ORIGINAL_ARTICLE
Europe on Fire; Medical Management of Terror Attacks - New Era and New considerations
https://beat.sums.ac.ir/article_44338_26087ed29f69eac225dec00aa2f9dd26.pdf
2016-10-01
183
185
Emergency Medcine
Trauma
Terror attacks
Medical management
Amir
Khorram-Manesh
amir.khorram-manesh@surgery.gu.se
1
Prehospital and Disaster Medicine Center, Department of Surgery, Institution of clinical sciences, Sahlgrenska Academy, Gothenburg University
LEAD_AUTHOR
ORIGINAL_ARTICLE
Two Validated Ways of Improving the Ability of Decision-Making in Emergencies; Results from a Literature Review
The aim of the current review wasto study the existing knowledge about decision-making and to identify and describe validated training tools.A comprehensive literature review was conducted by using the following keywords: decision-making, emergencies, disasters, crisis management, training, exercises, simulation, validated, real-time, command and control, communication, collaboration, and multi-disciplinary in combination or as an isolated word. Two validated training systems developed in Sweden, 3 level collaboration (3LC) and MacSim, were identified and studied in light of the literature review in order to identify how decision-making can be trained. The training models fulfilled six of the eight identified characteristics of training for decision-making.Based on the results, these training models contained methods suitable to train for decision-making.
https://beat.sums.ac.ir/article_44339_a029421dbd66de78dbe906d16ca0b43f.pdf
2016-10-01
186
196
Decision-making
Emergencies
Disasters
Crisis management
Training
Exercises
Simulation
Validated
Real-Time
Command and control
Communication
Collaboration
Multi-disciplinary
Amir
Khorram-Manesh
amir.khorram-manesh@surgery.gu.se
1
Prehospital and Disaster Medicine Center, Department of Surgery, Institution of clinical sciences, Sahlgrenska Academy, Gothenburg University
LEAD_AUTHOR
Johan
Berlin
2
AUTHOR
Eric
Carlström
3
AUTHOR
ORIGINAL_ARTICLE
Ultra-Early versus Early Excision and Grafting for Thermal Burns up to 60% Total Body Surface Area; A Historical Cohort Study
Objective: To compare the outcome of patients with up to 60% total body surface area (TBSA) thermal burns undergoing ultra-early and early excision and grafting.Methods: This historical cohort study was performed in two referral burn centers of Shiraz during a 1-year period from 2015 to 2016. We included those patients with thermal burns up to 60% TBSA who underwent ultra-early (48-72 hours) and early (7-10 days) excision and grafting. We excluded those who were hemodynamically unstable and those with electrical burns. The outcome of patients was determined by graft success, operation duration, blood loss, hospital length of stay and mortality rate. Results: We included a total number of 107 patients with mean age of 32.1 ± 11.6 years. There were 65 (60.7%) men and 42 (39.3%) women among the patients. Both study groups were comparable regarding the baseline characteristics. Ultra-early excision and grafting was associated with more, higher graft success rate (p=0.048), lower infection rate (p=0.037), shorter hospital length of stay (p=0.044) and lower mortality rate (p=0.027).Conclusion: Ultra-early excision and grafting in patients with thermal burns covering less than 60% TBSA was associated with higher graft success rate, shorter hospital length of stay, lower infection rate and lower mortality rate when compared to early surgery.
https://beat.sums.ac.ir/article_44340_e367105aa72b0066efc3dafc222a326c.pdf
2016-10-01
197
201
Ultra-early
Excision
Grafting
Thermal burns
Outcome
Abdolkhalegh
Keshavarzi
1
AUTHOR
Mehdi
Ayaz
2
AUTHOR
Maryam
Dehghankhalili
maryam_dhkh@yahoo.com
3
LEAD_AUTHOR
ORIGINAL_ARTICLE
Increased Likelihood of Arrhythmic Events Associated with Increased Anxiety in Patients with Implanted Cardiac Defibrillators after the Ahar-Varzegan Earthquake in East Azarbaijan, 2012
Objective: To determine the type and pattern of arrhythmic events following the 2012 Ahar-Varzegan Earthquake among patients implanted with cardiac defibrillators (ICDs) in East Azarbaijan province.Methods: In a prospective cohort study, conducted in East Azerbaijan Province of Iran, 132 patients were enrolled in two comparison groups according to the region of residence i.e., earthquake region (n= 98) and non-earthquake (n= 34) region in 2012. Data were collected for those meeting standard criteria for sustained ventricular arrhythmias (VAs), or supraventricular tachycardias (SVTs) and triggered ICD therapies, either shock or anti-tachycardia pacing (ATP). The state version of the State-Trait Anxiety Inventory (STAI-S) was used to assess general symptoms of anxiety in both groups.Results: Males comprised 81.1% of the participants. Mean age of the participants was 59.7 ±15 years. The frequency of patients with sustained VAs increased significantly after the earthquake (p=0.008). There were more VAs (mean 2.16 vs. 6.23; p=0.008) and they occurred earlier (6th vs. 16th day; p= 0.01) in the earthquake area. The mean frequency of SVTs and the total number of delivered ICD therapies were similar between groups. Differences in anxiety levels were not significant between groups but there was a trend for presence of greater number of patients with anxiety (p=0.07) and the relative severity of anxiety (p=0.08) in the earthquake area.Conclusion: In the earthquake area, the mean frequency of VAs increased and they occurred earlier in the earthquake area. The stress of anxiety might have served as a trigger for these events.
https://beat.sums.ac.ir/article_44341_11318adfc618d689bb434c322f9dc5c3.pdf
2016-10-01
202
210
Earthquake
Anxiety
Ventricular arrhythmias
Implantable defibrillators
Fatemeh
Ranjbar
1
Dep. of Psychiatry, Tabriz University of medical sciences,Tabriz, Iran
AUTHOR
Fariborz
Akbarzadeh
2
AUTHOR
Babak
Kazemi
babak.kazemi1395@gmail.com
3
LEAD_AUTHOR
Abdolmohammad
Ranjbar
4
AUTHOR
Sonia
Sharifi Namin
5
AUTHOR
Homayoun
Sadeghi-Bazargani
homayoun.sadeghi@gmail.com
6
AUTHOR
ORIGINAL_ARTICLE
Validity of the Electronic Triage System in Predicting Patient Outcomes in Tabriz, Iran: A Cross-Sectional Study
Objective: To validate the triage ratings performed by the Electronic Triage System (ETS) using hospitalization, length of stay, resource use, in-hospital mortality and patient bills as outcome measures.Methods: In this retrospective cross-sectional study the medical records of 387 patients were reviewed in a one-week period. The data included triage category and the outcome measures were hospitalization, length of stay, in-hospital mortality, patient bill, and used resources. The association between the triage category and hospitalization and death was assessed. The association between the triage category and the number of resources, length of stay, and the bill was also assessed.Results: The mean age of the patients was 43.65 ±21.17 years. Women comprised 40% (n=155) of 387 people who were included in the study. The frequency of Emergency Severity Index (ESI) 1, 2, 3, 4 and 5 categories were 18, 61, 127, 181 and 0 respectively. Phi and Cramer’s V for hospitalization and death were 0.365 (p<0.001) and 0.305 (p<0.001). Spearman's rho for bill, length of stay, and resource use were -0.483 (p<0.001), -0.228 (p<0.001) and -0.490 (p<0.001). The association between triage category and resource consumption was stronger than other outcomes.Conclusion: The ETS was valid in predicting all studied patient outcomes. The ETS has also the advantages of providing quick reports, giving feedback and providing data for research purposes.
https://beat.sums.ac.ir/article_44342_b1e1ef61923b453011acc47808889115.pdf
2016-10-01
211
215
Hospital Emergency Service
Triage
Emergency Severity Index
Electronic Triage System
Validity
Faramarz
Pourasghar
1
Road Traffic Injury Research Center and Department of Health Services Management, School of Management and Medical Informatics, Tabriz
University of Medical Sciences, Tabriz, Iran
AUTHOR
Jafar Sadegh
Tabrizi
2
Department of Health Services Management, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Alireza
Ala
3
Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Amin
Daemi
daemi.a@tak.iums.ac.ir
4
Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
The Burden of Road Traffic Injuries in Yazd Province - Iran
Objectives: To estimate the Disabled-adjusted Life Years (DALYs) of Road Traffic Accidents in patients referred to hospitals in Yazd Province, central Iran.Methods: This cross-sectional study was conducted in Yazd province during 2010. To calculate the Years of Life Lost (YLL) due to premature death and to calculate the incidence of non-fatal injuries and Years Lost due to Disability (YLD), the data were collected from Yazd death registration system and hospital records. The causes of death and nature of non-fatal injuries were classified using International Classification of Diseases (ICD-10). We estimated Disability Adjusted Life Years (DALYs) on the guidelines of the Global Burden of Disease Study (discount rate: 0.03, age weight: 0.04, constant age weight correction factor: 0.165). Age and sex composition was taken from the National Statistical Center for the year 2010.Results: During 2009, 483 deaths were caused by traffic accidents in Yazd Province, 382 (79.09%) of which were males, and 101 (20.91%) were females. The mortality rates for males and females were 70.98 and 20.15 in 100,000, respectively. The years of life lost due to premature deaths were 15.84/1000 in men and 4.75/1,000 in women. Total YLLs caused by traffic accidents were 10,908 years. The injuries caused by traffic accidents were calculated as 15.21 and 3.73/1,000 in males and females, respectively. The total YLDs was calculated 1.51/1,000. The total burden of Road Traffic Injuries in Yazd province was 12478 years (DALYs), 87.41% of which was due to premature death, and 12.59% was related to disability. Also, 78.32% was lost in males. The age specific peak of burden was in 15-29 year.Conclusion: This study showed that traffic accidents in Yazd impose a high burden. It seems that it is one of the health sector priorities. It is recommended to revise laws on use of motorcycles, especially on helmet use for motorcyclists, enforce strict laws in residential areas, and review social determinant affecting the incidence of such accidents.
https://beat.sums.ac.ir/article_44343_3abf463f7263fe0bac420d87df40143c.pdf
2016-10-01
216
222
Road traffic injuries
Yazd
Disability Adjusted Life Years (DALYs)
Mahmood
Vakili
1
MD, MPH, Associate Professor in Community Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Mohsen
Mirzaei
drmmirzaei@yahoo.com
2
MD, MPH, Department of Community Medicine, School of Medicine, Monitoring of Health Research Center ,Shahid Sadoughi University of Medical Sciences, Yazd, Iran
LEAD_AUTHOR
Azar
Pirdehghan
3
MD, MPH, Assistant Professor in Community Medicine,, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
AUTHOR
Mohamadreza
Sadeghian
4
MD, MPH, Health center of Yazd province, Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Majid
Jafarizadeh
5
MD, MPH, Health center of Yazd province, Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Mojtaba
Alimi
6
BS, Expert in public health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Shadi
Naderian
7
M.Sc, Student in Epidemiology, Shahid Sadoughi University of Medical Sciences,Yazd,Iran
AUTHOR
Arezoo
Aghakoochak
8
Reasercher, Monitoring of Health Research Center, Shahid Sadoughi University of Medical Sciences,Yazd, Iran
AUTHOR
ORIGINAL_ARTICLE
The Epidemiological Characteristics of Motorcyclists Associated Injuries in Road Traffics Accidents; A Hospital-Based Study
Objectives: To determine the epidemiology of injuries of the motorcyclists in road traffic accidents (RTIs) between 2008 and 2014 in East Azarbayejan province of Iran.Methods: A cross-sectional study was performed in East Azerbaijan province in Imam Reza hospital on motorcyclists subjected to injuries in RTIs between 2008 and 2014. Demographic characteristics (age, sex), duration of hospitalization, final status of injured people after discharge from the hospital, admission ward, number of admissions due to injuries in RTIs, nature of injury, and the clinical services provided to injured people were gathered from hospital information system (HIS). Demographic characteristics (age, sex), duration of hospitalization, final status of injured people after discharge from the hospital, admission ward, number of admissions due to injuries in RTIs, injured site of the body, nature of injury, and the clinical services provided injured people were gathered from HIS. Standardized data collection form was used for uniform handling of the data.Results: Most of the victims (94.4%) were male. The most frequent injuries pertained to the age group of 18-30 with 1676 (51.4%) injuries. Head, abdomen, lower back, lumbar spine, and pelvis, were the most common injured sites, respectively. Reduction of fracture and dislocation and cranial puncture were the most common provided services. The lowest survival time belonged to the age group over 60 years old.Conclusion: Injuries to the head are the most prevalent injuries among motorcyclists in RTIs. So it is suggested that proper interventions be implemented to ensure wearing helmet by motorcyclist and pillion passengers.
https://beat.sums.ac.ir/article_44344_f0d379709d6960ae6ec8c0e43bd5185b.pdf
2016-10-01
223
229
Epidemiology
Motorcycles
Injury
Morbidity
Iran
Saber
Ghaffari-fam
ghaffari.s68@gmail.com
1
School of Nursing of Miandoab, Urmia University of Medical Sciences, Urmia, Iran
AUTHOR
Ehsan
Sarbazi
2
MSc student of Epidemiology, Department of Statistics & Epidemiology and Student Research Committee, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Amin
Daemi
daemi.a@tak.iums.ac.ir
3
Health management and economics research center, Iran university of medical sciences, Tehran, Iran
AUTHOR
Mohammad Reza
Sarbazi
4
PhD student in applied ELT at Ilam University, Faculty of humanities and foreign languages Ilam, Iran
AUTHOR
Hossein Ali
Nikbakht
5
Social Determinants of Health Research Center, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
AUTHOR
Shaker
Salarilak
salarilak@yahoo.com
6
Department of Public Health, Medical Sciences Faculty, Islamic Azad University, Tabriz, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
An Epidemiological Study of Road Traffic Accidents in Guilan Province, Northern Iran in 2012
Objective: To determine the epidemiological characteristics of the road traffic injuries (RTIs) in Guilan province, northern Iran.Methods: This study was a cross-sectional study which included all of RTIs admitted to medical centers of Guilan province (northern Iran) during 2012. ICD-10 was used as diagnostic criteria. Demographic variables also injury circumstance and in hospital variables such as length of stay, time of admission, type of surgery, ICU admission, final outcome and mechanism of injury, anatomical part of injury according to Abbreviated Injury Scale (AIS) classification were derives from records by trained research team. Descriptive data is reported. The predictors of mortality were also determined.Results: The prevalence of road traffic injuries in Guilan province was 31 in 10,000 populations. Of total 7671 accidents, 5976 (77.9%) were men and 1695 (22.1%) were women. Mean age of these victims was 33.3 ± 17.289 years (32.64±16.939 for men, 35.62±18.312 for women). Most of them (32.5%) were 20-29 years old. Motorcycle-car accidents had the highest frequency followed by car-car crashes and car accidents involving pedestrians. Most of the patients (85.9%) were hospitalized and 280 injured died (3.7%). Upper extremities were the most sites of injuries. Male sex, length of hospital stay, multiple injuries and increased age were associated with road traffic accident associated mortality.Conclusion: RTIs cause enormous death and disability in this area and more road traffic preventive programs should be enforcement in these areas to reduce incidences RTI.
https://beat.sums.ac.ir/article_44345_76d79c374563a5e089d74a3e33bab1ca.pdf
2016-10-01
230
235
Road traffic injuries (RTIs)
Trauma
Epidemiology
Iran
Zahra
Mohtasham-Amiri
1
AUTHOR
Saeed
Dastgiri
saeed.dastgiri@gmail.com
2
LEAD_AUTHOR
Ali
Davoudi-kiakalyeh
3
AUTHOR
Ali
Imani
4
AUTHOR
Keyvan
Mollarahimi
5
AUTHOR
ORIGINAL_ARTICLE
An Unusual Case of Transorificial Abdomino-Thoracic Impalement Injury in a Child
Impalement injuries are rare in the paediatric age group. Still rarer are injuries which traverse multiple body cavities. Such injuries require multispecialty management at a tertiary care centre. We describe a case of an accidental impalement injury in a 12-year-old boy after a fall from height. The rod was seen passing through the right lung in the paracardiac region, piercing the diaphragm and segment IV of the liver and then coursing anterior to the inferior vena cava in the midline. It was seen passing through the small bowel at multiple places and then coursing behind the bladder, entering the rectum and anal canal. Intra-operatively, right intercostal chest drain was inserted. At laparotomy, the liver was mobilized and a diaphragmatic tear of 2×1cm was visualized. The rod traversed through the right lobe of liver with no active bleeding. Both the entry and exit sites through the liver were visualized. The rod was also seen passing through the small bowel and its mesentery. The rod entered the pelvis posterior to the bladder below the peritoneal reflection. Moderate hemoperitoneum and fecal contamination was present. The rod was successfully removed and the patient was discharged with good condition and was well on follow up.
https://beat.sums.ac.ir/article_44346_8dd8ad256843f9429b7a9f43c1b734a1.pdf
2016-10-01
236
239
Impalement injury
Metal rod
Child
Hemanshi
Shah
hemanshisshah@gmail.com
1
Professor and Head,
Department of Paediatric Surgery,
TNMC & BYL Nair Hospital,
Mumbai Central, Mumbai.
Maharashtra. India.
Pin: 400008.
LEAD_AUTHOR
Charu
Tiwari
2
Department of Paediatric Surgery,
TNMC & BYL Nair Hospital,
Mumbai Central, Mumbai.
Maharashtra. India.
Pin: 400008.
AUTHOR
Shalika
Jayaswal
3
Department of Paediatric Surgery,
TNMC & BYL Nair Hospital,
Mumbai Central, Mumbai.
Maharashtra. India.
Pin: 400008.
AUTHOR
Keshav
Murthy
4
Department of Paediatric Surgery,
TNMC & BYL Nair Hospital,
Mumbai Central, Mumbai.
Maharashtra. India.
Pin: 400008.
AUTHOR
ORIGINAL_ARTICLE
Extra Luminal Entrapment of Guide Wire; A Rare Complication of Central Venous Catheter Placement in Right Internal Jugular Vein
Central venous Catheterization (CVC) is a commonly performed procedure for venous access. It is associated with several complications. We report a rare case of extra luminal entrapment of guide wire during CVC placement in right jugular vein. We report a case of 28 years old female patient presented in our emergency with history of entrapped guide wire in right side of neck during CVC. X-ray showed coiling of guide wire in neck. CT Angiography showed guide wire coursing in between common carotid artery and internal jugular vein (IJV), closely abutting the wall of both vessels. The guide wire was coiled with end coursing behind the esophageal wall. Guide wire was removed under fluoroscopic guide manipulation under local anesthesia. We want to emphasize that even though CVC placement is common and simple procedure, serious complication can occur in hands of untrained operator. The procedure should be performed under supervision, if done by trainee. Force should never be applied to advance the guide wire if resistance is encountered.
https://beat.sums.ac.ir/article_44347_8283813ced22a727f98680a741263145.pdf
2016-10-01
240
243
Central venous catheter
Guide wire
Extra luminal entrapment
Jugular vein
Md
Ansari
drmasood_96@yahoo.com
1
PGIMER, Dr RML Hospital, New Delhi, India
LEAD_AUTHOR
Naveen
Kumar
drnaveenvmmc@gmail.com
2
PGIMER, Dr RML Hospital, New Delhi, India
AUTHOR
Shailesh
Kumar
shaileshkdr@gmail.com
3
PGIMER, Dr RML Hospital, New Delhi, India
AUTHOR
Sarita
Kumari
4
AUTHOR
ORIGINAL_ARTICLE
Ruptured Cystic Mesothelioma Diagnosed after Blunt Trauma; Case Report and Literature Review
The majority of blunt trauma is secondary to motor vehicle crashes,especially in those wearing seatbelts or sitting in the front or passenger seat location.Hollow viscus gastrointestinal injuries occur more frequently in small bowel, followed by colorectal, duodenum, stomach and appendix. A 25-year-old male presents after being involved in a motor vehicle accident. Initialworkup was significant for moderate amount of pelvic free fluid and curvilinear,cysticlike structures in the pelvis. He subsequently developed peritonitis and underwentdiagnostic laparoscopy, which revealed multiple cystic nodules arising from theperitoneum. Pathology demonstrated benign cystic mesothelioma (BCM). BCM is a very rarecondition of mesotheliallined, variably sized, fluidfilled cysts that arises from theserous, pericardial or peritoneal lining. Due to the scarcity of cases, its management and prognosis are not fully established. This singular case highlights the necessity for a clinician to have a widedifferential forunusual causes of free pelvic fluid after blunt abdominaltrauma.
https://beat.sums.ac.ir/article_44348_0090a5c584b6cd747de6d1f68f33a421.pdf
2016-10-01
244
247
Benign cystic mesothelioma
Blunt trauma
Laparoscopy
Francisco Igor
Macedo
macedofr@msu.edu
1
Michigan State University
LEAD_AUTHOR
Alice
Race
2
AUTHOR
Laszlo
Hoesel
3
AUTHOR
ORIGINAL_ARTICLE
Massive Pneumocephalus and Pneumorrhachis after Severe Skull Base Fracture
https://beat.sums.ac.ir/article_44349_f4ea98a416697e5bccee2e64784ef12b.pdf
2016-10-01
248
249
Pneumocephalus
Pneumorrhachis
Severe Skull Base Fracture
Hosseinali
Khalili
khalilih16@gmail.com
1
Shiraz University of Medical Sciences
AUTHOR
Amin
Niakan
aniakan@sums.ac.ir
2
Shiraz University of Medical Sciences
AUTHOR
Fariborz
Ghaffarpasand
fariborz.ghaffarpasand@gmail.com
3
Trauma Research Center, Shiraz University of Medical Sciences
LEAD_AUTHOR
ORIGINAL_ARTICLE
Pneumopericardium
https://beat.sums.ac.ir/article_44350_9ef3c56d9713164e3e6fae9fcde241f2.pdf
2016-10-01
250
251
Pneumopericardium
Thoracic injury
Tension pneumopericardium
Biplab
Mishra
1
JPN Apex Trauma Center, AIIMS, New Delhi
AUTHOR
Mohit
Joshi
drmohitjoshi@gmail.com
2
JPN Apex Trauma Center
All India Institute of Medical Sciences New Delhi
LEAD_AUTHOR
Amulya
Rattan
3
JPN Apex Trauma Center
All India Institute of Medical Sciences New Delhi
AUTHOR
Subodh
Kumar
4
JPN Apex Trauma Center
All India Institute of Medical Sciences New Delhi
AUTHOR
Amit
Gupta
5
JPN Apex Trauma Center
All India Institute of Medical Sciences New Delhi
AUTHOR
Sushma
Sagar
6
JPN Apex Trauma Center
All India Institute of Medical Sciences New Delhi
AUTHOR
ORIGINAL_ARTICLE
Acknowledgement of the Reviewers for 2016
https://beat.sums.ac.ir/article_44351_43f5c80474b1d84dd51daff4c2a6fa16.pdf
2016-10-01
252
Best
Reviewers
1
LEAD_AUTHOR