جستجوی مقالات مرتبط با کلیدواژه « emergency room » در نشریات گروه « پزشکی »

From the perspective of complexity science, this commentary addresses Tenbensel and colleagues’ study, which reveals varied gaming behaviours to meet the New Zealand Emergency Department (ED) metric. Seven complexity-informed principles previously published in this Journal are applied to formulate recommendations to improve the design and implementation of metrics. (1) Acknowledge unpredictability. When designing a metric, policy-makers need to leave room for flexibility to account for unforeseen situations. When implementing a metric, they need to promote sense-making of relevant stakeholders. (2) Sense-making shall be encouraged because it is a social process to understand a metric, align values and develop a coherent strategy. Sense-making is important to (3) cope with self-organised gaming behaviours and to (4) facilitate interdependencies between ED and other departments as well as organisations. (5) We also need to attend to the relationship between senior management and frontline staff. Additionally, to address one of the methodological weaknesses in Tenbensel and colleagues’ study, (6) adaptive research approach is needed to better answer emerging questions. (7) Conflict should be harnessed productively. I hope these recommendations could limit gaming in future metrics and encourage stakeholders to view inevitable gaming as an improvement opportunity.

Limb swelling is among the frequent complaints of patients referring to the emergency room (ER).

We decided to take a step towards facilitating the diagnostic process of patients who refer to ER with such complaint, and find out whether emergency medicine physicians (EMPs) can play an effective role in this regard. 

This was a diagnostic accuracy study in which all patients who referred to the ER with a complaint of unilateral leg swelling were studied. The patients underwent bedside sonography by the researchers, who were emergency medicine physicians (EMPs), and also underwent a second sonography by the in-charge radiologist using the same device and probe. The accuracy of the diagnoses made by researchers was evaluated using the radiologists’ opinion as the gold standard. 

In this study, the data of 52 patients were analyzed. In general, the agreement rate between the EMPs and radiologists was 0.863, which indicates a proper agreement. Based on the findings, Kappa agreement for the four differential diagnoses ranged from 0.639 to 0.919 and the AUC was between 0.750 and 0.976. 

In this study, the overall agreement between the EMPs and radiologists was appropriate.

Hard days have come for medical staff. Before the storm, we took some of our dearest colleagues, as well as some of our compatriots, with us and made us sad, but there is no mourning. We have to work even harder than before and fight. Keywords: Medical Resident; COVID-19; Emergency Room.

Patients with acute renal colic need to choose between undergoing medical treatments and re- ceiving interventions. The Aim of this study is to evaluate the outcomes of patients who are discharged from emergency departments with ureteral stones lesser than 6 millimeters. In doing so, the effect of diagnostic treat- ment approaches on clinical outcomes and referral rate is to be assessed.

This study was performed on patients with ureteral stones referred to emergency department of Shohadaye Tajrish Hospital between May2015 to June 2018. A checklist was filled out for each patient and it included their complete medical history, physical examination results and paraclinical data. Patients were then studied for 4 weeks to determine referral times to hospital and clinical outcomes.

105 patients include 81 men (77.14%) with average age of 37.1±12.4 years were studied. The mean stone diameter was 4.2±2.1 mm. Most of ureteral stones were seen in the right- hand side (60 percent). 71 patients (67.6%) did not have any history of nephrolithiasis and 73 (69.5%) did not have positive family history for nephrolithiasis. Ureteral stones were still observed in 42 patients (40%) after two weeks of studies and only one patient (1.1%) had stone in Ultrasound Imaging after 4 weeks of observations.

Most Patients (95%) with stones smaller than 6 mm responded to Medical Expulsive Therapy (MET) after 4 weeks and passed spontaneously ureteral calculi.

The ability to perform cardiopulmonary resuscitation (CPR) is among the most important professional skills for physicians and nurses. There is a wide difference among different countries respecting resuscitation success rate. Studies show weaknesses in performing resuscitation. This study aimed at assessing the effects of clinical audit of CPR in the emergency room based on the Situation Stabilization Model (SSM). This quasi-experimental study was done in 2017 in the emergency room of Baqiyatallah Hospital, Tehran, Iran. Using the Adib checklist, 35 resuscitations were assessed based on the steps of clinical audit. Then, a 1-month educational program was held for the resuscitation staffs in the study setting. Then, 35 new resuscitations were assessed using the same checklist. Finally, the results of the two measurements were compared. There were significant differences between two measurement time points regarding the mean scores of different resuscitation skills (P < 0.001). Primary resuscitation success rate increased from 6 (17.1%) cases at baseline to 8 (22.9%) of the cases after the intervention. This increase was not statistically significant (P = 0.47). Clinical audit in the emergency room based on the SSM improves the quality and the success rate of CPR. The success rate is in our study increased. Furthermore, the reported data were not statistically significant for improving the success rate; it is clinically important. Because primary resuscitation success rate increased from 6 (17.1%) cases at baseline to 8 (22.9%) cases after the intervention. These findings highlight the necessity and the importance of the clinical audit of care services as well as the implementation of educational interventions based on the existing weaknesses. Given the great importance and sensitivity of resuscitation, health-care staffs need to receive regular theoretical and practical in-service resuscitation-related training.

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.

In daily ENT practice foreign bodies in children are a frequent occurrence. In most instances, removal of the foreign body is easily accomplished. In some cases removal is only possible under brief general anesthesia.
The present work is intended to provide an overview of the first aid management of foreign bodies in the ENT field.
The study was conducted at the Charite University Hospital Berlin, campus Virchow Klinikum (Germany). All children referred to the otolaryngologist on duty in the emergency room between 2009 - 2013 with a suspected foreign body were included in the retrospective study.
517 children were included in our study. We removed foreign bodies from the following sites: ear 161, nasal cavity 237, nasopharynx 8, and oropharynx 29. Furthermore, 15 foreign bodies were found at other sites in the aerodigestive tract. 51 foreign bodies were removed under general anesthesia.
The management of foreign bodies in ENT in children should be adapted to the location, the nature of the foreign body and the child’s age in order to ensure a safe and gentle removal. Interdisciplinary collaboration is required in particular to avoid complications.

Traumatic injuries exert significant burden on human populations around the world. Iran as a developing country is at top 5 deadliest countries regarding injuries; however, few studies have examined the descriptive epidemiology of trauma in Iran.

To describe injuries regarding age, gender and injury mechanism and also time trend in emergency departments of Shahid Rajaee Trauma Center affiliated to Shiraz University of Medical Sciences.

This descriptive cross-sectional study was carried out on all trauma patients (n = 21542) admitted to Shahid Rajaee Trauma Hospital (level I trauma referral center in Shiraz) between March 2011 and March 2012. Data were analyzed separately by age, gender, month of admission, and injury mechanisms (motorcycle collision, car-pedestrian accidents, car-car accidents, fall from height, stab wounds and gunshot injuries).

With a mean age of 36.0 ± 17.2 years, a total number of 21542 patients were visited, 16524 (76.7%) of whom were male. The male to female ratio was 3.3:1 with injured men being significantly younger than women (mean age 33.7 + 16.6 and 43.6 ± 19.2 years, respectively). There were 1492 trauma victims older than 60 years accounting for the smallest proportion of the population (6.92%). On admission, 1699 patients (7.9%) required cardiopulmonary cerebral resuscitation (CPCR) with a sex ratio of 2:1. Among those requiring CPCR, falling down was the major cause (45.24%) of injury in elderly (patients over 60 year) and car accident in those under 60 year (43.94%).

Injuries affect all age groups; however, the disproportionately at risk population is the productive youth. Preventive strategies should focus on reducing trauma incidence among young men at population level. Considering the higher number of incidents occurring in mid spring and late summer, authorities should devise preventive plans mainly through alteration of traffic rules in this period.

Nurses as the major group of health service providers need to have a satisfactory quality of work life in order to give desirable care to the patients. Workplace violence is one of the most important factors that cause decline in the quality of work life. This study aimed to determine the quality of work life of nurses in selected hospitals of Isfahan University of Medical Sciences and its relationship with workplace violence. This was a descriptive-correlational study. A sample of 186 registered nurses was enrolled in the study using quota sampling method. The research instrument used was a questionnaire consisting of three parts: Demographic information, quality of work life, and workplace violence. Collected data were analyzed using descriptive and inferential statistics by SPSS version 16. The subjects consisted of 26.9% men and 73.1% women, whose mean age was 33.76 (7.13) years. 29.6% were single and 70.4% were married. About 76.9% of the subjects were exposed to verbal violence and 26.9% were exposed to physical violence during past year. Mean score of QNWL was 115.88 (30.98). About 45.7% of the subjects had a low level of quality of work life. There was an inverse correlation between the quality of work and the frequency of exposures to workplace violence. According to the results of this study, it is suggested that the managers and decision makers in health care should plan strategies to reduce violence in the workplace and also develop a program to improve the quality of work life of nurses exposed to workplace violence.

Researchers believe that there are social exchanges between the employers and employees, because the employees would be interested in their organization and trust it based on how the organization values them and their welfare, comfort, and security. This belief is known as perceived organizational support that makes employees consider themselves as a part of their organization and have a commitment to it. The literature review is very limited in both variables in Iran and thus few studies also report the perceived organizational support and job involvement at the lower levels in our country. This research aimed at studying the levels of perceived organizational support and job involvement, relationship between this two, and the demographic factors relationship with both of them.

This research was a descriptive analytical study conducted in 2012. The population included 123 emergency nurses in General Hospitals of Qom. Data were collected through Perceived Organizational Support and Job Involvement Questionnaires and analyzed using SPSS software, descriptive statistics and Spearman correlation and Chi-square test.

Both mean scores for perceived organizational support and job involvement were in average level, 146/12 and 35/38, respectively. There was a significant relationship between perceived organizational support and age, education, tenure, organizational position, and job shift. There was also a significant relationship between job involvement and age and education and finally between perceived organizational support and job involvement (P = 0/029).

The high correlation between perceived organizational support and job involvement indicates that the improvement of perceived organizational support are necessary through motivating the employees, showing interest in them, paying attention to them, respecting them, and providing development opportunity in the organization. These should be always considered by managers to improve job involvement

This study was performed to determine the demographic and outcome of penetrating abdominal trauma in patients attending to emergency medicine department.

This was a descriptive cross-sectional study in Imam Hossein Medical Center. Seventy five patients who came to our department with penetrating abdominal trauma during a 1 year period were enroled into this study and their demographic data and outcome (during the hospitalization) were recorded. The study was at Imam Hossein Medical Center, Tehran, Iran, from 2009 to 2010.

Our findings indicate these notable

84% of patients were less than 40 years old, most patients attended emergency department during the spring and summer, 72 patients (96%) arrived between 7 pm and 7 am, 74 patients (98.7%) had stab wound and one person (1.3%) was shot, eventually 46 patients (61%) had laparatomy performed and 2 patients (2.7%) died. 59 patients out of 75 study cases appealed to police department and legal medicine council.

The incidence of abdominal penetrating trauma due to stab wound is much higher than gunshot in our community, which indicates the importance of educating the emergency staff and preparing the emergency department work place to attend to these patients, especially during the night hours.