Original Article
Emergency Medical Services
Mohammad Ganji; Elham Navab; shima haghani; mahboobeh shali
Volume 10, Issue 2 , July 2024
Abstract
Objective: When dealing with patients with possible traumatic brain injury, prehospital emergencypersonnel must make decisions quickly with very little data. Determining the amount of risk thatthreatens patients can lead to making correct treatment decisions. The present study aimed todetermine and compare ...
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Objective: When dealing with patients with possible traumatic brain injury, prehospital emergencypersonnel must make decisions quickly with very little data. Determining the amount of risk thatthreatens patients can lead to making correct treatment decisions. The present study aimed todetermine and compare the diagnostic accuracy of early warning scores in prehospital care for thediagnosis of traumatic brain injury.Methods: This prospective study was conducted from December 2023 to January 2025 at hospitalsaffiliated with Tehran University of Medical Sciences. Sampling was performed purposefully, andnon-randomly and 250 trauma patients were enrolled in the study. Data collection was carried oututilizing a demographic questionnaire and various scoring systems, including the National EarlyWarning Score (NEWS2), Modified Early Warning Score (MEWS), Triage Early Warning Score (TEWS),and Modified Emergency Medical Score (MEMS). The data were analyzed using SPSS software.Results: The mean age of the patients was 40.90±15.78. Accident (56.8%) was the most commonmechanism of trauma, and multiple trauma (56%) was the most common type of trauma. TheNational Early Warning Score 2 showed the highest diagnostic accuracy with sensitivity of 82.2%,specificity of 81.1%, and area under the curve of 0.889(. The results of the independent t-testshowed that the mean score of the NEWS2 in prehospital care for patients with an initial diagnosis oftraumatic brain injury after 72 hours (12.3±29.4) was significantly lower compared to other patients(08.3±73.7) (P<0.001).Conclusion: While all four early warning scores were good at detecting ICU admission, there weresignificant differences in their performance measures. The higher diagnostic accuracy of the NationalEarly Warning Score 2 makes it a valuable tool in identifying patients with traumatic brain injury.
Original Article
Education
Amin Beigzadeh; MahmoodReza Dehghani; Sara Heydari
Volume 10, Issue 2 , July 2024
Abstract
Background: Active teaching is widely used in medical education to engage students and promote active learning. However, there is a paucity of research on how active teaching strategies can be applied to English Language learning in a Medical Education context. This study aimed to evaluate the effects ...
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Background: Active teaching is widely used in medical education to engage students and promote active learning. However, there is a paucity of research on how active teaching strategies can be applied to English Language learning in a Medical Education context. This study aimed to evaluate the effects of flipped classroom, and team-based learning on knowledge, and learning satisfaction of health sciences students. Methods: This quasi-experimental study was undertaken with 82 students who were divided into 3 groups, Flipped Group (FG), Team-based Learning (TBL), and Lecture Group (LG) at Sirjan School of Medical Sciences in 2023. Prior to study, the Oxford Quick Placement Test (OQPT) of 50 items was administered to homogenize students. To compare knowledge, a researcher-made knowledge test of English was administered at the baseline and after the intervention. Students’ satisfaction and their perspectives were obtained through a survey. Data were analyzed by Chi-squared, one-way ANOVA, Post hoc Tukey test, and Kruskal-Wallis H tests using SPSS software version 26, and content analysis for the open-ended responses.Results: Of the 117 students participating in the OQPT, 82 (70.10%) entered the study. They included, 21 (25.60%) males, and 61 (74.40%) females with the mean age of 19.57±1.52 years old. In the post-intervention, the FG scored significantly higher (56.71±16.48) than TBL (51.00±14.23), and the LG (39.41±11.45) (p<0.001). Satisfaction levels were highest in the FG. Students’ perspectives varied and were classified into two categories: advantages and challenges, corresponding to each teaching approach. Conclusions: The FG and TBL approaches significantly enhanced learning and student satisfaction compared to LG. These findings underscore the importance of active engagement in medical education, suggesting that innovative teaching strategies can effectively improve student experiences and academic success.
Original Article
Cardiology
Ata Firouzi; Alireza Raji Amir Hasani; naemeh Bahrami; Parnian Bahrami
Volume 10, Issue 2 , July 2024
Abstract
Objective: While PCI achieves high procedural success rates, persistent risks such as periprocedural thrombosis, inflammatory cascades, and myocardial hypoperfusion contribute to a bimodal pattern of early and late complications, underscoring gaps in current risk prediction models. This research focuses ...
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Objective: While PCI achieves high procedural success rates, persistent risks such as periprocedural thrombosis, inflammatory cascades, and myocardial hypoperfusion contribute to a bimodal pattern of early and late complications, underscoring gaps in current risk prediction models. This research focuses on identifying the risk factors contributing to recurrent coronary events, particularly stent thrombosis and in-stent restenosis, in patients admitted to the cardiac emergency department.Methods: A retrospective cohort study was conducted on 204 patients at Shahid Rajaei Hospital to analyze their clinical records, including demographic data, cardiovascular risk factors, and treatment history. Data collection utilized a structured checklist encompassing demographics, cardiovascular risk factors, treatment history, procedural details, and outcomes. Statistical analyses (PRISM version 9.0) included descriptive statistics and multivariable logistic regression to assess predictors of outcomes.Results: Multivariate logistic regression analysis revealed that for same-artery re-involvement, the duration after first myocardial infarction was significantly associated with increased risk (P < 0.0001, OR = 3.666). Regarding stent thrombosis, multiple factors including duration after myocardial infarction (P < 0.001), not taking Plavix (P = 0.033), MI type (P = 0.001), diabetes mellitus (P = 0.002), cigarette smoking (P = 0.029), and absence of family history (P = 0.03) all demonstrated significant effect. For in-stent restenosis, only the absence of diabetes (P = 0.018, OR = 0.432) was significantly associated with decreased likelihood of this outcome.Conclusion: The study also emphasizes the importance of early detection, regular follow-ups, and effective management strategies, such as pharmacological intervention and lifestyle changes, to reduce the risk of adverse cardiac outcomes. Additionally, it was found that a prolonged duration since the initial myocardial infarction significantly elevates the risks of same-artery re-occlusion and stent thrombosis.
Original Article
Pulmonology
Ali Mohammad Rousts; Saeed Safari; Mehri FarhangRanjbar; Seyed Hadi Aghili
Volume 10, Issue 2 , July 2024
Abstract
Objective: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a significanthealthcare burden. This study aimed to compare three risk assessment tools in predicting theoutcomes of COPD exacerbation.Methods: This prospective cohort study was conducted between October 2023 and November2024 ...
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Objective: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a significanthealthcare burden. This study aimed to compare three risk assessment tools in predicting theoutcomes of COPD exacerbation.Methods: This prospective cohort study was conducted between October 2023 and November2024 at five hospitals in Iran (three in Tehran, one in Shahr-e-Rey, and one in Nehbandan). A total of392 patients admitted with acute exacerbation of COPD were enrolled using consecutive sampling.The predictive accuracy of the Ottawa COPD Risk Scale (OCRS), DECAF, and BAP-65 for adverseoutcomes (ICU admission, mechanical ventilation, and mortality) was assessed. The area under thereceiver operating characteristic curve (AUC-ROC) and performance metrics (sensitivity, specificity,predictive values, and likelihood ratios) were calculated for each score. AUCs were compared usingpaired sample ROC analysis with significance set at P<0.05.Results: The AUCs for OCRS, DECAF, and BAP-65 in predicting cumulative adverse outcomes (CAO)were 0.78 (95% CI: 0.73–0.83), 0.79 (95% CI: 0.74–0.83), and 0.79 (95% CI: 0.74–0.83), respectively(P<0.05). For CAO, DECAF and BAP-65 demonstrated the most balanced performance at optimalcutoff, with sensitivities of 69.8% (95% CI: 61.9–75.4) and 68.2% (95% CI: 59.7–75.6) and specificitiesof 78.7% (95% CI: 0.74.5–0.81.8) and 78% (95% CI: 72.5–82.5). OCRS had a sensitivity of 61.2% (95%CI: 52.6–0.77) and a specificity of 84.8% (95% CI: 80.3–89.5). No significant confounding or effectmodifications from demographics, lifestyle factors, or comorbidities were found except for age withDECAF, which performed better in younger patients.Conclusion: DECAF and BAP-65 showed the most balanced performances in predicting CAOamongst the three tools. Paired with a clinician’s judgment, these tools offer valuable insights forbetter triage and clinical decision-making in managing acute COPD exacerbation.
Original Article
Trauma
Willy Johan; Ari Prasetyadjati; Istan Irmansyah Irsan; Munsifah Zaiyanah; Nanik Setijowati
Volume 10, Issue 2 , July 2024
Abstract
Objective: Trauma-related deaths are among the top 10 causes of mortality, with an average of three deaths from traffic accidents every hour in Indonesia. In 2012, there were 117,949 traffic accidents resulting in 29,544 deaths (25.04%). In 2021, there were 103,645 accidents with 25,266 deaths (24.37%). ...
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Objective: Trauma-related deaths are among the top 10 causes of mortality, with an average of three deaths from traffic accidents every hour in Indonesia. In 2012, there were 117,949 traffic accidents resulting in 29,544 deaths (25.04%). In 2021, there were 103,645 accidents with 25,266 deaths (24.37%). Despite efforts to record trauma cases in Indonesia, existing scoring systems from developed countries face limitations. This study aims to propose a new, locally adapted scoring system to improve the management of multiple trauma cases, particularly at Saiful Anwar General Hospital (RSSA), Malang.Methods: This observational analytic study with a retrospective cohort design was conducted at RSSA, Malang, Indonesia, from January 2021 to December 2022. A total of 506 multiple trauma patients from the RSSA Emergency Department were included, selected through purposive sampling. Data analysis involved the use of the t-test or the Mann-Whitney U test for numerical and ordinal data, the chi-square or Fisher's test for nominal data, followed by multivariate logistic regression to establish a scoring system.Results: Logistic regression through backward elimination identified 15 significant predictors of in-hospital mortality: age (p = 0.000, OR = 0.967), pulse rate (p = 0.006, OR = 0.981), GCS (p = 0.000, OR = 1.381), intracerebral hemorrhage (p = 0.105, OR = 0.966), subdural hemorrhage (p = 0.001, OR = 0.875), infratentorial hemorrhage (p = 0.000, OR = 0.151), subfalcine herniation (p = 0.038, OR = 0.871), transtentorial herniation (p = 0.050, OR = 0.038), mandibular fracture (p = 0.004, OR = 0.235), etc. GCS was the strongest predictor (Wald = 50.54). Although intracerebral hemorrhage and lung tissue injury (p > 0.05) were retained due to clinical relevance, the model showed excellent discriminatory power, with an area under the curve (AUC-ROC) of 0.917 and a 95% confidence interval of 0.886–0.948.Conclusion: The MTPS scoring system developed in this study can predict the prognosis of multiple trauma patients with strong discrimination (0.917) and is expected to improve the quality of trauma care in accordance with WHO guidelines at RSSA Malang.
Review Article
Disaster
Saeed Safari; Iraj Najafi; Mahmoud Yousefifard; Mohammad Mehdi Forouzanfar; Hamid Mazloom; Ali Sharifi
Volume 10, Issue 2 , July 2024
Abstract
Introduction: This study aimed to investigate the diagnostic accuracy of serum levels of lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) in evaluating the risk of Acute Kidney Injury (AKI) following traumatic rhabdomyolysis.
Methods: A systematic review and meta-analysis were conducted ...
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Introduction: This study aimed to investigate the diagnostic accuracy of serum levels of lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) in evaluating the risk of Acute Kidney Injury (AKI) following traumatic rhabdomyolysis.
Methods: A systematic review and meta-analysis were conducted by searching Medline, Embase, Scopus, and Web of Science for relevant studies up to June 2025, considering terms such as ‘‘Crush Syndrome,’’ ‘‘Crush Injury,’’ ‘‘Rhabdomyolysis,’’ AND ‘‘Serum Glutamic Oxaloacetic Transaminase,’’ ‘‘SGOT,’’ or ‘‘Aspartate Transaminase.’’ Studies that compared LDH or AST levels in traumatic rhabdomyolysis patients with and without AKI were included. The pooled effect size was evaluated using the standardized mean difference (SMD), and a 95% confidence interval (CI) was calculated. A random-effects model was employed to handle the heterogeneity. Subgroup analyses were conducted based on age group (adults and pediatrics). All analyses were performed using the statistical program STATA 17.0.
Results: For AST, the initial database search identified a total of 5,120 articles (2362 duplicates). Initially, 2,758 studies were screened by title and abstract, 52 articles were selected for full-text assessment, and finally, six articles were included in the quantitative analysis. In the case of LDH, the initial database search identified 4,044 articles (1471 duplicates). The initial 2,573 articles were screened by title and abstract, 49 articles were selected for full-text review, and finally, five studies were included in the quantitative analysis.
A total of seven studies involving 277 AKI and 2592 non-AKI patients were included in the meta-analysis. The pooled SMD for AST was 1.46 (95% CI: 0.79–2.13, I2 = 88.02%) in adults and 0.80 (95% CI: 0.23–1.37, I2 = 65.49%) in children. Similarly, the SMD for LDH was 2.16 (95% CI: 0.20–4.11, I2 = 97.37%) in adults and 1.18 (95% CI: 0.70–1.67, I2 = 32.94%) in children.
Conclusion: Current evidence suggests a significant association between elevated levels of AST and LDH and the incidence of AKI following traumatic rhabdomyolysis, with moderate and low levels of evidence, respectively. However, due to the limited number of studies, it was not possible to assess their effectiveness as a screening test.
Original Article
emergency nursing
Oanh Tran
Volume 10, Issue 2 , July 2024
Abstract
ABSTRACTIntroduction: Orthostatic hypertension (OH) is one of the most common symptoms of autonomic nervous system disorder in patients with type 2 diabetes. This study aimed to determine the percentage of OH among Vietnamese older adults with type 2 diabetes and its influencing factors.Material and ...
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ABSTRACTIntroduction: Orthostatic hypertension (OH) is one of the most common symptoms of autonomic nervous system disorder in patients with type 2 diabetes. This study aimed to determine the percentage of OH among Vietnamese older adults with type 2 diabetes and its influencing factors.Material and Methods: A cross-sectional descriptive study of 96 older adults with type 2 diabetes treated in a large hospital in Central Vietam from January 2021 to April 2021. Data were collected using a demographic and health-related questionnaire and Omron electronic sphygmomanometers for blood pressure (BP) measurement. OH was diagnosed according to 1996 diagnosis criteria of the American Autonomic Society and the American Academy of Neurology. Descriptive statistics, independent t-test, Chi-square, univariable and multivariable logistic regression were used for analysis with p-value≤0.05.Results: The prevalance of OH among older adults with type 2 diabetes was 46.9%. Some predicting factors with OH in older adults with type 2 diabetes were gender, duration of diabetes, glycated hemoglobin A1c (HbA1C) (p<0.05).Conclusion: OH among older adults with type 2 diabetes is quite high and healthcare providers should pay attention more to older female adults who had a long duration of diabetes and a high HbA1C value.