The role of military medicine and the significance of training military medicine.

Military forces are exposed to various kinds of special diseases for their occupational condition. As an academic discipline, Military Medicine serves to meet the healthcare needs of the forces. Professional Military Medicine has started working nearly from modern wars time in the 20th century. Regarding the growing global trends of war, terrorism, and natural disasters as well as modern changes in war strategies, weapons, and their consequences, Military Medicine is undergoing an evolution process. This review study was conducted to investigate the role and place of Military Medicine and the related approaches, medical curriculum, and the priority of developing specialized academic subfields of Military Medicine in Iran. Military physicians are in great need of knowledge, attitude, and skills. Today, Military Medicine includes a specialized approach, mobility, resuscitation, and stabilization of the injured as well as pre-hospital practices. Developing a specialized field for military emergency medicine with a special curriculum has been a priority in Iran that can meet the requirements of military forces for successful missions. Medical medicine departments of Military Medicine schools require new educational plans and curricula with specialized Military Medicine approaches and developments based on emerging needs. The most appropriate and the best option for military missions and emergencies in Iran is the physicians educated and specialized in Military Medicine.

Planning basics of need-based trauma training in asymmetric warfare focusing elements, materials, and sources of training.

Introduction and Aim: Trauma is one of the major causes of death and inability among populations serving on battlefields. Hence, all active forces on battlefields need to be prepared to cope with trauma. Therefore, training on trauma is a requirement for the battlefield, and achieving it is possible through need/facility-based training. Besides, one of the 10 elements of Akker is the educational and sources and materials component. Nowadays, educational resources have certainly changed significantly compared to previous decades. These days, sources like digital libraries, e-books, multimedia elements, podcasts, self-study, or training software are among the most important sources that seem to be very important with the expansion of technology. Methods: In the present study, which is a qualitative validation study conducted in winter and spring 2021 in Tehran, Iran, the participants were selected from among experts and trauma fields practitioners active in warfare. Findings: The inclusion criteria were willingness to participate in the study, having a history of treatment practice, and training trauma in battlefields.

Efficacy of active and passive evidence-based practice training for postgraduate medical residents: a non-randomized controlled trial.

OBJECTIVE: This study examined the effects of two evidence-based practice (EBP) educational programs for postgraduate medical residents on their attitude, behavior, knowledge, outcome, and competencies in EBP. RESULTS: Forty-five and thirty-five medical residents were recruited in the active and passive educational intervention groups, respectively. Among those, 39 and 30 participants were included in the final analysis. The participants of the active group received 12 h of EBP-structured presentation. The passive educational group received EBP education through their daily rounds, evidence-based journal clubs, and morning reports. Participants were evaluated with EBP-KABQ and ACE tools questionnaires. The active and passive intervention groups were not significantly different from each other at the baseline in the EBP-KABQ questionnaire and ACE tools score (p > 0.05). However, most questions in the EBP-KABQ questionnaire were significantly different from the pre-intervention measurement and the passive intervention group after the educational intervention. Educational intervention in both groups led to a significant difference in ACE tools score between groups (8.86 ± 2.62 vs. 7.31 ± 2.92, p = 0.029, in the active and passive groups, respectively). Paired t-test analysis revealed that our intervention led to a significant increase in ACE tool scores in both groups (p < 0.000, in both groups).

Investigation of hospital indoor air quality for the presence of SARS-Cov-2.

PURPOSE: Unidentified dynamics for the causative agent of COVID-19, SARS-Cov-2, led to the critical public health issue. Suspicion for the airborne potential of SARS-Cov-2 is an important problem for its transmission and relevant epidemics. This research investigated hospital indoor air quality to SARS-Cov-2 occurrence and determination its air born potential. METHODS: The site study was a referral hospital with 630 beds for admitting of COVID-19 patients. Air sampling was done (n = 31) on selected wards including Emergency 1, Emergency 2, bedridden (4-B, 10-D), ICU 2, ICU 3, CT-SCAN, and laundry. The average temperature and relative humidities were 22 ± 1 °C and 43 percent respectively. All glass impinger used for sampling in which the sampling pumps capacities were 5 and 40 L.min- 1. Sampling duration time was 20 and 15 minutes and 100 to 1000 L of air were gathered. All parts of the sampling equipment were completely disinfected by hot water, ethanol (70%), chlorine solution (1000 ppm), hot water (70 °C for 1 min) and washed with distilled water. The transmitting media (7 ml) was injected into impinger and residual of this media (2 ml) was sent to the virology laboratory within 2 hours and preserved on refrigerator < 4 °C. Analysis of samples was performed by RT-PCR and repeated for accuracy control. RESULTS: All of the samples were negative for SARS-Cov-2 occurrence. These results showed that SARS-Cov-2 had not airborne potential in this hospital. CONCLUSIONS: Although SARS-Cov-2 similar to the SARS virus but, SARS-Cov-2 is not an airborne virus.

Adipose-derived mesenchymal stem cells ameliorate lung epithelial injury through mitigating of oxidative stress in mustard lung.

Aim: We investigated potential efficacy of autologous adipose-derived mesenchymal stem cell (MSC) on oxidative stress (OS) and airway remodeling in patients with chronic mustard lung. Patients & methods: Ten patients received 100 × 106 cells every 20 days for 4 injections over a 2-month period. Results: A gradual improvement was observed for 6 min walk test scores, pulmonary function tests and respiratory quality after MSCs therapy. A significant decrease was found for the mean levels of Mucin-1 protein (KL-6; p = 0.022) and Clara cell protein 16 (CC16; p = 0.005). Antioxidants had a tendency to be higher after each injection. Conclusion: Our findings revealed that MSCs therapy can be safely used for improvement of lung injury and regeneration in these patients without adverse effects. Trial registration number: NCT02749448 (ClinicalTrials.gov).

Outcomes of Crowding in Emergency Departments; a Systematic Review.

INTRODUCTION: Emergency Department (ED) crowding is a global public health phenomenon affecting access and quality of care. In this study, we seek to conduct a systematic review concerning the challenges and outcomes of ED crowding. METHODS: This systematic review utilized original research articles published from 1st January 2007, to 1st January 2019. Relevant articles from the PubMed (MEDLINE), EMBASE, and Google scholar databases were extracted using predesigned keywords. Following the PRISMA guidelines, two reviewers independently evaluated the quality of the studies using Critical Appraisal Skills Programme for cohort studies and qualitative studies, and Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument for studies. RESULTS: Out of the total of 73 articles in the final record, we excluded 15 of them because of poor quality. This systematic review synthesized the reports of 58 original articles. The outcomes of multiple individual patients and healthcare-related challenges are comprehensively assessed. CONCLUSIONS: ED crowding affects individual patients, healthcare systems and communities at large. The negative influences of crowding on healthcare service delivery result in delayed service delivery, poor quality care, and inefficiency; all negatively affecting the emergency patients' healthcare outcomes, in turn.

Adipose-Derived Mesenchymal Stem Cells for Treatment of Airway Injuries in A Patient after Long-Term Exposure to Sulfur Mustard.

OBJECTIVE: Sulfur mustard (SM) is a potent mutagenic agent that targets several organs, particularly lung tissue. Changes in morphological structure of the airway system are associated with chronic obstructive pulmonary deficiency following exposure to SM. Although numerous studies have demonstrated pathological effects of SM on respiratory organs, unfortunately there is no effective treatment to inhibit further respiratory injuries or induce repair in these patients. Due to the extensive progress and achievements in stem cell therapy, we have aimed to evaluate safety and potential efficacy of systemic mesenchymal stem cell (MSC) administration on a SM-exposed patient with chronic lung injuries. MATERIALS AND METHODS: In this clinical trial study, our patient received 100×106cells every 20 days for 4 injections over a 2-month period. After each injection we evaluated the safety, pulmonary function tests (PFT), chronic obstructive pulmonary disease (COPD) Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), Borg Scale Dyspnea Assessment (BSDA), and 6 Minute Walk Test (6MWT). One-way ANOVA test was used in this study which was not significant (P>0.05). RESULTS: There were no infusion toxicities or serious adverse events caused by MSC administration. Although there was no significant difference in PFTs, we found a significant improvement for 6MWT, as well as BSDA, SGRQ, and CAT scores after each injection. CONCLUSION: Systemic MSC administration appears to be safe in SM-exposed patients with moderate to severe injuries and provides a basis for subsequent cell therapy investigations in other patients with this disorder (Registration Number: IRCT2015110524890N1).

Barriers Against Implementing Blunt Abdominal Trauma Guidelines in a Hospital: A Qualitative Study.

INTRODUCTION: Clinical practice guidelines are structured recommendations that help physicians and patients to make proper decisions when dealing with a specific clinical condition. Because blunt abdominal trauma causes a various range of mild, single-system, and multisystem injuries, early detection will help to reduce mortality and resulting disability. Emergency treatment should be initiated based on CPGs. This study aimed to determine the variables affecting implementing blunt abdominal trauma CPGs in an Iranian hospital. METHODS: This study was conducted as a qualitative and phenomenology study in the Family Hospital in Tehran (Iran) in 2015. The research population included eight experts and key people in the area of blunt abdominal trauma clinical practice guidelines. Sampling was based on purposive and nonrandom methods. A semistructured interview was done for the data collection. A framework method was applied for the data analysis by using Atlas.ti software. RESULTS: After framework analyzing and various reviewing and deleting and combining the codes from 251 codes obtained, 15 families and five super families were extracted, including technical knowledge barriers, economical barriers, barriers related to deployment and monitoring, political will barriers, and managing barriers. CONCLUSION: Structural reform is needed for eliminating the defects available in the healthcare system. As with most of the codes, subconcepts and concepts are classified into the field of human resources; it seems that the education and knowledge will be more important than other resources such as capital and equipment.

User Acceptance of Picture Archiving and Communication System in the Emergency Department.

BACKGROUND: Picture archiving and communication system (PACS) has allowed the medical images to be transmitted, stored, retrieved, and displayed in different locations of a hospital or health system. Using PACS in the emergency department will eventually result in improved efficiency and patient care. In spite of the abundant benefits of employing PACS, there are some challenges in implementing this technology like users' resistance to accept the technology, which has a critical role in PACS success. OBJECTIVES: In this study, we will assess and compare user acceptance of PACS in the emergency departments of three different hospitals and investigate the effect of socio-demographic factors on this acceptance. MATERIALS AND METHODS: A variant of technology acceptance model (TAM) has been used in order to measure the acceptance level of PACS in the emergency department of three educational hospitals in Iran. A previously used questionnaire was validated and utilized to collect the study data. A stepwise multiple regression model was used to predict factors influencing acceptance score as the dependent variable. RESULTS: Mean age of participants was 32.9 years (standard deviation [SD] = 6.08). Participants with the specialty degree got a higher acceptance score than the three other groups (Mean ± SD = 4.17 ± 0.20). Age, gender, degree of PACS usage and participant's occupation (profession) did not influence the acceptance score. In our multiple regression model, all three variables of perceived usefulness (PU), perceived ease of use (PEU) and the effect of PACS (change) had a significant effect in the prediction of acceptance. The most influencing factor was change with the beta of 0.22 (P value < 0.001). CONCLUSION: PACS is highly accepted in all three emergency departments especially among specialists. PU, PEU and change are factors influencing PACS acceptance. Our study can be used as an evidence of PACS acceptance in emergency wards.

Hospital Readmission Through the Emergency Department.

BACKGROUND: Hospital readmission places a high burden on both health care systems and patients. Most readmissions are thought to be related to the quality of the health care system. OBJECTIVES: The aim of this study was to examine the causes and rates of early readmission in emergency department in a Tehran hospital. PATIENTS AND METHODS: A cross-sectional investigation was performed to study readmission of inpatients at a large academic hospital in Tehran, Iran. Patients admitted to hospital from July 1, 2014 to December 30, 2014 via the emergency department were enrolled. Descriptive statistics were used to summarize the distribution demographics in the sample. Data was analyzed by chi2 test using SPSS 20 software. RESULTS: The main cause of readmission was complications related to surgical procedures (31.0%). Discharge from hospital based on patient request at the patient's own risk was a risk factor for emergency readmission in 8.5%, a very small number were readmitted after complete treatment (0.6%). The only direct complication of treatment was infection (17%). CONCLUSIONS: Postoperative complications increase the probability of patients returning to hospital. Physicians, nurses, etc., should focus on these specific patient populations to minimize the risk of postoperative complications. Future studies should assess the relative connections of various types of patient information (e.g., social and psychosocial factors) to readmission risk prediction by comparing the performance of models with and without this information in a specific population.

Assessing the Physical Environment of Emergency Departments.

BACKGROUND: Emergency Department (ED) is considered to be the heart of a hospital. Based on many studies, a well-organized physical environment can enhance efficacy. OBJECTIVES: In this study, we aimed to investigate the influence of physical environment in EDs on efficacy. MATERIALS AND METHODS: This analytical cross-sectional study was conducted via the faculty members of the ED and residents of Shahid Beheshti University of Medical Sciences in Tehran, Iran. Data were collected using a predefined questionnaire. Descriptive statistics and ANOVA were used to analyze the data. RESULTS: Sixty-two participants, including 21 females and 41 males, completed the questionnaires. The mean age of the participants was 37 years (SD: 8.42). The mean work experience was 8 years (SD: 4.52) and all the studied variables varied within a range of 3.3 - 4.2. Time indices had the highest mean among variables followed by capacity, work space, treatment units, critical care units and, triage indices, respectively. CONCLUSIONS: In general, time indices including length of patient stay in the ED and space capacity, emphasizing the need to address these shortcomings.

Endoscopic approach for excision of juvenile nasopharyngeal angiofibroma: complications and outcomes.

The purposes of this study are to report the efficacy of the endoscopic approach for juvenile nasopharyngeal angiofibroma (JNA) and to compare its related intra- and postoperative complications with findings from traditional approaches in the literatures. This study is a retrospective report of 47 cases of JNA that were treated with nasal endoscopic surgery between 1998 and 2005. According to the staging system by Radkowski et al (Arch Otolaryngol Head Neck Surg. 1996;122:122-129), the staging of the included patients were the following: 21 in stages IA to IIB, 22 in IIC, 3 in IIIA, and 1 in IIIB. Five patients were embolized before surgery. The mean blood hemorrhage in embolized patients was 770 mL, whereas in nonembolized patients, it was 1403.6 mL. In the follow-up period (mean, 2.5 years), the recurrence was found in 9 patients (19.1%), and mean time of recurrence was 17 months after surgery. The rupture of cavernous sinus occurred in 2 cases with no mortality. The mean hospital stay was 3.1 days in all cases and 1.8 days in embolized patients. The findings of this study demonstrate that endoscopic resection of JNA is a safe and effective technique because of decrease in blood loss, hospitalization, and recurrence rate, especially in tumors that are not extended through intracranial space. It is therefore strongly recommended that this modality is implemented as the first surgical step for tumors with stages I to IIIA of the Radkowski's staging system.

Electroorganic synthesis of new benzofuro[2,3-d]pyrimidine derivatives.

Electrochemical oxidation of 3,4-dihydroxybenzoic acid (1) in the presence of 1,3-dimethylbarbituric acid (2) and 1,3-diethyl-2-thiobarbituric acid (3) as nucleophiles in aqueous solution has been studied using cyclic voltammetry and controlled-potential coulometry. The results indicate that 1 via Michael reaction under electro-decarboxylation reaction converts to benzofuro[2,3-d]pyrimidine derivatives (6a, 6b). The electrochemical synthesis of 6a, 6b has been successfully performed in an undivided cell in good yields and purity.