Mohammad Gholami; sina valiee; naser kamyari; salam vatandost
Volume 11, Issue 3 , July 2023, , Pages 146-153
Abstract
Objective: Breaking bad news (BBN) is a critical aspect of healthcare delivery that can have significantimplications for patients’ outcomes. Inadequate and inappropriate delivery of bad news can result in detrimentalpsychological and emotional effects. This study aimed to compare the performance ...
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Objective: Breaking bad news (BBN) is a critical aspect of healthcare delivery that can have significantimplications for patients’ outcomes. Inadequate and inappropriate delivery of bad news can result in detrimentalpsychological and emotional effects. This study aimed to compare the performance of emergency department(ED) personnel and patients’ preferences in BBN.Methods: This descriptive-analytical study was conducted in 2022, and 135 patients who were admitted to theED were included using quota sampling. Data were collected using a demographic questionnaire, a researchermadequestionnaire, and a standard questionnaire on attitudes toward the methods of BBN in the ED. The datawere analyzed using SPSS software (version 16), and a p-value<0.05 was considered statistically significant.Results: The results showed that the majority of patients (69.6%) received bad news from nurses. Based on theconditions mentioned in the standard questionnaire, the overall performance of personnel was 6.08±4.22 out of19, while the overall attitude score (59.66±7.66 out of 76) revealed patients’ high tendency to receive bad news.There was a statistically significant difference between the total score of personnel performances and the totalscore of patients’ attitudes (p=0.001).Conclusion: The performance of ED personnel concerning patients’ attitudes toward the method of BBN inthe emergency department was not optimal. Therefore, it is recommended to implement appropriate trainingprograms for medical professionals, especially physicians, and nurses, to enhance their communication skillsand reduce the detrimental effects of inappropriate delivery of bad news in medical settings.
Mehdi Torabi; Zahra-Sadat Amiri; Moghaddameh Mirzaee
Volume 11, Issue 2 , April 2023, , Pages 83-89
Abstract
Objective: This study aimed to investigate blood glucose levels in patients with brain injury caused by mildtraumatic brain injury (TBI) as a foundation for determining whether these patients need a brain CT scan ornot.Methods: This cross-sectional study was conducted on patients with mild TBI, who were ...
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Objective: This study aimed to investigate blood glucose levels in patients with brain injury caused by mildtraumatic brain injury (TBI) as a foundation for determining whether these patients need a brain CT scan ornot.Methods: This cross-sectional study was conducted on patients with mild TBI, who were referred to theemergency department from March 1, 2022, to September 1, 2022. After the confirmation of mild TBI by anemergency medicine specialist, blood samples were taken from the patients to measure blood glucose levels.Then a brain CT scan was performed, and blood glucose levels were compared between patients with andwithout CT indications of brain injury. A checklist was used to collect data, and the data were analyzed usingSPSS software (version 23).Results: In the CT scans of the 157 patients included in the study, 30 patients (19.2%) had a brain injury inthe CT scan. The mean blood glucose level was significantly higher in patients with brain injury, especially inthe presence of vertigo and ataxia, than patients without brain injury in the CT scan (p<0.0001). There was asignificant positive correlation between age and blood glucose level (r=0.315, p<0.0001).Conclusion: Patients with mild TBI who had signs of brain injury in the CT scan had significantly higher bloodglucose levels than patients with normal CT scan findings. Although indications for performing a brain CTscan are usually based on clinical criteria, blood glucose levels can be helpful in determining the requirementfor a brain CT scan in patients with mild TBI.
Soheil Rafiee; Alireza Baratloo; Arash Safaie; Alireza Jalali; Khalil Komlakh
Volume 10, Issue 4 , October 2022, , Pages 165-171
Abstract
Objective: To probe the factors associated with the outcomes of traumatic brain injury (TBI) patients admittedto emergency department (ED).Methods: This is a cross-sectional study that data gathering was performed via census methods, retrospectively.During one year, all head injury’s patients who ...
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Objective: To probe the factors associated with the outcomes of traumatic brain injury (TBI) patients admittedto emergency department (ED).Methods: This is a cross-sectional study that data gathering was performed via census methods, retrospectively.During one year, all head injury’s patients who admitted to the ED of a tertiary center in Tehran, Iran wereincluded. Age, gender, mechanism of injury, Glasgow coma scale (GCS) and injury severity score (ISS)on admission, presence of extra-cranial injuries, findings of brain computed tomography (CT), duration ofhospitalization, and in hospital outcomes were recorded. Outcome’s assessment for survivors was performedwithin a 6 months-period after discharge based on Glasgow outcome scale (GOS). The variables and outcomes’association were assessed.Results: Totally, 506 patients were evaluated with the mean age of 36.77±21.1 years that 411 (81.2%) were men.Follow up at 6-months post injury was feasible in 487 (96.2%) patients; 59 (11.7%) out of 506 eligible patientsdied. Logistic regression analysis showed the association between assessed variables and patients’ outcome asfollows: age>65 years (OR: 12.21; p<0.001), GCS on admission <8 (OR: 62.99; p<0.001), presence of traumaticIntracerebral hemorrhage (ICH) in brain CT scan (OR: 20.11; p=0.010), duration of hospitalization ≥ 5 days(OR: 0.28; p=0.001).Conclusion: The findings of the current study distinguished some variables that were associated with thepoor outcome of the patients with TBI. Therefore, TBI patients with any of these risk factors may need closecontinues monitoring, early ICU admission, and some other special extra care in ED.
Pitsucha Sanguanwit; Chaiyaporn Yuksen; Nishapa Laowattana
Volume 9, Issue 3 , July 2021, , Pages 118-124
Abstract
Objective: To compare the intubation success rate of the first attempt between Video Laryngoscopy (VDL) and Direct Laryngoscopy (DL) in the emergency department (ED). Methods: This is a study of a randomized control trial includes the patients with acute respiratory failure and the emergency ...
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Objective: To compare the intubation success rate of the first attempt between Video Laryngoscopy (VDL) and Direct Laryngoscopy (DL) in the emergency department (ED). Methods: This is a study of a randomized control trial includes the patients with acute respiratory failure and the emergency physician who intended to perform intubation in the ED from July 2015 to June 2016. We were selected the patients randomly by the sequentially numbered opaque sealed envelopes technique and were assigned to undergo the first attempt of either VDL (n=78) or DL (n=80). We collected the data information regarding the demographic characteristics, predictors of difficult intubation, rapid sequence intubation, attempt, Cormack–Lehane view, and immediate complications. Results: The success of VDL in the first attempt was 73.1%, which were tended to be better than DL (58.8%) (p=0.060). Glottis view (Cormack–Lehane view 1–2) of VDL was significantly better (88.5%) than of DL (72.5%) (p=0.010). The immediate complications were not different. Conclusions: VDL showed a trend of better success than DL. VDL can increase the first-attempt intubation success and provide a better glottis view in emergency intubation. Trial registration: The trial was registered in the Thai Clinical Trial Registry, identifier TCTR 20200503003. Registered 16 June 2020, ‘Retrospectively registered’, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=6186
Gaurav Kaushik; Ankita Sharma; Dinesh Bagaria; Subodh Kumar; Sushma Sagar; Amit Gupta
Volume 9, Issue 2 , April 2021, , Pages 60-66
Abstract
Objective: To describe the restructuring if in-hospital systems of care at a Level -1 trauma center in India and to analyze volume and patterns of injury for future preparedness as well as to institute preventive measures for specific injuries during health emergencies like COVID-19.Methods: The data ...
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Objective: To describe the restructuring if in-hospital systems of care at a Level -1 trauma center in India and to analyze volume and patterns of injury for future preparedness as well as to institute preventive measures for specific injuries during health emergencies like COVID-19.Methods: The data were extracted from a prospectively managed trauma registry at level-1 trauma center in India. We compared data of lockdown period with data of the same number of days from the pre-lockdown period. Patients were grouped according to age, gender, cause of injury, place of injury, injury severity, and injury outcome for comparative analysis between two periods.Results: Total emergency department (ED) footfall due to trauma decreased significantly by 73% during lockdown period. Injuries resulting due to blunt forces, increased significantly. There was a significant decrease in the percentage of patients having major injury. The road traffic injuries (RTIs) cases were less, but number of falls reported increased significantly during lockdown. Significantly less number of patients presented without receiving primary care. Majority of the patients were transported using private cars, police vehicle, and two wheelers during lockdown, however, as expected significantly less number of patients were transported by three wheelers. The comparative analysis between quantitative data points shows significant difference in median ISS and length of stay during lockdown. Conclusion: This study highlighted that the preparedness during health emergencies should not focus solely on the response to treatment of infectious disease but also on ensuring access and provision of reasonable quality of care for non-infectious illnesses, especially acute conditions like trauma.
Maryam Gholami; Sedigheh Torabi Davan; Maryam Gholami; Shahram Boland Parvaz; Mehrnaz Gholami; Parisa Chamanpara; Leila Shayan
Volume 8, Issue 3 , July 2020, , Pages 179-185
Abstract
Objective: To investigate the effects of sesame oil extracted from tahini (Ardeh) on pain severity in patients with upper or lower limbs trauma. Methods: This double-blinded randomized clinical trial study was conducted on 120 patients with upper or lower trauma in Shahid Rajaee Hospital, Shiraz, Iran, ...
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Objective: To investigate the effects of sesame oil extracted from tahini (Ardeh) on pain severity in patients with upper or lower limbs trauma. Methods: This double-blinded randomized clinical trial study was conducted on 120 patients with upper or lower trauma in Shahid Rajaee Hospital, Shiraz, Iran, from May the 1st through November 30th, 2016. The patients were randomly assigned to two groups using block randomization. The intervention group received topical sesame oil extracted from tahini (Ardeh) and the placebo group received cooking oil. Pain severity, pain sensitivity and heaviness of painful site were assessed. Results: Overall, we included 90 patients with traumatic limb injuries in this study who were randomized to two study groups. The mean age of the patients was 28.3 ± 6.8 (ranging from 25 to 35) years and there were 63 (70%) men and 27 (30%) women among the patients. In the sesame oil group, the mean changes in the pain severity (-1.53 ± 0.57, p <0.001), pain sensitivity (-1.45 ± 0.64, p <0.001) and heaviness of painful site (-1.56 ± 0.68, p <0.001) were significantly lower when compared to the placebo group in the second day of the intervention. None of the patients experience adverse drug effects. Conclusion: Our findings suggest that the topical use of sesame oil extracted from Tahini has a pain reliever effect on the skin after bruising and it helps prevent skin discoloration in patients with traumatic injuries of limbs. Clinical Trial Registry: IRCT20171017036838N1
Milad Ahmadi Marzaleh; Rita Rezaee; Abbas Rezaianzadeh; Mahnaz Rakhshan; Gholamhassan Haddadi; Mahmoudreza Peyravi
Volume 7, Issue 3 , July 2019, , Pages 300-306
Abstract
Objective: To develop a national model for hospitals’ Emergency Department (ED) preparedness when facing radiation and nuclear incidents as well as nuclear terrorism in Iran.Methods: This analytical study was carried out in 2019 via Delphi technique in two rounds and prioritization using a pairwise ...
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Objective: To develop a national model for hospitals’ Emergency Department (ED) preparedness when facing radiation and nuclear incidents as well as nuclear terrorism in Iran.Methods: This analytical study was carried out in 2019 via Delphi technique in two rounds and prioritization using a pairwise questionnaire. Using classic Delphi technique and pairwise comparison, the components were given to 32 specialists in emergency medicine, nuclear medicine, medical physics, nuclear physics, radiobiology and radiation protection, health in disaster and emergency, and passive defense. Finally, the national model was developed by holding two focus group sessions.Results: The results from the two rounds of Delphi technique showed that 31 factors of preparedness were classified into three main classes, namely staff, stuff, and structure (system). Only three factors were excluded and the rest were agreed upon by the specialists. Given the weight of each class, it was found that staff preparedness and stuff preparedness had the highest and lowest priorities, respectively.Conclusion: Comprehensive preparedness requires enhancing and promoting cultural, social, economic, and political levels. Indeed, all preparedness levels should be promoted in alignment with each other. Hence, governments should align their policies to manage such incidents.
Joaquin Valle Alonso; John Turpie; Islam Farhad; Gabrielle Ruffino
Volume 7, Issue 1 , January 2019, , Pages 67-71
Abstract
Sepsis and septic shock remain a major cause of morbidity and mortality globally. In septic patient’s bedside physical examination can often be unhelpful in helping to identify the source of infection and, therefore, decide upon appropriate management. Protocols for point-of-care-ultrasound ...
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Sepsis and septic shock remain a major cause of morbidity and mortality globally. In septic patient’s bedside physical examination can often be unhelpful in helping to identify the source of infection and, therefore, decide upon appropriate management. Protocols for point-of-care-ultrasound (POCUS) in critically-ill patients who present with shock or trauma have been described elsewhere including rapid ultrasound in shock (RUSH), focused assessment with sonography for trauma (FAST), and focused cardiac ultrasound (FOCUS). Although the use of POCUS in sepsis has been reported in existing literature, there is not an algorithm for when POCUS is indicated in septic patients. We describe the case of a 70-year-old woman who presented to the emergency department (ED) with a 1-week history of diarrhoea and vomiting. The initial diagnosis in ED was viral gastroenteritis with prerenal acute kidney injury and she was initially referred to the medial team. However, the patient remained hypotensive and oliguric after 2 litters of IV fluids. A point-of-case-ultrasound (POCUS) showed a right kidney with moderate hydronephrosis. Urology team was immediately contacted with a CT that confirmed an obstructive stone causing moderate kidney hydronephrosis. Emergency nephrostomy was performed and the patient was discharged and has remained asymptomatic.
Nurettin Aktas; Umut Gulacti; Ugur Lok; Irfan Aydin; Tayfun Borta; Murat Celik
Volume 6, Issue 1 , January 2018, , Pages 64-70
Abstract
Objective: To identify errors in forensic reports and to describe the characteristics of traumatic medico-legal cases presenting to the emergency department (ED) at a tertiary care hospital.Methods: This study is a retrospective cross-sectional study. The study includes cases resulting in a forensic ...
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Objective: To identify errors in forensic reports and to describe the characteristics of traumatic medico-legal cases presenting to the emergency department (ED) at a tertiary care hospital.Methods: This study is a retrospective cross-sectional study. The study includes cases resulting in a forensic report among all traumatic patients presenting to the ED of Adiyaman University Training and Research Hospital, Adiyaman, Turkey during a 1-year period. We recorded the demographic characteristics of all the cases, time of presentation to the ED, traumatic characteristics of medico-legal cases, forms of suicide attempt, suspected poisonous substance exposure, the result of follow-up and the type of forensic report.Results: A total of 4300 traumatic medico-legal cases were included in the study and 72% of these cases were male. Traumatic medico-legal cases occurred at the greatest frequency in July (10.1%) and 28.9% of all cases occurred in summer. The most frequent causes of traumatic medico-legal cases in the ED were traffic accidents (43.4%), violent crime (30.5%), and suicide attempt (7.2%). The most common method of attempted suicide was drug intake (86.4%). 12.3% of traumatic medico-legal cases were hospitalized and 24.2% of those hospitalized were admitted to the orthopedics service. The most common error in forensic reports was the incomplete recording of the patient's “cooperation” status (82.7%). Additionally, external traumatic lesions were not defined in 62.4% of forensic reports.Conclusion: The majority of traumatic medico-legal cases were male age 18-44 years, the most common source of trauma was traffic accidents and in the summer months. When writing a forensic report, emergency physicians made mistakes in noting physical examination findings and identifying external traumatic lesions. Physicians should make sure that the traumatic medico-legal patients they treat have adequate documentation for reference during legal proceedings. The legal duties and responsibilities of physicians should be emphasized with in-service training.
Mohammadreza Maleki; Seyyed Meysam Mousavi; Mina Anjomshoa; Nasrin Shaarbafchizadeh; Zeinab Naimi Taleghani
Volume 5, Issue 4 , October 2017, , Pages 292-298
Abstract
Objective: To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors.Methods: A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design ...
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Objective: To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors.Methods: A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design of ED encounters for a 3-month period, six months before and six months after the introduction of an emergency medicine residency program in an Iranian teaching hospital. The second phase included semi-structured interviews with five individuals which purposively selected to participate in qualitative design. Quantitative data were analysed descriptively and qualitative data were analysed using an iterative framework approach.Results: The most patients were admitted to the hospital in night shift, both before and after the resident EMS. No statistically significant differences were found among all of the waiting times during the two time periods except for the average time interval between admission and physician start time (p<0.0001), which increased (instead of reducing), and the average time interval between physician start time and first treatment measure (p<0.0001), which decreased during the year the residents began. The interviewees revealed the intradisciplinary conflicts and interferences existing between ED and other specialist departments, are main important factor to delayed processing of patients visits.Conclusion: This study has shown that intradisciplinary conflict would affect the outcomes of emergency medicine residency program and ED process. These new findings enhance the understanding of the nature of conflicts and will persuade policy makers that design a set of clinical practice guidelines to clarify the duties and responsibilities of parties involved in ED.
Amin Daemi
Volume 4, Issue 1 , January 2016, , Pages 62-63
Abbas Heydari; Amir Emami Zeydi
Volume 2, Issue 2 , April 2014, , Pages 99-100
