Factors affecting simulators of the hospital emergency department during emergencies and disasters in Iran: a qualitative study

Objective: The simulation strategy is so important for appropriate responses and preparedness of hospital emergency department staff in emergencies to strengthen team building and care focused on the interdisciplinary community. Therefore, this study aimed to identify the factors affecting the hospital emergency department's simulators during emergencies and disasters. Methods: This conventional content analysis study was conducted in 2021. Participants were selected from Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis. Results: Analysis of the data results through semi-structured interviews showed 4 main categories and 11 subcategories including management and leadership (the structure, casualty management, command, interactions and coordination, communications and information, as well as human resources), and increasing the capacity (resources (physical resources, and financial resources)), modern technology approaches (information technology), laws and policies (policies, guidelines, and rules). Conclusion: The simulation technology use can be effective in preparing the hospital emergency department in the event of disasters, strengthening management and leadership, proper planning, appropriate organizational culture, organizational learning, interactions and coordination, casualty management, as well as providing resources, equipment, items, processes, and instructions. So, the use of these new technological training is recommended to improve responses in times of emergencies and disasters

The effects on functional balance in hemiplegic stroke individuals wearing an ankle foot orthosis with rocker bottom shoes

Background: One of the disorders in stroke patients is asymmetrical posture, which leads to decreased movement and balance control. An ankle-foot orthosis (AFO) is the most common orthopedic device used in patients with post-stroke hemiplegia, and are often utilized with shoes. The purpose of this study was to investigate the effect, in stroke patients, of rocker bottom shoes on an AFO in the clinical assessments of balance compared to standard shoes on an AFO.    Methods: This quasi-experimental study involved 10 chronic stroke patients. The evaluated individuals were under four conditions using rocker bottom shoes and standard shoes coupled with a rigid AFO immediately, and after a 3-week adaptation. The walking speed was assessed using a 10-m walk test (10 MWT), and the clinical assessments of balance were evaluated using the Timed-Up and Go test (TUG) and the Functional Reach Test (FRT).   Results: The findings revealed that wearing rocker bottom shoes on the AFO significantly increased walking speed, the distance on the FRT, and reduced the TUG compared to wearing standard shoes on the AFO (p < 0.05). Conclusion: The study indicated that stroke patients showed an improvement in walking speed and functional balance when utilizing the AFOs with rocker bottom shoes. This outcome could be a possibility in application by doctors to prescribe this type of footwear for individuals who have had a stroke

Association of Opium Addiction with Coronary Artery Ectasia and Coronary Artery Disease

Background: Coronary artery ectasia (CAE) is a rare cardiovascular disorder with unknown mechanisms and related risk factors. The roles played by homocysteine in induction of cardiovascular diseases (CVDs) have also been documented previously. This project was designed to assess the relationship between opium and CAE and coronary artery disease (CAD). Methods: This cross-sectional study was performed on 46 patients with CAE, 30 patients with CAD, and 42 cases without CAE and CAD (controls). Demographic data and information regarding opium consuming and also smoking were collected using a standard checklist. Serum levels of homocysteine, creatinine (Cr), urea, fasting blood glucose (FBG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), and cholesterol were determined. Findings: Statistical analysis revealed that opium consumers were significantly higher in patients with CAD and CAE when compared to healthy controls. Opium increased serum levels of Cr in the normal controls, and decreased HDL in the patients with CAD. Homocysteine serum levels were not significantly different between the groups. Conclusion: The results of study showed that opium addiction was associated with increased risk of CAE and CAD, independent of homocysteine serum levels

Determining the diagnostic value of tracheal intubation by palpation and auscultation methods compared to the chest X-ray method in children

Background It is important to determine the proper location of tracheal tube for proper ventilation. In this study, we compared the diagnostic value of tracheal intubation with two methods of palpation and auscultation with chest X-ray (CXR) method in pediatric. Methods In this interventional study, 80 patients under 6 years of age were included. After tracheal intubation appropriate depth of tracheal tube was determined by auscultation and recorded, then by palpation depth of tracheal tube determined and tube was fixed. The length of the tube was calculated with the standard formula based on age. After surgery, CXR was taken and, according to the landmark, the distance from the end of the tube to the anterior lower tooth was recorded. Results Interclass correlation coefficient (ICC) between the palpation method and the standard method in the number of fixing tracheal intubation was 0.573, which shows the average and significant correlation between these two methods in determining the fixed number of tracheal intubation. ICC between the auscultation and the standard method in fixing tracheal intubation number was 0.430, which shows the average and significant agreement between these two methods in determining the fixed number of tracheal intubation. There is no significant relationship between sex and the average number of fixing tracheal intubation in all methods. Conclusions This study has shown that both palpation and auscultation methods are appropriate, but with a slightly higher palpation ICC, the palpation can be considered relatively better

Professional Resilience among Trauma Emergency Department Nurses in Iran: A Qualitative Study

Introduction: Nursing staff’s professional resilience plays an important role in overcoming the stressful and adverse situations common to the trauma emergency department and helps to achieve positive outcomes.&nbsp;Objective: This study intended to explore the concept of resiliency among Iranian trauma emergency department nurses.&nbsp;Methods: Data were collected using semi-structured interviews with 21 trauma emergency department nurses and analysed through a deductive content analysis based on the general conceptual model of resilience derived from King and Rothstein’s study.&nbsp;Results: All codes were nested into the four main categories of the above-mentioned model including: 1) Personal characteristics; 2) Opportunities, supports and resources; 3) Self-regulatory processes; 4) Positive outcomes. Some new sub-categories including Professional abilities (sub-category of Personal characteristics) and Cooperation with colleagues and Volunteers’ declaration of readiness (sub-categories of opportunities, supports and resources) were developed in this study. In the positive outcomes category, three sub-categories including Improved professional abilities, Personal growth, and Job retention were developed.&nbsp;Conclusion: Our results demonstrated that Iranian trauma emergency department nurses could achieve positive outcomes using specific affective, cognitive, and behavioural personality traits, professional abilities and effective external supports from different resources during self-regulatory processes. It is suggested that nurses should be selected for work in the emergency department based on appropriate characteristics and skills

Professional Resilience among Trauma Emergency Department Nurses in Iran: A Qualitative Study

Introduction: Nursing staff’s professional resilience plays an important role in overcoming the stressful and adverse situations common to the trauma emergency department and helps to achieve positive outcomes.&nbsp;Objective: This study intended to explore the concept of resiliency among Iranian trauma emergency department nurses.&nbsp;Methods: Data were collected using semi-structured interviews with 21 trauma emergency department nurses and analysed through a deductive content analysis based on the general conceptual model of resilience derived from King and Rothstein’s study.&nbsp;Results: All codes were nested into the four main categories of the above-mentioned model including: 1) Personal characteristics; 2) Opportunities, supports and resources; 3) Self-regulatory processes; 4) Positive outcomes. Some new sub-categories including Professional abilities (sub-category of Personal characteristics) and Cooperation with colleagues and Volunteers’ declaration of readiness (sub-categories of opportunities, supports and resources) were developed in this study. In the positive outcomes category, three sub-categories including Improved professional abilities, Personal growth, and Job retention were developed.&nbsp;Conclusion: Our results demonstrated that Iranian trauma emergency department nurses could achieve positive outcomes using specific affective, cognitive, and behavioural personality traits, professional abilities and effective external supports from different resources during self-regulatory processes. It is suggested that nurses should be selected for work in the emergency department based on appropriate characteristics and skills

The Correlation between Cerebral Oximetry and Mean Arterial Pressure (MAP) Values during the Pediatric Cardiac Surgery

Background: Multimodal cerebral monitoring can reduce the incidence of neurological complications as well as the hospital costs associated with caring for cardiac surgery patients. Given the prevalence of cardiac surgeries, the need for cardiopulmonary bypass devices and the few studies in this area, further studies are needed. In this study, we aimed to investigate the correlation between cerebral oximetry and mean arterial pressure during pediatric cardiac surgery.Method: The present study is a descriptive correlational one. To obtain the results, the cerebral oximetry monitoring and blood pressure were established and baseline values were recorded. Patients were then anesthetized under the same monitoring and anesthesia method, and the cerebral oximetry and blood pressure were recorded in a checklist prepared by the researcher before, during and after the cardiopulmonary pump. Data was analyzed by SPSS software (version 25).Results: 58 children undergoing cardiac surgery were included in the study, 51.7% of whom were male. At the study time, the mean age of the patients was 1.92±2.05 years; and their mean weight was 9.86 ± 4.86 kg. A significant relationship was found between the mean arterial pressures (MAP) and the right and left cerebral oximetry.Conclusion: According to the findings, there is a significant relationship between MAP and cerebral oximetry in pediatric cardiac surgery. This study shows that by increasing MAP during cardiopulmonary pump, the brain perfusion and oxygenation of the brain can be increased. Peripheral oximetry also plays an important role in reducing hospital costs related to the care of cardiac surgery patients

A comparative study of stored arterial versus venous blood collected using the acute normovolemic hemodilution method in coronary artery bypass grafting patients in Iran

Background In the present study, arterial and venous blood was collected from patients who were candidates for elective coronary artery bypass grafting (CABG); the blood was stored for 28 days and cellular, biomechanical, and hematological changes in blood were compared to determine whether stored arterial blood is superior to stored venous blood. Methods The present follow-up comparative study included 60 patients >18 years of age, with hemoglobin >14 mg/dl and ejection fraction >40% who were candidates for CABG. After induction of anesthesia, 250 ml of arterial or venous blood was drawn from patients (arterial blood group and venous blood group). Laboratory blood samples were taken at specified times from the collected blood and re-injected into the patients after CABG. Results Significant differences were observed in pH, partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), bicarbonate (HCO3), and glucose values at several time points between the groups. Other parameters such as urea and creatinine did not show any significant differences between the groups. Conclusions Twenty-eight days of storage can have a negative effect on some of the cellular, biochemical, and hematological components of arterial and venous blood; however, the quality of stored arterial blood and venous blood does not differ significantly

Ruptured Abdominal Aortic Aneurism with Atypical Manifestations; a Case Report

پارگی آنوریسم آئورت شکمی عارضه ای با میزان مورتالیتی بالا در مراجعه کنندگان به بخش اورژانس می باشد. علائم شایع آن شامل درد شکم، پشت و پهلوها بوده و هیپوتانسیون و سنکوپ از سایر تظاهرات آن می باشد. ولی گاها این بیماران با تظاهرات نامعمول مراجعه می کنند که با توجه به این مهم، در این گزارش به معرفی بیماری با تظاهرات آتیپیک پرداختیم. تشخیص اولیه این عارضه بر مبنای ظن بالینی بالا و انجام سونوگرافی شکمی بر بالین است. استاندارد تشخیصی سی تی اسکن شکمی در بیماران پایدار از نظر علائم حیاتی است. درمان انجام جراحی باز یا اندوواسکولار است و تاخیر در درمان با مرگ و میر بسیار بالایی همراه خواهد بود.Abdominal aortic aneurysm is a condition with a high mortality rate among those presenting to the emergency department. Its common symptoms include abdominal, back, and flank pain and hypotension and syncope are among its other manifestations. However, sometimes these patients present with uncommon manifestations. Considering this important point, we have introduced a patient with atypical manifestations in the present report. Initial diagnosis of this condition is based on high clinical suspicion and performing bedside abdominal ultrasonography. Diagnostic standard is abdominal computed tomography (CT) scan in patients with stable vital signs. The treatment is performing endovascular or open surgery and delay in treatment is accompanied with a high rate of mortality.

Temperature measurement and control system for transtibial prostheses: single subject clinical evaluation.

The snug fit of a prosthetic socket over the residual limb can disturb thermal balance and put skin integrity in jeopardy by providing an unpleasant and infectious environment. The prototype of a temperature measurement and control (TM&C) system was previously introduced to resolve thermal problems related to prostheses. This study evaluates its clinical application in a setting with reversal, single subject design. The TM&C system was installed on a fabricated prosthetic socket of a man with unilateral transtibial amputation. Skin temperature of the residual limb without prosthesis at baseline and with prosthesis during rest and walking was evaluated. The thermal sense and thermal comfort of the participant were also evaluated. The results showed different skin temperature around the residual limb with a temperature decrease tendency from proximal to distal. The TM&C system decreased skin temperature rise after prosthesis wearing. The same situation occurred during walking, but the thermal power of the TM&C system was insufficient to overcome heat build-up in some regions of the residual limb. The participant reported no significant change of thermal sense and thermal comfort. Further investigations are warranted to examine thermography pattern of the residual limb, thermal sense, and thermal comfort in people with amputation.N/