Prehospital Electronic Patient Care Report Systems: Early Experiences from Emergency Medical Services Agency Leaders

Background: As the United States embraces electronic health records (EHRs), improved emergency medical services (EMS) information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement electronic patient care report (e-PCR) systems. We sought to characterize motivations for adoption of e-PCR systems, challenges associated with adoption and implementation, and emerging implementation strategies. Methods: We conducted a qualitative study using semi-structured in-depth interviews with EMS agency leaders. Participants were recruited through a web-based survey of National Association of EMS Physicians (NAEMSP) members, a didactic session at the 2010 NAEMSP Annual Meeting, and snowball sampling. Interviews lasted approximately 30 minutes, were recorded and professionally transcribed. Analysis was conducted by a five-person team, employing the constant comparative method to identify recurrent themes. Results: Twenty-three interviewees represented 20 EMS agencies from the United States and Canada; 14 EMS agencies were currently using e-PCR systems. The primary reason for adoption was the potential for e-PCR systems to support quality assurance efforts. Challenges to e-PCR system adoption included those common to any health information technology project, as well as challenges unique to the prehospital setting, including: fear of increased ambulance run times leading to decreased ambulance availability, difficulty integrating with existing hospital information systems, and unfunded mandates requiring adoption of e-PCR systems. Three recurring strategies emerged to improve e-PCR system adoption and implementation: 1) identify creative funding sources; 2) leverage regional health information organizations; and 3) build internal information technology capacity. Conclusion: EMS agencies are highly motivated to adopt e-PCR systems to support quality assurance efforts; however, adoption and implementation of e-PCR systems has been challenging for many. Emerging strategies from EMS agencies and others that have successfully implemented EHRs may be useful in expanding e-PCR system use and facilitating this transition for other EMS agencies

Frequency of lower limb injuries and their Causes among motorcycle accident admitted into Imam Hossein hospital during one year

Background and Aim: Motor vehicle accidents are common cause of mortality, morbidity and disability. Human factors are principle cause for frequency of motor vehicle accident. In most studies, 52-40% lower limb injuries are trauma from a motorcycle accident. These accidents cause high financial cost and harm for society.Materials and Methods: In this study, patients with lower limb injuries referred to the hospital trauma ward of Imam Hussein were evaluated during one year. Questionnaire forms were designed and completed for patients then data of these forms was inserted in a database. The information was analyzed by statistical software SPSS 18.Results: from 766 patients with lower limb traumas which were examined and evaluated, 92 % were male and mean age of patients was 25± 12 years. 156 patients suffered from head and neck trauma and 134 persons had skin damage in addition to lower limb trauma. Injury to leg was most common injuries in lower leg and tibia shaft fracture was more frequent than lower bone fracture. Most injuries in pelvic trauma associated with fractures of the superior pubic ramus and coccyx bone. Seventy percent of related knee injuries included injury to patella and tibia plateau. The most observed injuries in ankle and foot were lateral malleolus fracture and lisferanc injuries. About 11 percent of patients were discharged from emergency room after primary management and other patients were admitted in hospital.Conclusion: Given the high incidence of lower extremity injuries, especially the leg, in the accident of motorcycle riders, procurement and construction of efficient protective equipment, especially protective guard can be effective in reducing accidents.  ReferencesCrawford R. Trauma audit: experience in north-east Scotland. Br J Surg 1991; 78(11):1362-6.McNicholl B P, Fisher R B, Dearden C H. Transatlantic perspectives of trauma systems. Br J Surg 1993; 80(8):985-7. Rutledge R, Fakhry S, Rutherford E, Muakkassa F, Meyer A. Comparison of APACHE II, Trauma Score, and Injury Severity Score as predictors of outcome in critically injured trauma patients. Am J Surg 1994; 167(6): 622-3.Mohammadfam A, Ghazizadeh A. Epidemiology of Road Traffic Causes Death in Tehran 1387. The Scientific Journal of Kurdistan University of Medical Sciences (SJKUMS) 2002; 6(23):33-35.Murray C J L, Lopez AD. The Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard University Press on behalf of the World Bank and WHO. 1996.Kopits E, Cropper M. Traffic fatalities and economic growth. Washington, DC: World Bank, 2003. Policy research working papers No 3035.Ahmad S, Charesaz S. Injuries resulting from motorcycle- induced trauma during two years in Shahid Motahari Clinical Center of URMIA. SJFM 2006; 12(2):79-83.Drysdale W F, Kraus J F, Frantic C E, Riggins R S. Injury Patterns in motorcycle collisions. J Trauma 1975; 15 (2): 99-115.Wick M, Ekkernkamp A, Muhr G. The epidemiology of multiple traumas. Chirurg 1997 (11); 68: 1053-8.Hatamabadi H R, Vafaee R, Haddadi M, Abdalvand A, Soori H. Necessity of an integrated road traffic injuries surveillance system: a community-based study. Traffic Inj Prev 2011; 12(4):358-62.Javid M, Shahcheraghi G, Lahiji F A, Ahmadi A, Farhadi A, Akasheh G A. Road Traffic Injuries in Children. Iranian journal of Orthopaedic surgery 2006; 4(3): 1-6.Hell W, Lob G. Common patterns of motorcycle injury. Ann Proc Assoc Adv Automot Med 1993; 37: 77-86..Araqi E, Vahedian M. Study on susceptible and damages from motorcycle accidents in Mashhad in 2005. Ofogh-e-Danesh, quarterly journal of Gonabad university of medical sciences and health services 2006; 13(1):34-40.Committee on trauma research. Injury in America: A continuing Public Health Problem. Washington DC: National Academy press; 1985.Mackenzie E J, Morris J A Jr, Smith G S, Fahey M. Acute hospital costs of trauma in the United States: Implications for Regionalized Systems of care. J Trauma 1990; 30 (9): 1096 -101.Ghorbani A. Epidemiology of Injuries and their Causes among Traumatic Patients Admitted into Shahid Mottahari Hospital. Gonbad-e Qabus 2008; 15 (1):29-34.Hatamabadi H R, Vafaee R, Haddadi M, Abdalvand A, Soori H. Epidemiologic Study of Road Traffic Injuries by Road User Type Characteristics and Road Environment in Iran: A Community-Based Approach. Traffic Inj Prev 2012; 13:1–5.Yunesian M, Moradi A, Khaji A, Mesdaghinia A R, Zargar M. Evaluation of the effect of offender motorcyclists' penalty enforcement project on the incidence of road traffic accident injuries in Tehran. Payesh 2007; 6(1). 19-26.Fernando J, Plasencia A, Ricart I, Canaleta X, Segui-Gomez M. Motor - vehicle injury Patterns in emergency-department patients in south -European urban setting. Annu Proc Assoc Adv Automot Med 2000; 44: 445-58.Peek C, Braver E R, Shen H, Kraus J F. Lower extremity injuries from motorcycle crashes: a common cause of preventable injury. J Trauma 1994; 37 (3): 358-64.                    

Evaluation of Parameter Related to Preventative Measures on the Child Injuries at Home

Background and Aims: The harms resulted from home injuries are a major factor in child mortality. The current study aims to evaluate the factors associated with the knowledge and performance level of mothers in terms of adopting preventive behaviors to avoid home injuries.Materials and Methods: The target population of this descriptive - analytical study is all mothers of preschool children suffering from home injuries referring to Imam Hossein and Haft-E-Tir hospitals. Mothers’ data were collected using a valid and reliable questionnaire.After dividing the knowledge level and the status of mothers’ preventive behaviors into two groups, the relationship between factors was assessed by using Chi-square and multivariate logistic regression and the status of mothers preventive behaviors were studied as well.Results: Finally, 230 mothers (mean age 5.2 ± 29.4) were studied. 75.0 of them had good awareness, and 56.0 % also had a good performance. Mother's absence for at least 8 hours per day (0.12 = OR), increase of the number of preschool children (0.03 = OR) and employed mother (0.01 = OR) are the things that hinder preventive behaviors in home injuries. While the history of home injuries during the past 3 weeks (13.3 = OR), mother’s appropriate awareness of preventive behaviors (28.9 = OR) and high-income families (2.4 = OR) lead to the adoption of preventive behaviors by mothers.Conclusion: Awareness is the only modifiable factor and it can be improved by educational interventions. Support of assistance and social welfare agencies for employed mothers can improve the current status of preventive behaviors in home injuries.REFERENCES :          1.    Lao Z, Gifford M, Dalal K. Economic cost of childhood unintentional injuries. Int J Prev Med. 2012 May;3(5):303-12.2.    Zaloshnja E, Miller TR, Lawrence BA, Romano E. The costs of unintentional home injuries. American journal of preventive medicine. 2005;28(1):88-94.3.    Schneiderman JU, Leslie LK, Hurlburt MS, Zhang J, Horwitz SMC. Caregiver reports of serious injuries in children who remain at home after a child protective services investigation. Maternal and child health journal. 2012:1-8.4.    Grossman DC. The history of injury control and the epidemiology of child and adolescent injuries. The future of children. 2000:23-52.5.    Sengoelge M, Hasselberg M, Laflamme L. Child home injury mortality in Europe: a 16-country analysis. The European Journal of Public Health. 2011;21(2):166-70.6.    Hooper R, Coggan C, Adams B. Injury prevention attitudes and awareness in New Zealand. Injury Prevention. 2003;9(1):42-7.7.    Hong J, Lee B, Ha EH, Park H. Parental socioeconomic status and unintentional injury deaths in early childhood: consideration of injury mechanisms, age at death, and gender. Accident Analysis and Prevention; Accident Analysis and Prevention. 2010;42(1):313-9.8.    Chen E, Matthews KA, Boyce WT. Socioeconomic differences in children's health: how and why do these relationships change with age? Psychological bulletin. 2002;128(2):295-329.9.    Scholer SJ, Hickson GB, Ray WA. Sociodemographic factors identify US infants at high risk of injury mortality. Pediatrics. 1999;103(6):1183-8.10.  Phelan K, Khoury J, Atherton H, Kahn RS. Maternal depression, child behavior, and injury. Injury prevention. 2007;13(6):403-8.11.  Thein M, Lee B, Bun P. Knowledge, attitude and practices of childhood injuries and their prevention by primary caregivers in Singapore. Singapore medical journal. 2005;46(3):122.12.  Smithson J, Garside R, Pearson M. Barriers to, and facilitators of, the prevention of unintentional injury in children in the home: a systematic review and synthesis of qualitative research. Injury Prevention. 2011;17(2):119-26.13.  Phelan KJ, Khoury J, Xu Y, Liddy S, Hornung R, Lanphear BP. A randomized controlled trial of home injury hazard reduction: the HOME injury study. Archives of pediatrics & adolescent medicine. 2011;165(4):339-43.14.  Kendrick D, Coupland C, Mulvaney C, Simpson J, Smith S, Sutton A, et al. Home safety education and provision of safety equipment for injury prevention. Cochrane Database Syst Rev. 2007;1(1):197-204.15.  Bruce BS, Lake JP, Eden VA, Denney JC. Children at risk of injury. Journal of Pediatric Nursing. 2004;19(2):121-7.16.  Carman J, Friedman E, Lamb D, Lennon K. Evaluating the impact of a child injury prevention project. Community Practitioner. 2006;79(6):188-92.17.  Ma B, Xi HJ, Wang JL, Yan Y, Tang HT, Zhu SH, et al. Pediatric burns due to hot water from water dispenser: a neglected issue that should be highly concerned. Chinese medical journal. 2012 Jun;125(11):2053-6.18.  Hu M, Hu GQ, Sun ZQ, He X. Epidemiological survey of the prevalence of non-fatal injury among children aged 5-14 years in China. Biomedical and environmental sciences : BES. 2012 Aug;25(4):407-12.19.  Eldosoky R. Home-related injuries among children: knowledge, attitudes and practice about first aid among rural mothers. EMHJ. 2012;18(10):1021-7.20.  Thein MM, Lee BW, Bun PY. Knowledge, attitude and practices of childhood injuries and their prevention by primary caregivers in Singapore. Singapore medical journal. 2005 Mar;46(3):122-6.21.  Kendrick D, Smith S, Sutton A, Mulvaney C, Watson M, Coupland C, et al. The effect of education and home safety equipment on childhood thermal injury prevention: meta-analysis and meta-regression. Injury Prevention. 2009;15(3):197-204.22.  Kendrick D, Smith S, Sutton A, Watson M, Coupland C, Mulvaney C, et al. Effect of education and safety equipment on poisoning-prevention practices and poisoning: systematic review, meta-analysis and meta-regression. Archives of disease in childhood. 2008;93(7):599-608.23.  Anh TT, Hongkrailert N, Sermsri S. Factors related to Preventive Behavior on Home Injury among Mothers with Children under 5 Years Old at Communes of Hungyen Province, Vietnam. Journal of Public Health. 2007;5(2):66-9.24.  Masjedi MR, Naghan PA, Taslimi S, Yousefifard M, Ebrahimi SM, Khosravi A, et al. Opium Could Be Considered an Independent Risk Factor for Lung Cancer: A Case-Control Study. Respiration. 2013;85:112-8.25.  Heydari G, Yousefifard M, Hosseini M, Ramezankhani A, Masjedi MR. Comparison of Cigarette Smoking, Knowledge, Attitude and Prediction of Smoking for the Next Five Years and Their Association between Students, Teachers and Clergymen. International Journal of Preventive Medicine. 2013;4(5):557-64.26.  Nasrollahzadeh D, Kamangar F, Aghcheli K, Sotoudeh M, Islami F, Abnet C, et al. Opium, tobacco, and alcohol use in relation to oesophageal squamous cell carcinoma in a high-risk area of Iran. British journal of cancer. 2008;98(11):1857-63.27.  Tomruk O, Soysal S, Gunay T, Cimrin AH. First aid: Level of knowledge of relatives and bystanders in emergency situations. Advances in therapy. 2007;24(4):691-9.28.  Gielen AC, Wilson MEH, Faden RR, Wissow L, Harvilchuck JD. In-home injury prevention practices for infants and toddlers: the role of parental beliefs, barriers, and housing quality. Health Education & Behavior. 1995;22(1):85-95.29.  Vladutiu C, Nansel T, Weaver N, Jacobsen H, Kreuter M. Differential strength of association of child injury prevention attitudes and beliefs on practices: a case for audience segmentation. Injury Prevention. 2006;12(1):35-40.30.  Vincenten JA, Sector MJ, Rogmans W, Bouter L. Parents' perceptions, attitudes and behaviours towards child safety: a study in 14 European countries. International Journal of Injury Control and Safety Promotion. 2005;12(3):183-9.31.   Hatamabadi HR, Mahfoozpour S, Alimohammadi H, Younesian S. Evaluation of factors influencing knowledge and attitudes of mothers with preschool children regarding their adoption of preventive measures for home injuries referred to academic emergency centers, Tehran, Iran. International Journal of Injury Control and Safety Promotion. 2013 Jul 26. [Epub ahead of print].

Outcome of nonspecific abdominal pain in the discharged patients from the emergency department

Background and Objective: The causes of non traumatic abdominal pain are varied from mild to severe onset. This study was carried out to assess the outcome of the patients with non-specific abdominal pain discharged from the emergency department. Methods: This cohort study was carried out on 247 patients (68.4% female, 31.6% male) with non-specific abdominal pain which referred to the emergency department of Imam Hossain hospital in Tehran, Iran during 2010-11. The existence or improvement of pain, readmission to hospital and possible subsequent complications diagnose and death was recorded after four-week through telephone follow-up. Results: 247 patients with non-specific abdominal pain were enrolled. Out of 158 patients with recurrence pain, 71 (45%) patients were admitted to the hospital again that finally, cause of pain was diagnosed in 45 (28.5%) patients. The most common cause of abdominal pain was irritable bowel syndrome (3.2%). History of similar pain (OR=4.04, P<0.05), abnormal findings in abdominal ultrasonography (OR=8.2, P<0.05), abnormal urine analysis (OR=7.4, P<0.05) and abdominal pain persisted for more than 2 days (OR=4.04, P<0.05) were independent factors to identifying the causes of abdominal pain. Conclusion: Nonspecific abdominal pain will not lead to appropriate recognition and most of them recover without any complication

Correlation of total serum magnesium level with clinical outcomes in stroke patients

Background and Objective: Magnesium (Mg) ion has possible role in protecting neurons and glia from ischemic damage through the cerebral blood flow and neuronal action. This study was done to evaluate the correlation of total serum Mg level with clinical outcomes in stroke patients. Materials and Methods: This cross sectional study was done on 316 patients whom diagnosed with stroke in Imam Hossein hospital, Tehran, Iran during 2010-11. Mg levels in all patients were measured. Also, recurrent transient ischemic attack (TIA), recurrent myocardial infarction or stroke, unstable angina and death as clinical outcomes were follow-up for period of 3 and 6 months after admission. Data were analyzed using SPSS-18, Chi-Square, Fisher and Pearson correlation tests. Results: The mean age of patients was 65±15.8 year. Limb weakness (69.9%) and haemoplasia with 63.6% were the most common clinical complaints. Death was the most common finding in 3 month (16.8%) and recurrent stroke was the most common finding in 6 month follow up (2.5%). There was no significant difference between the total serum Mg and the first and second three-months follow up of clinical outcomes. Conclusion: This study can not show a significant correlation between total serum Mg levels and clinical outcomes after 3 and 6 month follow up in stroke patients

Derivation and validation of a scoring system to identify patients with bacteremia and hematological malignancies at higher risk for mortality

BACKGROUND: The aim of this study was to develop and validate a reliable clinical prediction rule that could be employed to identify patients at higher likelihood of mortality among those with hematological malignancies (HMs) and bacterial bloodstream infections (BBSIs). METHODS AND FINDINGS: We conducted a retrospective cohort study in nine Italian hematological units. The derivation cohort consisted of adult patients with BBSI and HMs admitted to the Catholic University Hospital (Rome) between January 2002 and December 2008. Survivors and nonsurvivors were compared to identify predictors of 30-day mortality. The validation cohort consisted of patients hospitalized with BBSI and HMs who were admitted in 8 other Italian hematological units between January 2009 and December 2010. The inclusion and exclusion criteria were identical for both cohorts, with type and stage of HMs used as matching criteria. In the derivation set (247 episodes), the multivariate analysis yielded the following significant mortality-related risk factors acute renal failure (Odds Ratio [OR] 6.44, Confidential Interval [CI], 2.36-17.57, P<0.001); severe neutropenia (absolute neutrophil count <100/mm(3)) (OR 4.38, CI, 2.04-9.43, P<0.001); nosocomial infection (OR, 3.73, CI, 1.36-10.22, P\u200a=\u200a0.01); age 6565 years (OR, 3.42, CI, 1.49-7.80, P\u200a=\u200a0.003); and Charlson Comorbidity Index 654 (OR, 3.01, CI 1.36-6.65, P\u200a=\u200a0.006). The variables unable to be evaluated at that time (for example, prolonged neutropenia) were not included in the final logistic model. The equal-weight risk score model, which assigned 1 point to each risk factor, yielded good-excellent discrimination in both cohorts, with areas under the receiver operating curve of 0.83 versus 0.93 (derivation versus validation) and good calibration (Hosmer-Lemshow P\u200a=\u200a0.16 versus 0.75).CONCLUSIONS: The risk index accurately identifies patients with HMs and BBSIs at high risk for mortality; a better initial predictive approach may yield better therapeutic decisions for these patients, with an eventual reduction in mortality