients with intracranial hemorrhage had significantly higher mean of MPV index than the patients with normal brain-CT scan and patients with evidence of brain infarction (p<0.001).

The MVP index can be a predictor of the type of hemorrhagic or ischemic finding in emergency CT scan in stroke patients. This relationship may help to better understand the physiopathologic role of platelets in the development of stroke (hemorrhagic or ischemic), but will not replace cerebral computed tomography to diagnose the type of stroke, or it may not initiate treatment for hemorrhagic stroke.

The novel coronavirus (SARS-CoV-2 [2019-nCoV]) is the origin of several cases of pneumonia in Wuhan, Hubei province, China. According to the reported data, children are less common to be infected by COVID-19. Besides, their mortality rate is almost zero.

In this article, we investigated six children who were infected by COVID-19 and discuss the various symptoms of disease in children.

In this article, we investigated six children with various clinical manifestations, and based on our patients' presentations, death undoubtedly occurs among children infected by COVID-19. The majority of our sample population includes boys, therefore we suggest this theory that this virus is more probable to be severe among the male gender.

Four weeks have passed from the first reported case of covid-19 in Iran. During the past month, thousands of patients ran to emergency departments (EDs) due to respiratory complaints. From the beginning of coronavirus disease 2019 (COVID-19) outbreak, EDs have become particular units for admitting patients with respiratory complaints. The question is “what happens to other routine patients of ED?”

Violence against women is a global phenomenon, and varies based on the political, social and cultural characteristics of each place and location. Domestic violence is the most common type of violence against women. This study was performed with aim to investigate physical domestic violence and its most common contributing factors.

This case-control study was performed in 2016-2019 on 23 pregnant women referred to trauma emergency of Shahid Hasheminezhad and Emal Reza hospitals of Mashhad with complaint of trauma due to domestic violence and other 23 patients due to trauma of other factors. Data collection was done by researcher-made questionnaire including three sections (demographic characteristics, type of domestic violence, and contributing factors). Data were analyzed by SPSS software (version 16) and Chi-square, Fisher-exact, Student t, or Mann-Whitney tests. P

During the three year period of study, 23 pregnant women referred to the emergency department of two referral hospitals in Mashhad due to domestic violence. Regression analysis showed that the most common contributing factors of domestic violence were previous history of domestic violence, unemployment and economic problems, history of previous hospital admission due to domestic violence and drug abuse of spouse. 16 patients (34.6%) leaved the hospital against medical advice in domestic violence group and 30 patients (65.2%) patients hospitalized for further evaluation and treatment. Leaving the hospital against medical advice was significantly higher in domestic violence trauma patients (p=0.001).

Among the most important causes of domestic violence in the present study were the positive history of domestic violence in the person or family, as well as unemployment and economic problems.

A general bond additive index (GBA) can be defined as , where α(e) is edge contributions. The Mostar index is a new topological index whose edge contributions are α(e) = | nu - nv| in which nu is the number of vertices of lying closer to vertex u than to vertex v and nv can be defined similarly. In this paper, we propose some new results on the Mostar index based on the vertex-orbits under the action of automorphism group. In addition, we detrmined the structures of graphs with Mostar index equal 1. Finally, compute the Mostar index of a family of nanocone graphs.

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For the edge e = uv of a graph G, let nu = n(u|G) be the number of vertices of G lying closer to the vertex u than to the vertex v and nv= n(v|G) can be defined simailarly. Then the ABCGG index of G is defined as ABCGG =sum_{e=uv} sqrt{f(u,v)}, where f(u,v)= (nu+nv-2)/nunvThe aim of this paper is to give some new results on this graph invariant. We also calculate the ABCGG of an infinite family of fullerenes.

Today, with the advances in the treatment of cardiovascular patients such as intravascular stents, cardiac valves and intraventricular pacing and heart transplantation, many patients require the use of anticoagulants such as warfarin, sprain, Plavix, osvix, Ticlopidine and other drugs. Drugs that cause warfarin toxicity can also disrupt patients' hemodynamic conditions and can be dangerous in older people with underlying diseases. This review study examines some of the most common drug interactions with warfarin. Considering the increasing use of herbal medicine by patients, the importance of educating patients on warfarin is crucial, as many of these drug interactions are dangerous and life-threatening. Due to widespread drug interactions with warfarin and comprehensive use of non-prescription drugs in our country, accurate education and training of warfarin users is of paramount importance. Today, with the advances in the treatment of cardiovascular patients such as intravascular stents, cardiac valves and intraventricular pacing and heart transplantation, many patients require the use of anticoagulants such as warfarin, sprain, Plavix, osvix, Ticlopidine and other drugs. Drugs that cause warfarin toxicity can also disrupt patients' hemodynamic conditions and can be dangerous in older people with underlying diseases. This review study examines some of the most common drug interactions with warfarin. Considering the increasing use of herbal medicine by patients, the importance of educating patients on warfarin is crucial, as many of these drug interactions are dangerous and life-threatening.

In this article, we report a case of penetrating chest trauma as a suicide attempt. Case

A 40-year-old man complained of chest pain following a fall from a height (about three days ago). The patient refused to provide a complete history. After obtaining new and detailed patient's history from his father and reviewing his psychiatric file, it was determined that he performed trauma with the intention of committing suicide to his chest with a metal wire. There were two points of injury in his left hemithorax with infected crusts. Radiologic evaluation showed two foreign bodies in left hemithorax and hemothorax. Patient underwent surgery and finally was transferred to psychiatry unit.

It is important to get a detailed history of patients, especially those with mental disabilities and psychiatric disorders. Careful examination of these patients is recommended, even with the initial examinations. Key words: trauma, suicide, hemothorax, medical error

Background Atopic dermatitis (AD) is detrimental to the infants' and their families' quality of life. We aimed to study the disease effects on Iranian infants and their familiesapplying theinfants’ dermatitis quality of life index (IDQOL), and the dermatitis family impact questionnaires (DFI). Materials and Methods Questionnaires (DFI and IDQOL) were translated into Persian and retranslated into English. Three experts assessed the content validity of the questionnaires by evaluating the relevance and transparency of the tools. Test-re-test was used to evaluate the questionnaires reliability. The reliability and internal consistency of the IDQOL and DFI were accessed by Cronbach’s alpha coefficient which was 0.74. The construct validity of the questionnaires was assessed using the Pearson correlation index to evaluate convergent and divergent validity. 50 Infants with AD fulfilling the criteria as well as their parents entered the study in Mashhad, Iran, in 2017. An independent-sample t-test was used to compare mean scores and one-way ANOVA was used to analyze other data. Results Intense itching (64%), taking one to more than two hours to get the child to sleep (52%), and three to more than five hours of infant sleep disturbance (34%) were significant. Family expenses (70%), and emotional stress (68%) affected the families' quality of life prominently. There were significant differences between the average DFI scores and other allergic diseases, both among infants suffering from AD (p = 0.04), and their families (p = 0.03(. Conclusion The Persian versions of the questionnaires (DFI and IDQOL) have validly and reliably measured both groups' quality of life. Theyexperienced remarkable disturbances in their quality of life.

Background and purpose: Lack of clear boundaries and standard reference about the diagnosis of stroke, necessary evaluations and interventions, effective treatments, and referral of stroke patients resulted in various inconsistent services. Therefore, this study aimed at developing practical national strategies for stroke in Iran. Clinical guidelines about diagnosis and management of stroke were extracted from different guidelines. Three guidelines were selected according to AGREE scoring system after quality assessment and evaluation of clinical guidelines. In order to adapt the guidelines, recommendations of the three clinical guidelines were recorded in the form of clinical questions. Evidence supporting each recommendation was identified based on references and compared in terms of initial outcomes. Cost of interventions, the side effects, and clinical benefits were also studied. Finally, the national guideline for management of stroke was developed. The results of this investigation were presented as clinical recommendations for diagnosis and management of stroke (2016). For example, strict control of blood glucose level and fever in patients with aneurysmal subarachnoid hemorrhage was recommended in the guideline. The current indigenous stroke guide for the Iranian population is believed to be of great benefit in screening, referral, diagnosis, treatment, and follow-up of stroke.

Anesthesia is performed in two major methods including regional and general. The aim of this study was to compare the effect of anesthesia method (spinal and general) on oxidative stress in diabetic patients underwent diabetic amputation surgery.
In this randomized control trial, 40 patients with diabetic foot who were candidate for foot amputation surgery at our academic hospital in 2013, were selected and divided into two groups based on anesthesia method. Lipid peroxide level and serum total antioxidant capacity (TAC) were measured before anesthesia induction and one hour after surgery. As the normal range, the findings obtained from 23 healthy volunteers were utilized.
Mean age was 54.9±11.21 and 52.4±11.23 years in the spinal anesthesia (SA) and the general anesthesia (GA) group, respectively (P=0.49). Serum TAC in GA group increased from 1.03±0.04 mM to 2.98±0.7 mM. In SA group, the increase of serum TAC from 1.22±0.11 mM to 3.42±0.5 mM was observed that indicated the increase of serum TAC in both groups was not significantly different (P=0.21). Serum Malondialdehyde (MDA) in GA and SA groups did not show a significant difference before surgery (31.14±3.9 mM vs. 29.06±2.49 mM in GA and SA groups, respectively) (P=0.31), while it was significantly different after surgery (23.14±2.6 mM and 19.24±2.7 mM in GA and SA groups, respectively) (P=0.03).
lower limb amputation can help to control oxidative stress in diabetic patients; and considering serum MDA as a marker of oxidative stress, SA seems to be more effective to control this problem.

Ectopic pregnancy (EP) is considered a common disease worldwide. This study is intended to present a case report of ectopic pregnancy presented with syncope, a rare symptom.
Case: A 31 years old woman presented in emergency department of an academic trauma center with the chief complaint of head trauma. She was suffering of severe headache following falling down because of syncope. In prices exam she had unstable vital signs and was complaining of abdominal pain and tenderness. Routine laboratory tests including β-hCG, head CT scan, complete abdominal and abdominopelvic sonography were ordered for the patient. Results showed positive β-hCG and abundant free fluid in the abdominal cavity in sonography. After approval of ruptured ectopic pregnancy diagnosis, patient underwent laparotomy, salpingectomy and cystectomy.

Infertility of couples has many negative psychological and social consequences for society, and the physicians always seek to find the causes and treatment for this problem. Detection and treatment of Uterine and tubal causes can reduce the incidence of infertility. Therefore, this study was performed with aim to assess abnormal findings of hysterosalpingography (HSG) in infertile couples.
This descriptive study was performed on 308 women referring to the radiology clinic of Imam Reza hospital for hysterosalpingography between 2008 and 2015. A checklist was prepared from data recorded in files and reports of radiography. Data were analyzed by SPSS software (version 16).
During the study period, 308 infertile women referred with mean age of 30.5±6.4 years and mean duration of infertility of 2.4±2.8 years. 54% of patients had primary infertility and 46% secondary infertility. The most common pathology among the infertile women was tubo-peritoneal factor (72.5%). In 38 cases (10%), association of several other pathologies was observed. In patients with pathologies of the uterus, uterine horns (Bicornate) was the most common abnormal finding.
In hysterosalpingography of infertile women, the most common causes of infertility were tubo-peritoneal, Multifactorial and uterine factors, respectively.

Children are important component of future society and providing their health care is a national investment. With regard to close contact between mother and child, so, improving the mothers’ knowledge about neonatal care and the risk factors can be effective to prevent neonatal mortality and morbidity. This study was performed with aim to evaluate mothers’ knowledge about neonatal care in three educational hospitals of Mashhad University of Medical Sciences.
This cross-sectional study was conducted in 2014 on 784 pregnant women referred to maternity wards of Omolbanin, Emam reza and Ghaem hospitals. The data collection tool was a researcher-made questionnaire on neonatal care. Data were analyzed by SPSS software (version 16) and using t-tests, Chi-square and ANOVA. P The knowledge of 50 mothers (6.4%) about neonatal care was poor, 430 (54.8%) moderate and 295(37.6%) good. The mothers with diploma level education had the highest level of knowledge than other mothers. There was significant relationship between mother's level of education, job and mode of delivery with mother's knowledge about neonatal care (P=0.005).
Due to the effect of mother's knowledge in the prevention of neonatal disease and mortality, it is better to focus more on educating mothers, especially in the field of mother’s diet and exercise, nipple cracking, and safe drugs during breastfeeding for all mothers.