The outcomes of head trauma due to road traffic accident in hospitalized elderly patients

Introduction: Head trauma is one of the most important causes of death in trauma centers. In particular, treatment of head injury in the elderly seems more complicated than that of the young and middle aged. This study aimed to identify the outcomes of head trauma due to road traffic accidents (RTAs) in elderly patients. Materials and Methods: In a descriptive-analytical study, records of 294 elderly patients with head trauma due to RTA retrieved from health information system were reviewed using a checklist. The outcomes of patients were evaluated using the Glasgow Outcome Scale. Complete recovery and partial disability were considered as favorable outcomes, whereas severe disability, vegetative state, and death were defined as unfavorable outcomes. Descriptive factors and adjusted coefficients were calculated using SPSS software. Results: Of 294 elderly patients, 77.2 were men. About half of the road accidents had occurred in urban areas (58.8). Less than half of the injured elderly were pedestrian (44.9). The mean Glasgow Coma Scale of patients equaled 13.42 ± 3.29. Unfavorable outcomes were observed only in 20.4 of the patients. There were significant differences in head injury severity between the groups with favorable and unfavorable outcomes (P Conclusion: The results of our study mentioned that most of the elderly who had accidents were pedestrian, most of which occurred in the cities. Moderate and severe head injuries in patients had unfavorable clinical outcome

Pre-Hospital and Post-Hospital Quality of Care in Traumatic Spinal Column and Cord Injuries in Iran

STUDY DESIGN: A retrospective study.OBJECTIVES: The quality of care (QoC) for spinal column/cord injury patients is a major health care concern. This study aimed to implement the QoC assessment tool (QoCAT) in the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to define the current state of pre- and post-hospital QoC of individuals with Traumatic Spinal Column and Spinal Cord Injuries (TSC/SCIs).METHODS: The QoCAT, previously developed by our team to measure the QoC in patients with TSC/SCIs, was implemented in the NSCIR-IR. The pre-hospital QoC was evaluated through a retrospective analysis of NSCIR-IR registry data. Telephone interviews and follow-ups of patients with SCI evaluated the QoC in the post-hospital phase.RESULTS: In the pre-hospital phase, cervical collars and immobilization were implemented in 46.4% and 48.5% of the cases, respectively. Transport time from the scene to the hospital was documented as &lt;1 hour and &lt;8 hours in 33.4% and 93.9% of the patients, respectively. Post-hospital indicators in patients with SCI revealed a first-year mortality rate of 12.5% (20/160), a high incidence of secondary complications, reduced access to electrical wheelchairs (4.2%) and modified cars (7.7%), and low employment rate (21.4%).CONCLUSION: These findings revealed a significant delay in transport time to the first care facilities, low use of immobilization equipment indicating low pre-hospital QoC. Further, the high incidence of secondary complications, low employment rate, and low access to electrical wheelchairs and modified cars indicate lower post-hospital QoC in patients with SCI. These findings imply the need for further planning to improve the QoC for patients with TSC/SCIs.</p

The Association between Social Capital and Burnout in Nurses of a Trauma Referral Teaching Hospital

Social capital is a multi-faceted phenomenon in social sciences that massively affects many social fields. It can be a helpful factor in promoting health. Among the groups with high burnout, nurses have always shown higher levels of burnout. Studies have revealed that social capital can be an important factor affecting burnout. This study aimed to determine the extent of the effect of social capital on burnout in nurses of a trauma referral teaching hospital in Rasht. This was a descriptive correlational study conducted on 214 nurses of a trauma referral teaching hospital. Maslach standard questionnaire and the social capital questionnaire devised by Boyas and colleagues were used. Data were analyzed using descriptive statistics, Pearson correlation coefficient, and linear regression analysis to determine the extent of the effect of social capital on burnout. The study showed an inverse association between social capital and burnout. The intensity of the relationship was -0.451 (P<0.0001). Also, the linear regression model of social capital on burnout variable showed that the regression coefficient of social capital equaled -0.34. The determination coefficient of this regression model indicated that social capital explained 20% of burnout changes. The results showed high burnout in emotional exhaustion dimension and an inverse association between social capital and burnout. Thus, attempts should be made to promote social capital dimensions among nurses. Given the inevitability of job stress in a nursing environment, and managers should plan on improving the working conditions and training techniques to deal with such stress

Epidemiology of Traumatic Spinal Fractures and Spinal Cord Injuries in Guilan, North of Iran

Background: Epidemiological knowledge of traumatic spinal fractures and spinal cord injuries (SCIs) is essential for preventive planning and health policy-making. The present study was conducted to investigate the epidemiological features of traumatic spinal fractures and SCIs in Guilan province, Iran. Methods: The present cross-sectional study was performed on all 15-80 years old patients with trauma admitted to Poursina Hospital from January 2015 to December 2017. The individual characteristics, time, place and mechanism of trauma and diagnostic characteristics of spinal trauma were gathered using trauma registry system. The incidence and epidemiological distribution of spinal fractures among traumatic patients were then estimated. Results: The incidence of traumatic spinal fractures was found to be 0.6% in 2015, 0.3% in 2016 and 0.2% in 2017. The men to women ratio was 2.33:1. Motor Vehicle Accident (MVA) and falls were respectively the most common mechanisms of trauma and their incidence were higher in rural communities than in urban communities. There was significant relationships between mechanism of trauma and the site of vertebral fracture (P-value = 0.02). Lumbar vertebrae mostly caused by falls while cervical vertebrae caused by MVA. The incidence of SCI in all the patients with spinal fractures was 18.23% in 2015-17. SCIs were found to be more prevalent in 15-45 year olds compared to other age groups. Quadriplegia (54.83%) and paraplegia (38.7%) were the most prevalent SCI-induced types of paralysis. The incidence of SCI was significantly associated with the site of spinal fractures, although it was not associated with mechanism of trauma. Conclusion: This study revealed that the incidence of spinal fractures were decreased in recent years and MVA is the major cause of spinal fractures. Preventive programs are recommended to focus on traffic engineering and the training of drivers and pedestrians, especially in high-risk populations

Incidence of Spinal Cord Injury in Traumatic Patients Admitted to a Trauma Referral Center in Guilan

Background & Aim: Patients with spinal cord injury (SCI) impose a heavy burden on health care system. Awareness on prevalence and incidence of SCI is important because this would show the necessity of prevention. This study aimed to investigate the epidemiology and types of traumatic spinal cord injuries in a trauma referral center in Guilan. Methods & Materials/Patients: This is a descriptive study which was conducted on patients with spinal cord trauma using a questionnaire during one year. The questionnaire included demographic information, injured spinal cord area, mechanism of injury, and type of neural damage based on ASIA scale. The data were analyzed using SPSS18 and descriptive statistics. Results: Out of 76 study patients, 68 (88.2%) were men with mean age of 35.2 ± 1.45 years. The most common cause of SCI was motor vehicle accidents (MVA) (48.7%). 34 patients (44.7%) had cervical spine injury and in 23 patients (30.3%), thoraco-lumbar injuries caused SCI. 29.7% of patients suffered from paraplegia and 10.8% quadriplegia. 25 patients (38.5%) had complete SCI. 7 patients with SCI (9.2%) died during hospitalization. In this study, increased age was identified as a risk factor for death. In 4 of these patients (57.1%) cervical SCI was the underlying cause of death. Conclusion: Young men were the group at highest risk and the most mechanism leading to SCI was motor vehicle accidents. Many of these accidents are preventable; thus, more attention should be devoted to safety policies based on needs of the vulnerable groups. Besides, comprehensive education program with clear and practical goals should be developed

Solutions to Implement Wearing Helmet Legislation: A Content Analysis

INTRODUCTION Due to the unsafe design of this type of vehicle, motorcyclists die approximately 28 times more often than car occupants [1]. The increasing trend of motorcycle accidents has been emphasized in several studies [1-3]. A significant number of motorcyclists do not follow traffic rules. Wearing a helmet is one of the most important rules [4]. Enforcing wearing helmet legislation has increased helmet use [5] and prevented serious motorcyclist injuries [6]. After canceling the mandatory wearing of helmets in some countries, the death rate of these users has increased by 25-28% [7, 8]. It has been reported that the use of helmets in Iran among motorcyclists is about 30% and that of passengers is 10% which indicates the low use of helmets [9]. The use of standard helmets has significantly prevented the fractures of the middle face of Iranians [10]. Of course, the lack of seriousness of the police and regulatory bodies aggravates the disobedience of this group [11]. Few studies have shown that the police avoid fining these motorcyclists due to reasons such as lack of motivation and work pressure, and recommend solutions such as increasing the number of cameras in cities, automatic identification of motorcycles, helmets, and license plates [12]. AIM(s) The purpose of this study was to explain the proposed solutions to solve the problem of implementing wearing helmet legislation from the perspective of regulatory bodies and motorcyclists. RESEARCH TYPE This qualitative study is of the contractual content analysis type. RESEARCH SOCIETY, PLACE & TIME This study was conducted by the method of Graham and Lundman (2004) [13] in Rasht, Iran in 2021. The participants were from Gilan, Iran, and had at least one year of work experience with motorcycle or at least three years of motorcycle riding experience. SAMPLING METHOD & NUMBER To identify the employees of the regulatory bodies, the method of brainstorming and fishbone diagrams were used. The rest of the participants were selected by snowball method. The selection of the samples was done by the principle of maximum diversity and the participants were selected from different ages, sex, education, job, and work experience categories to provide a diverse range of experiences. Sampling continued until information saturation, i.e. no formation of classes and sub-classes and new information. METHOD The interviews were conducted by an interviewer experienced in qualitative research. The time and place of the interview were chosen by the participants. In-depth and semi-structured interviews were conducted with an interview guide. To facilitate communication, it first started with demographic questions, then the main question titled "What are the effective ways to enforce wearing helmet legislation among motorcyclists?" was raised and then participants were asked about their experiences of the solutions, ways of better implementation of wearing helmet legislation, and probing questions to clarify more details. The duration of the interview was between 45 and 60 minutes, and a second interview was conducted with three people to clarify ambiguous points. ETHICAL PERMISSION This study was conducted after obtaining the code of ethics from the Research Vice-Chancellor of Gilan, IranUniversity of Medical Sciences (IR.GUMS.REC.1398.517). STATISTICAL ANALYSIS The process of data analysis was based on the method of Graham and colleagues in 2004, according to which these steps were carried out: implementing the interviews after reviewing them several times to find a correct understanding, extracting meaningful units, classifying compact units, and choosing a suitable label for them, sorting sub-categories, and choosing a suitable title that can cover the resulting categories [13]. Guba and Lincoln's four evaluative criteria were also used to strengthen the results of the qualitative part [14]. FINDING by TEXT Saturation was achieved in the sample of 17, but the sampling was completed with 20 participants. There were 9 participants from regulatory bodies, 4 university faculty members, 3 traffic policemen, and 4 motorcyclists. All of them were male and the rest of their demographic characteristics are given in the table (Table 1). Solutions for implementing the wearing helmet legislation in four categories named; hard, correction, support, and soft solutions were revealed in 14 subclasses and 55 codes as described in Table 2. MAIN COMPARISION to the SIMILAR STUDIES The results of this study were included in four categories: the use of hard, corrective, support, and soft solutions. The first category was hard solutions. The participants believed that fines, strictures, and determination to enforce them by the regulatory authorities have a great impact on the enforcement of the helmet legislation. In a similar study, helmet use by motorcyclists was significantly associated with police stations at intersections, and motorcyclists who crossed police-monitored intersections were more likely to wear helmets [15]. Even those participants who believed in the effectiveness of education, mentioned education first and then strictness next to it. This can be done by various methods, including the adoption of new laws, and strict enforcement of the law with higher fines [16]. Therefore, wearing helmet legislation for motorcyclists can be enforced by using emphatic strategies [15, 17]. The second class extracted was corrective solutions. Similarly, some studies have recommended the adoption of new laws for motorcyclists and the modification of previous laws [16, 18], and broader legislation is recommended in addition to changing existing laws to improve helmet use [19]. There is a need to reform driver's license processes, because having a driver's license is the most important factor that affects the driver's attitude and makes them comply with the rules of wearing a helmet [20]. Therefore, like a study in Nepal, the evidence shows that it is necessary to reform, organize and redefine motorcycling laws in Iran [17]. The solutions of the next level were law enforcement and motorcyclist support. These results reveal that the problems of law enforcement, including not having enough employees, high volume of work, and low living conditions should be considered. The need to support the police by people and organizations has been emphasized before [21]. There is ample evidence that helmet laws are effective in increasing helmet use and reducing injuries [22, 23]. In a previous study, the experiences of medical workers in Bandar Abbas, Iran, showed that in the implementation of wearing helmet legislation, the individual, social, family, economic and cultural factors of the motorcyclist should be taken into account [24]. Therefore, by eliminating the deficiencies in the human and financial resources of the regulatory bodies and the proper management of existing resources, some of the problems of the traffic police and driving can be solved and death and serious injuries to motorcyclists can be prevented. Increasing the number of cameras in cities that increase the ability to identify motorcyclists without helmets is also recommended. This task is done using vehicle identification, helmet identification, and automatic license plate recognition [12]. Finally, soft solutions were the fourth category. A study in Iran has shown that motorcyclists who do not have driver's license used drugs significantly more and had personality disorders and depression [25]. In a study in Malaysia, a significant percentage of motorcyclists did not wear helmets properly, and most of the child passengers did not wear helmets. Therefore, despite the legal approval of wearing a helmet for motorcyclists and passengers, there is a lack of public awareness of the safety and benefits of using a helmet and a lack of adequate and appropriate implementation [2]. In this regard, the importance of education along with the application of the law, which is one of the results of this class, becomes clear. According to the previous emphasis, a driver must have a certified skill license, and the knowledge of the motorcyclist and the severity of the law are introduced as the two main influencing factors [26]. In a grounded theory study reported in Kerman, Iran, policies and intervention programs to control injuries and promote safety among motorcyclists should focus on socio-cultural barriers to helmet use in general and changing motorcyclists' attitudes toward mortality in particular [27 ]. LIMITATIONS One of the limitations of the present study is the limitations related to qualitative studies, which quantitative data such as the frequency of experiences cannot be obtained and presented. SUGGESTIONS It is suggested to extract the experiences of the heads and elders of the country's traffic in this matter through interviews for further studies. CONCLUSIONS There are four categories of solutions for implementing wearing helmet legislation from the point of view of policymakers, police, and motorcyclists. The use of hard solutions such as the diligence and seriousness of the regulatory bodies in implementing the law on wearing helmets and corrective solutions such as drafting new laws and amending existing laws, support solutions such as supporting the police and motorcyclists, and finally, soft solutions such as education and culturalizing and the use of mass media are effective in implementing these laws. CLINICAL & PRACTICAL TIPS in POLICE MEDICINE The police and employees who are responsible for enforcing the wearing helmet legislation on motorcyclists should try to use all kinds of legal solutions. However, besides these golden solutions, the use of gentle and soft solutions such as education and culturalizing should be considered. In this regard, the duties of policymakers are to formulate new laws and amend existing laws, to support the police and motorcyclists. ACKNOWLEDGMENTS We would like to thank Gilan University of Medical Sciences, which provided the financial costs of this research project. We are also grateful to all participants in this research, including motorcyclists and regulatory bodies. CONFLICT of INTEREST The authors state that there is no conflict of interest in the present study. FUNDING SOURCES This article was completed with the financial support of Gilan University of Medical Sciences

Investigation of Surgery Characteristics in Patients with Spondylolisthesis, Rasht, Iran from 2006 to 2011

Background & Aim: Spondylolisthesis is a visible deformity in lumbosacral region with vertebral slip and fracture or other deformities of pars interarticularis. This study aims at investigating the characteristics of spondylolisthesis surgery in operated patients. Methods & Materials/Patients: This is a retrospective study which included all the patients who had undergone spondylolisthesis surgery by one same surgeon from 2006 to 2011. Demographic characteristics such as age, gender, and surgery information including type of spondylolisthesis, incision site, laminectomy site, foraminotomy site, fixation site of vertebra and site of vertebral disc evacuation were collected. The data were analyzed using SPSS (Version16). Results: 52 of 63 enrolled patients were women (82.5%) and 11 men (17.5%) with mean age of 49.6 years. Based on frequency, spondylolisthesis types were 60 degenerative (95.2%), 2 post-surgical (3.2%) and 1 post-traumatic (1.6%), respectively. 58 patients had spondylolisthesis only in one vertebra and 5 patients in two vertebrae. The total number of slipped vertebrae was 68, in which slip was seen in L3, L4 or L5 vertebrae. In 42 patients, laminectomy was performed only in one vertebra, in 19 patients in two vertebrae, in 1 patient in three vertebrae and in 1 patient in five vertebrae. The total number of vertebrae with foraminotomy was 106. The highest frequency of foraminotomy was seen in L5, L4, and S1 vertebrae, respectively. Except in one case, the rest 62 patients underwent fixation surgery in two or three vertebrae. Conclusion: Based on the results, the frequency of spondylolisthesis was approximately five times in women compared to men. The most common type was degenerative spondylolisthesis. Type of surgery was fixation with pedicle screw and fusion

Epidemiology of head injuries in pedestrian-motor vehicle accidents

Abstract Despite efforts of many countries to improve pedestrian safety, international reports show an upward trend in pedestrian-motor vehicle accidents. Although the most common cause of death of pedestrians is head injuries, there is a lack of knowledge on the epidemiology and characteristics of head injury in terms of the Glasgow Outcome Scale to be used for prevention. However, this study aimed to determine the epidemiology of pedestrian-motor vehicle accidents, the characteristics of head injury, and differences in the Glasgow Outcome Scale in terms of gender. In this retrospective analytical study, the data of 917 eligible injured pedestrians were obtained from the two databases of the Trauma System and the Hospital Information System. The data were analyzed using SPSS software (Version 21). The mean age of all 917 injured pedestrians was 47.55 ± 19.47 years. Most of the injured pedestrians (42.10%) were in the age range of 41–69 years and 81.31% were male. Moreover, 83.07% did not have any acute lesions on the CT scan. The most common brain lesion was brain contusion (n = 33, 3.60%), subarachnoid hemorrhage (n = 33, 3.60%), and skull fracture (n = 29, 3.16%). Among all concurrent injuries, lower extremity/pelvic injuries were observed in 216 patients (23.56%). Outpatient treatment (n = 782, 85.27%), airway control/endotracheal intubation (n = 57, 6.22%), and resuscitation (n = 35, 3.82%) were the most applied treatments respectively. There were significant differences in the Glasgow Outcome Scale between men and women (P- value = 0. 012). The high rate of mortalities, disability, head injuries, contusion, subarachnoid hemorrhage, and skull fractures in pedestrians involved in MVAs emphasizes the need for developing and implementing prevention strategies including appropriate management and risk reduction. Male pedestrians were at higher risk of motor vehicle accidents and worse Glasgow Outcome Scale. The presented data identified the main types of pedestrian injuries and suggested the importance of adopting appropriate preventive strategies to achieve the most effective interventions for creating a safer community

تبیین تجارب نیاز های ایمنی مصدومان دوچرخه سوار بستری در مرکز آموزشی- درمانی پور سینا گیلان در سال 1400

Background and Aim: The quantitative studies have shown that cyclists around the world have different attitudes and perceptions of safety needs. Therefore, in this study, we want to examine the experiences of injured cyclists about safety needs in a qualitative study. Methods: The present study was a qualitative study witha&nbsp; content analysis method. The study population consisted of male or female cyclists over 18 years of age who were injured in a crash or fall while cycling and one or more of their limbs were injured and hospitalized in Poursina Medical Center. Excel details of these clients were obtained from the registration system ofthe&nbsp; Guilan Road Trauma Research Center. People with various characteristics in terms of age, sex, education, marriage, sex, occupation, length of hospital stay, etc. were included in the study. The number of participants was twenty. Interviews were conducted by medical students with the cooperation and supervision of supervisors. Results: Safety factors from the experiences of injured cyclists included nine categories, which were: orderly cycling, holding training courses, supervising cycling, observing the principles of cycling, being equipped with safety equipment, having the right to an exclusive route , Reviewing exclusive routes, creating a sense of security and creating peace in women cyclists. Conclusion: Authorities should try to make the factors that were safe in the experiences of these injured as much as possible to give these users a sense of calm and security, thereby encouraging others to ride a bicycle as a clean vehicle for the environment. Please cite this article as: Sedaghati Voshme Saraei F, Khodadadi-Hassankiadeh N, Kouchakinejad-Eramsadati L, Homaie Rad E, Yousefzadeh-Chabok S. Explaining the Experiences of the Safety Needs of Injured Cyclists Hospitalized in the Educational- Therapeutic Center of Poursina in Guilan in 2021. Irtiqa Imini Pishgiri Masdumiyat. 2022;10(3):198-09.سابقه و هدف: در مطالعات کمی نشان داده‌شده که دوچرخه ­سواران در سراسر جهان نگرش­ ها و درک متفاوتی از نیاز­های ایمنی دارند. لذا در این مطالعه می­ خواهیم تجارب دوچرخه­ سواران مصدوم در مورد نیازهای ایمنی‌بخش در یک مطالعه کیفی بررسی کنیم. هدف تبیین تجارب مصدومان دوچرخه ­سوار بستری در مرکز آموزشی- درمانی پور سینا گیلان از نیاز­های ایمنی در سال 1400 بود. روش کار: این مطالعه کیفی با روش تحلیل محتوا انجام شد. مشارکت‌کنندگان، دوچرخه­ سواران مرد یا زن بالای 18 سال بودند که در حین دوچرخه‌سواری دچار آسیب از نوع تصادف یا سقوط شده و به یک یا بیشتر از یک اعضا و اندام آن­ها آسیب واردشده بود. اکسل مشخصات این مراجعه‌کنندگان از سیستم ثبت مرکز تحقیقات تروما جاده‌ای گیلان اخذ شد و با مشارکت‌کنندگان ارتباط تلفنی برقرار شد. بیست نفر با ویژگی­‌های متنوع ازنظر سن، جنس&nbsp; در مطالعه گنجانده شدند. یافته‌ها: تجارب دوچرخه­ سواران از نیاز­های ایمنی شامل نه طبقه بود : قانونمند کردن دوچرخه‌سواری، برگزاری دوره­ های آموزشی، نظارت بر دوچرخه‌سواری، رعایت اصول دوچرخه‌سواری، مجهز بودن به تجهیزات ایمنی، حق داشتن مسیر انحصاری، بازنگری مسیر­های انحصاری، ایجاد حس امنیت، و ایجاد آرامش در بانوان دوچرخه‌سوار. نتیجه‌گیری: مسئولین امر باید سعی نمایند به نیاز­های ایمنی این گروه توجه نمایند و عواملی که در تجارب این مصدومان ایمنی‌بخش بیان‌شده بود را تا حد ممکن فراهم نمایند تا به این کاربران احساس آرامش و امنیت بدهند. به این مقاله، به صورت زیر استناد کنید: Sedaghati Voshme Saraei F, Khodadadi-Hassankiadeh N, Kouchakinejad-Eramsadati L, Homaie Rad E, Yousefzadeh-Chabok S. Explaining the Experiences of the Safety Needs of Injured Cyclists Hospitalized in the Educational- Therapeutic Center of Poursina in Guilan in 2021. Irtiqa Imini Pishgiri Masdumiyat. 2022;10(3):198-09