The Effects of Air Pollution on Ischemic Stroke Admission Rate / 전남의대학술지

The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2+/-13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O3 levels amplifies this risk, while a transient increase in NO2 (p<0.001) and SO2 (p<0.001) levels has the same effect. Long-term changes in PM(10) (p<0.001) and PM(2.5) (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department.

The Effects of Air Pollution on Ischemic Stroke Admission Rate / 전남의대학술지

The present study aimed to determine the relationship between the level of air pollutants and the rate of ischemic stroke (IS) admissions to hospitals. In this retrospective cross-sectional study, stroke admissions (January-March 2012 and 2013) to an emergency department and air pollution and meteorological data were gathered. The relationship between air pollutant levels and hospital admission rates were evaluated using the generalize additive model. In all 379 patients with IS were referred to the hospital (52.5% male; mean age 68.2+/-13.3 years). Both transient (p<0.001) and long-term (p<0.001) rises in CO level increases the risk of IS. Increased weekly (p<0.001) and monthly (p<0.001) average O3 levels amplifies this risk, while a transient increase in NO2 (p<0.001) and SO2 (p<0.001) levels has the same effect. Long-term changes in PM(10) (p<0.001) and PM(2.5) (p<0.001) also increase the risk of IS. The findings showed that the level of air pollutants directly correlates with the number of stroke admissions to the emergency department.

effect of emergency department overcrowding on efficiency of emergency medicine residents' education

Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding [EDO] on the training of emergency medicine residents [EMR] is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR's education. In this cross-sectional study, the effects of overcrowding on EMR's education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs. The crowding level was calculated based on the national emergency department overcrowding scale [NEDOCS]. The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. 130 questionnaires were filled out during 61 shifts. 47 [77.05%] shifts were overcrowded. The attend's ability to teach was not affected by overcrowding in the resuscitation room [p=0.008]. The similar results were seen regarding the attend's training ability in the acute care unit. It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs

Axillary nerve block in comparison with intravenous midazolam/fentanyl for painless reduction of upper extremity fractures

The painful nature of fractures has made it inevitable to use various anesthetic techniques to reduce or immobilize fractured parts. In the present study, axillary nerve block was compared with intravenous midazolam/fentanyl to induce anesthesia for Painless Reduction of Upper Extremity Fractures. The subjects in the present clinical trial consisted of 60 patients with upper extremity fractures. They were randomly divided into two equal groups of intravenous sedation [IVS] with midazolam/fentanyl and axillary nerve block [ANB]. Rate of anesthesia induction, recovery time, and pain intensities at baseline, during the procedure and at the end of the procedure were recorded in both groups. Data was analyzed and compared between the two groups with SPSS 18 statistical software using appropriate tests. Demographic data, vital signs and means of pain intensities at the beginning of the procedure were equal in the two groups. In the IVS group, the overall duration of the procedure was shorter with more rapid onset of anesthesia [P<0.05]. In contrast, the recovery time was much shorter in the ANB group [P<0.001]. No life or organ threatening complications were observed in the two groups. Axillary nerve block can be considered an appropriate substitute for intravenous sedation in painful procedures of the upper extremity

Nerve stimulator guided axillary block in painless reduction of distal radius fractures; a randomized clinical trial

Given the high prevalence of upper extremity fractures and increasing need to perform painless reduction in the emergency departments, the use of analgesic methods with fewer complications and more satisfaction appears to be essential. The aim of this study is comparison the nerve stimulator guided axillary block [NSAB] with intravenous sedation in induction of analgesia for painless reduction of distal radius fractures. In the present randomized clinical trial, 60 patients [18-70 years of age] suffered from distal radius fractures, were divided into two equal groups. One group received axillary nerve block by nerve stimulator guid-ance and the other procedural sedation and analgesia [PSA] using midazolam/fentanyl. Onset of analgesia, duration of analgesic effect, total procedure time and pain scores were recorded using visual analogue scale [VAS] and the outcomes were compared. Chi-squared and student t test were performed to evaluate differences between two groups. Sixty patients were randomly divided into two groups [83.3% male]. The mean age of patients was 31 +/- 0.7 years. While the onset of analgesia was significantly longer in the NSAB group, the mean total time of procedure was shorter than PSA [p<0.001]. The NSAB group needed a shorter post-operative observation time [P<0.001]. Both groups experienced equal pain relief before, during and after procedure [p>0.05]. It seems that shorter post-operative monitoring time and consequently lesser total time of procedure, make nerve stimulator guided axillary block as an appropriate alternative for procedural sedation and analgesia in painless reduction of distal radius fractures in emergency department

Privacy, confidentiality and facility criteria in designing emergency departments of the teaching hospitals of Shahid Beheshti University of Medical Sciences in 2007

This study aimed to evaluate the design of emergency departments regarding to the patients' and staff's privacy, confidentiality and facilities in general teaching hospitals. Emergency departments of all the general teaching hospitals of Shahid Beheshti University of Medical Sciences, Tehran, Iran were evaluated in 2007 through both direct observation and interview with hospital authorities, and staff. Relevant criteria were studied by a 27-item questionnaire including 19 items for facilities and 7 items for privacy and confidentiality. Extent of emergency departments was the last common criterion. Data analysis has been done using t-test and descriptive statistics when appropriate. SPSS Software version 16 was used to facilitate quantitative analysis. Eleven out of nineteen criteria [58%] for the facilities were not found in the emergency departments. Privacy criteria had an overall partially more acceptable situation. Only one criterion of privacy and confidentiality was negative for all the emergency departments. It was calm gynecologic and delivery room with specific toilet. The mean was 469.6 [SD=96] square meters for existing extent of emergency departments and 1461.6 [SD=262.1] square meters for the idea for the ideal values [P<0.01]. Privacy, confidentiality and enough facilities should be considered in designing of teaching hospitals for both stuff and patients. Most of them need to be reconstructed based on new national standards

Accessed criteria to different parts of emergency unit in general teaching hospitals of Shaheed Beheshti medical university

To assess general hospitals of Shaheed Beheshti medical university in terms of emergency unit designing for access to its different parts. Imam Hussein, Loghman, Shohada Tajrish, Taleghani and Shaheed Modares general teaching hospitals of SBMU which had higher visit per year were assessed for 40 criteria of access to different parts of their emergency unit by a checklist. Data have been gathered by an emergency medicine resident through interview with related personnel. Collected data compared with standards which have been used in emergency medicine. Only eleven to sixteen out of 40 criteria had been fulfilled in selected hospitals. Thirteen criteria have been missed and only five criteria were fulfilled in all the hospitals. Others missed in one or more. Some of the essential criteria like cardio respiratory resuscitation room being near the entrance, dissociation between ambulance and outpatient entrance, obvious entrance for emergency unit, easy access to laboratory and radiology from emergency unit, lack of markers for triage were missed in all and criteria for traumatic and psychological patients were missed in almost all. Easy visual access to patients through nursing station, use of elevator and waiting room in emergency unit were observed in all the hospitals. It seems that access criteria are not considered correctly in designing of the study hospitals. Designing hospitals need its requirements and emergency unit location should be considered at first stages of designing