Effect of repetitive feedbackon residents' communication skills improvement

Peer reviewedPublisher PD

A Comparison of Verapamil and Digoxin for Heart Rate Control in Atrial Fibrillation

Purpose: Atrial fibrillation (AF) is one of the most common types of sustained dysrhythmia and there are some disagreements about its treatment. The goals of AF treatment include the control of ventricular rate, the establishment of sinus rhythm and the prevention of thromboembolic events. In this study, the effect of verapamil was compared to digoxin on heart rate control in patients with AF. Methods:This descriptive study was conducted in an emergency department (ED) in Iran. Sixty patients with a new onset AF and rapid ventricular response receiving digoxin or verapamil were included and observed. Results:Two thirty-patient groups receiving verapamil or digoxin were evaluated. The heart rate was significantly decreased in both groups (p = 0.002); however, the cardioversion was not noticed in both of them. The best rate control in verapamil and digoxin groups was observed after 5.9 mg (46.7%) and 0.6 mg (36.7%), respectively. Conclusion: Administration of verapamil in comparison with digoxin has no difference to control the heart rate in AF patients. It should be taken into consideration that prospective randomized studies should be conducted to identify the efficacy and select the best of these two drugs to treat AF patients

The Accuracy of GAP and MGAP Scoring Systems in Predicting Mortality in Trauma; a Diagnostic Accuracy Study

Introduction: Trauma scoring systems help physicians and nurses to be informed of injuries to a patient and assist their decision making in the cases of trauma and importantly prediction of their outcome and prognosis. Objective: This study aimed to compare the accuracy of GAP and MGAP scoring systems as predictors of mortality in trauma patients. Methods: This diagnostic accuracy study was conducted amongst 1861 trauma patients admitted to Rajaee Hospital in Shiraz, Iran, during 2017. The data on demographic features were extracted from the patients’ records. Then, trauma scoring systems including injury severity score (ISS), GAP, MGAP, and Glasgow coma scale (GCS) were compared to evaluate their accuracy in predicting mortality. Area under the receiver operating characteristic (ROC) curve was used to evaluate the accuracy of different trauma scoring systems and detect the sensitivity and specificity in order to predict status of discharge after 24 hours. Results: Based on the results, the area under the ROC curve was 0.8 for GCS. Moreover, Area Under Curve (AUC) of GAP was 0.91 and amongst different values, GAP value of ≤18 was selected as the cut-off point, since it exhibited the best sensitivity and specificity (72.99 and 95.52, respectively). In addition, the area under the ROC curve was 0.9 for MGAP, and value of ≤23 was selected as the cut-off point because it showed the best sensitivity and specificity (81.04 and 87.70, respectively). Additionally, AUC of ISS was 0.88. Conclusion: Both GAP and MGAP methods were able to appropriately predict mortality and were not significantly different; hence, both can be used for the right triage of patients and to predict the severity of injuries and subsequent mortality. Moreover, GAP and ISS had the best specificity and sensitivity, respectively

The Accuracy of GAP and MGAP Scoring Systems in Predicting Mortality in Trauma; a Diagnostic Accuracy Study

Introduction: Trauma scoring systems help physicians and nurses to be informed of injuries to a patient and assist their decision making in the cases of trauma and importantly prediction of their outcome and prognosis. Objective: This study aimed to compare the accuracy of GAP and MGAP scoring systems as predictors of mortality in trauma patients. Methods: This diagnostic accuracy study was conducted amongst 1861 trauma patients admitted to Rajaee Hospital in Shiraz, Iran, during 2017. The data on demographic features were extracted from the patients’ records. Then, trauma scoring systems including injury severity score (ISS), GAP, MGAP, and Glasgow coma scale (GCS) were compared to evaluate their accuracy in predicting mortality. Area under the receiver operating characteristic (ROC) curve was used to evaluate the accuracy of different trauma scoring systems and detect the sensitivity and specificity in order to predict status of discharge after 24 hours. Results: Based on the results, the area under the ROC curve was 0.8 for GCS. Moreover, Area Under Curve (AUC) of GAP was 0.91 and amongst different values, GAP value of ≤18 was selected as the cut-off point, since it exhibited the best sensitivity and specificity (72.99 and 95.52, respectively). In addition, the area under the ROC curve was 0.9 for MGAP, and value of ≤23 was selected as the cut-off point because it showed the best sensitivity and specificity (81.04 and 87.70, respectively). Additionally, AUC of ISS was 0.88. Conclusion: Both GAP and MGAP methods were able to appropriately predict mortality and were not significantly different; hence, both can be used for the right triage of patients and to predict the severity of injuries and subsequent mortality. Moreover, GAP and ISS had the best specificity and sensitivity, respectively

The roles of lncRNAs and miRNAs in pancreatic cancer: a focus on cancer development and progression and their roles as potential biomarkers

Pancreatic ductal adenocarcinoma (PDAC) is among the most penetrative malignancies affecting humans, with mounting incidence prevalence worldwide. This cancer is usually not diagnosed in the early stages. There is also no effective therapy against PDAC, and most patients have chemo-resistance. The combination of these factors causes PDAC to have a poor prognosis, and often patients do not live longer than six months. Because of the failure of conventional therapies, the identification of key biomarkers is crucial in the early diagnosis, treatment, and prognosis of pancreatic cancer. 65% of the human genome encodes ncRNAs. There are different types of ncRNAs that are classified based on their sequence lengths and functions. They play a vital role in replication, transcription, translation, and epigenetic regulation. They also participate in some cellular processes, such as proliferation, differentiation, metabolism, and apoptosis. The roles of ncRNAs as tumor suppressors or oncogenes in the growth of tumors in a variety of tissues, including the pancreas, have been demonstrated in several studies. This study discusses the key roles of some lncRNAs and miRNAs in the growth and advancement of pancreatic carcinoma. Because they are involved not only in the premature identification, chemo-resistance and prognostication, also their roles as potential biomarkers for better management of PDAC patients

Hospitalization due to traffic accidents among the elderly, Shiraz, 2018; mortality, severity, and injury pattern

Background: Aging results in declined function, which leads to loss of capacity and respond to injury. Hence, the duration of treatment after traffic accident increases in these patients. The present study aimed to identify the factors affecting the elderly hospitalization. Study Design: This was a cross-sectional study. Materials and Methods: This cross-sectional study was conducted on 768 trauma patients aged 65 years and more due to traffic injuries, referred to Rajaee (Emtiaz) hospital trauma referral center, Shiraz, Iran, in 2018. Data were collected through the hospital's health information system, as well as readings and encoding patient's clinical records. Poisson regression was performed to evaluate the partial effects of each covariate on geriatric trauma patients. Results: The mean age of injured patients was 73.27 ± 6.88 years, of which 7.29 expired. Extremities and externals (58.20) and head and neck (18.36) were the most commonly injured regions of the body. Each year after 65 led to 0.03 times increase in the length of hospitalization. The male's hospital stay was 1.15 times more than females. Conclusion: According to the results, length of hospitalization had a direct correlation with aging among elderly trauma patients. Since the elderly population is on the rise, it is necessary for the policymakers to come up with preventive measures to reduce the number of accidents and casualties

The Prevalence of Type ”A" Behavior and its Relationship With Some Variables Among Sultan Qaboos University Students

The current research aims to Investigate the prevalence of type "A" behavior among Sultan Qaboos University (SQU) students and to show how the average of spread in type “A" is affected by some variables (gender of student, type of college, age, number of male brothers and number of female sisters, family income, type of father’s personality, type of mother's personality). In order to achieve that, a scale to measure type A" behavior has been designed. This scale consists of 37 items, divided between four dimensions of type “A“ behavior (hostility and aggressiveness, body physiology and movements, urgency, impatience, competition energy and ambition). This scale has acceptable psychometric indicators such as: face validity, factorial validity, item discrimination and reliability. The scale has been administered to 734 male and female students from seven different colleges in Sultan Qaboos University. The results in general showed low rate of type “A” behavior among SQU students, which was 5.18% (5.0896 for male, and 5.2596 for female). In the demographic variables the results showed that the gender; of students in the first dimension (hostility and aggressiveness) has a significant level for the males, while the third (urgency and impatience) was significant for the females, and the variable of college type in the second dimension (body physiology and movements) was significant for the students of Humanities colleges, and the number of male brothers in the third dimension (urgency and impatience) was significant for the less number of brothers). The type of father's personality in the second dimension (body physiology and movements) and the third (urgency and impatience) and in type “A “was generally significant for the strict type. Other variables (age, number of female sisters, family income and mother's personality) had no effect on type “A “ behavior or any of its dimensions

Mortality Analysis of Patients with Paraquat Poisoning Treated at Two University Hospitals in Shiraz, Iran

Background: Poisoning with paraquat (PQ) is highly fatal. In this study; demographic and clinical characteristics of  a series of patients with acute PQ poisoning treated at two university hospitals in Shiraz, Iran are presented and predictive factors for mortality are analyzed. Methods: This was an analytical cross-sectional study on consecutive PQ poisoned patients admitted to Shoushtari and Ali Asghar hospitals in Shiraz, Iran during 21st March 2012 to 20th March 2013. To find out predictive factors for mortality, independent variables were compared between death and survival using Fisher’s exact test. To determine the factors that had the strongest impact on mortality, logistic regression analysis was done. Results: Fifty-two patients (73.1% men) were included with mean age of 28.2 ± 10.3 years. The most common clinical findings were nausea and vomiting (88.5%), pharyngeal congestion (82.7%), epigastric pain (80.8%), increased creatinine (57.7%), increased liver enzymes (53.8%) and metabolic acidosis (53.8%). The volume of poison ingested was significantly higher in deceased compared to survived patients (P < 0.001). Death was significantly higher in patients with pharyngeal congestion (P = 0.001), respiratory distress (P < 0.001), loss of consciousness (P = 0.025), increased creatinine (P < 0.001), increased liver enzymes (P < 0.001), metabolic acidosis (P < 0.001), increased bilirubin (P < 0.001), respiratory acidosis (P = 0.001), increased INR (P = 0.023), suicidal intention (P < 0.001), and oral exposure (P = 0.047). After putting these factors to logistic regression model, only respiratory distress, increased bilirubin, increased liver enzymes and increased creatinine continued to be significantly associated with mortality. Conlcusion: PQ poisoning is associated with high mortality requiring an immediate assessment of patients and prediction of prognosis. Renal and hepatic failure in addition to respiratory distress can be the strongest risk factors for poor prognosis in acute PQ poisoning