Burnout among Healthcare Providers of COVID-19; a Systematic Review of Epidemiology and Recommendations

Introduction: In the current systematic review, we intended to systematically review the epidemiology of burnout and the strategies and recommendations to prevent or reduce it among healthcare providers (HCPs) of COVID-19 wards, so that policymakers can make more appropriate decisions. Methods: MEDLINE (accessed from PubMed), Science Direct, and Scopus electronic databases were systematically searched in English from December 01, 2019 to August 15, 2020, using MESH terms and related keywords. After reading the title and the abstract, unrelated studies were excluded. The full texts of the studies were evaluated by authors, independently, and the quality of the studies was determined. Then, the data were extracted and reported. Results: 12 studies were included. Five studies investigated the risks factors associated with burnout; none could establish a causal relationship because of their methodology. No study examined any intervention to prevent or reduce burnout, and the provided recommendations were based on the authors\u27 experiences and opinions. None of the studies followed up the participants, and all assessments were done according to the participants\u27 self-reporting and declaration. Assessing burnout in the HCPs working in the frontline wards was performed in four studies; others evaluated burnout among all HCPs working in the regular and frontline wards. Conclusion: Paying attention to the mental health issues, reducing the workload of HCPs through adjusting their work shifts, reducing job-related stressors, and creating a healthy work environment may prevent or reduce the burnout

Assessment of tuberculosis among male prisoners in Shiraz central prison, south of Iran.

Background: Prisons play an important role in the prevalence of Tuberculosis (TB) in a region. This study aimed to determine the situation of TB in high-risk male prisoners in Shiraz central prison of Fars province in southern Iran. Methods: This cross-sectional study (June-October 2018) was conducted on male prisoners in Shiraz central prison, southern Iran. According to 4 criteria, the prisoners were determined as high-risk prisoners for TB, and para clinical tests included three sputum samples and chest radiograph were performed for them. Then, the high risk and low risk participants were compared in terms of demographic characteristics and past medical history. Results: Among 2,995 prisoners, only 108 (3.6%) had at least one of the high-risk criteria. But after performing further TB tests for these prisoners, no prisoners with TB disease were found. The high-risk prisoners were statistically older than low-risk prisoners (38.30±9.74 vs. 35.17±9.62, P=0.001). Also, the length of incarceration was statistically different in both groups (P=0.002), and drug abuse was more in high-risk group (P<0.001). Moreover, high risk prisoners used cigarettes/day more (14.87±11.55 vs. 9.71±9.09, P<0.001), but both groups were not different in term of the marital status (P=0.519), educational level (P=0.662), job (P=0.39), and nationality (P=0.342). Conclusion: Our results showed that none of the high-risk prisoners for TB had positive test. The length of incarceration, drug abuse, smoking, as well as age were more in high-risk prisoners in comparing low risk group

Adult emergency department performance in the largest teaching hospital in southern Iran: a 1.5-year cross-sectional study

Background: Emergency department (ED) is one of the most important hospital departments, with significant effects on public health. The aim of this study was to evaluate the adult ED's performance of the largest teaching hospital in southern Iran. Methods: In this retrospective cross-sectional study (March 2017-August 2018), the registered data in the Hospital Information System (HIS) were collected, and the ED’s performance was assessed based on the Iranian emergency performance index. The slopes of the trend lines were calculated for each indicator. Moreover, 2 six-month periods were compared. Results: The data of 104,081 patients were analyzed. The mean (±standard deviation) of visited patients per-month was 5,782.28 (±1258.55). The slope of the trend line was negative for all indicators, except for discharge from ED with personal responsibility. The mean duration of waiting time for the first visit by physician in each triage level slightly decreased. Comparison of the two six-month periods showed a significant difference between the visited patient (P<0.0001). The percentage of patients disposed within six hours (P<0.0001), leaving ED within 12 hours (P<0.0001), as well as the percentage of successful cardiopulmonary resuscitation (P=0.014) in the six-month period of 2018 was significantly lower. The percentage of discharge with personal responsibility significantly increased (P=0.005). Conclusion: Although the number of patients visited in this ED decreased, all indicators had dropped. However, the percentage of discharge with personal responsibility was increased. Moreover, the mean duration of waiting time for the first visit by physician slightly decreased in each triage level

Transferred Patients by Fars Province’s Helicopter Emergency Medical Service (HEMS); A 2-Years Cross-Sectional Study in Southern Iran

Objective: To investigate the patients transferred by helicopters, as well as an emergent medical services that were performed for them.Methods: In this retrospective cross-sectional study, all patients who were transferred by Fars province of Helicopter Emergency Medical Services (HEMS) to Shiraz hospitals, southern Iran (March 2017-March 2019) were investigated. Patients’ information was collected and analyzed includes age, gender, dispatch reason, trauma mechanisms, take hold of emergent medical services, as well as the air transportation time, time between dispatch from the origin hospital and starting the procedures, and patients’ outcome.Results: Eighty-three patients were enrolled with the mean±SD age of 36.9±19.47 years that 75.9% had trauma (p <0.0001). Mental status deterioration (25.3%) was the most dispatched indications. The mortality rate was 13.25% totally (11.11% in traumatic vs. 10% in non-traumatic). The mean±SD of air transportation time was significantly lower than ground transportation in both traumatic (p=0.0013) and non-traumatic (p <0.0001) patients. Also, the mean±SD of time between dispatch from the origin hospital and starting the procedures wasstatistically lower in air transportation in both traumatic (p=0.0028) and non-traumatic (p=0.0017) patients.Conclusion: Most of the patients transferred by HEMS were traumatic. The air transportation time as well as the time between dispatches from the origin hospital to the starting of the procedures were significantly lower in HEMS in comparison with ground transportation for both traumatic and non-traumatic patients

مروری بر مقاله با عنوان "مقایسه روش بخیه با چسب مايع بافتی در ترميم زخم های صورت اطفال؛ یک مطالعه مورد شاهدی"

Dear Editor-in-Chief of Iranian Journal of Emergency Medicine In volume 5 of the journal (2018), a paper was published titled "Comparison of Liquid Tissue Adhesive and Suture in Pediatric Wound Repair; a Case Control Study", about which some points and questions should be raised: 1. In the title and methods section of this paper, the authors stated that this study is a "case control study", while case-control studies are a type of observational study, which start with the outcome and end with exposure; as patients (as case group) and non-patients (as control group) will be questioned or examined regarding previous exposure. In addition, since they are observational, no interventions are performed in this type of study.سردبیر محترم مجله طب اورژانس ایران &nbsp; در دوره 5 (شماره پیوسته 7) 97-1396 این مجله، مقاله ای تحت عنوان "مقایسه روش بخیه با چسب مايع بافتی در ترميم زخم های صورت اطفال؛ یک مطالعه مورد شاهدی" به چاپ رسیده است. راجع به این مقاله نکات و سوالاتی مطرح می باشد: 1- نویسندگان در عنوان و روش کار این مقاله بیان نموده اند که این مطالعه از نوع "مورد شاهدی غیر کنترل شده" است، درحالیکه مطالعات مورد شاهدی نوعی از مطالعات مشاهده ای هستند که از پیامد شروع شده و به مواجهه ختم می شوند؛ به طوری که دو گروه از افراد بیمار و غیر بیمار در مورد مواجهه مورد پرسش قرار گرفته یا بررسی می گردند. همچنین، به جهت مشاهده ای بودن، در این نوع مطالعات هیچ نوع مداخله ای (intervention) انجام نمی گیرد. اما روش کار در این مقاله به گونه ای بیان شده که دو نوع ترمیم زخم (مداخله درمانی) برای بیماران با زخم صورت انجام گرفته که پیامد آن، پس از دوره چهار روزه و شش روزه مورد ارزیابی قرار گرفته است. در هدف مطالعه نیز ذکر شده که "هدف از انجام این مطالعه، بررسی پیامد ترمیم زخم در اطفال با استفاده از دو روش چسب مایع بافتی و بخیه بود" که همین جمله گواه مطالعه ای است که پیامد را مورد سنجش قرار داده و نه مواجهه را. در واقع، در این مطالعه انجام شده دو گروه شاهد و مورد از نظر مواجهه در گذشته بررسی نشده اند، و به نظر می رسد نوع طراحی انجام گرفته در این مقاله، شبیه مطالعات quasi-experimental می باشد. همچنین، بهتر است کلمه "غیر کنترل شده" که در خط اول روش کار آمده است، به طور دقیق توضیح داده شود. 2- از سویی، اگر این مطالعه از نوع مورد شاهدی باشد، لازم است در نتایج شاخص نسبت شانس یا OR (Odds Ratio) همراه با فاصله اطمینان محاسبه و ذکر شود. 3- همچنین نحوه سنجش میزان رضایتمندی بیمار و والدین مبهم است و لازم است توضیحات تکمیلی به مطالعه اضافه شود. با توجه به نکات ذکر شده، به نظر می رسد لازم است اصلاحات لازم انجام شده و همچنین نکات تکمیلی به این مقاله اضافه شود

Visual Disturbances in Patients With Acute Methanol Poisoning: A Cross-sectional Study: Acute methanol poisoning and visual disturbances

Background: Methanol poisoning is a serious problem in public health, especially in developing countries. The present study aimed to evaluate the incidence of visual disturbances in patients with acute methanol poisoning in the south of Iran.Methods: This cross-sectional study (from 21/March/2014 to 21/March/2019) was conducted on all adult patients’ medical records who were referred to Ali-Asghar Hospital in Shiraz City, Iran, with acute methanol poisoning. The required data were collected using a data-gathering form and were then analyzed.Results: Twenty male patients were enrolled in this research, with Mean±SD age of 33.15±10.40 years. Visual disturbances were observed in 15(75%) of the study subjects, as the most common clinical manifestations. Blurred vision (40%) and blindness (35%) were the most frequent visual disturbances in the study participants. None of the study subjects reported photophobia. The explored variables did not differ between patients with visual disturbances and those without visual disturbances. Only one patient who encountered blindness was expired.Conclusion: The incidence of visual disturbances in the study patients with acute methanol poisoning was higher than that of similar studies

Hypoglycemia in Patients With Pure Benzodiazepine Poisoning: Hypoglycemia in patients with pure benzodiazepine poisoning

Background: Various studies investigated the effects of benzodiazepines on insulin and blood glucose levels and provided contradictory results. The present study aimed to evaluate the clinical effects of benzodiazepine poisoning on hypoglycemia.Methods: This retrospective cross-sectional study (from 22/June/2018 to 22/December/2018) was conducted on all medical records of adult patients with benzodiazepine poisoning who were referred to Ali-Asghar Hospital. The required data were collected using a data-gathering form and then analyzed.Results: In total, 61 patients were enrolled in this study. Furthermore, 19 (31.2%) patients developed hypoglycemia. Besides, 50 (82%) patients used benzodiazepine for a suicide attempt, i.e. higher in patients with hypoglycemia (P&lt;0.0001). Multivariate logistic regression test data indicated that benzodiazepine consumption for suicide attempt (OR=47.978, P=0.001, 95%CI, 5.313-433.277), and the respiratory rate at the time of suicide (OR=0.549, P=0.023, 95%CI, 0.328-0.920) were predictive factors for hypoglycemia in patients with benzodiazepine poisoning.Conclusion: Our study data suggested that 31% of patients who were poisoned with benzodiazepines developed hypoglycemia. The suicidal use of drugs and respiratory rates were predictive factors for hypoglycemia in these patients

يافته هاي الكتروكارديوگرافي مرتبط با ايسكمي ميوكارد در بيماران با علايم غير قلبي مراجعه كننده به اورژانس نمازي در سال 1397

Introduction: Silent myocardial ischemia is defined as the presence of objective evidence of cardiac ischemia in the absence of chest discomfort or one of the symptoms equivalent to angina. The aim of this study was to evaluate the electrocardiography (ECG) findings related to cardiac ischemia in non-cardiac patients with suspected silent myocardial ischemia referring to the emergency department. Methods: This retrospective cross-sectional study (March 2018-March 2019) was conducted on adult patients with non-cardiac complaints referring to the Emergency Department of Shiraz Namazi Hospital, southern Iran, with triage levels 1 and 2, who were suspected to have silent myocardial ischemia, and underwent ECG and two troponin tests after admission. Patients with trauma, triage levels 3-5, those with typical chest pain, and patients with diagnosis of ST-Elevation Myocardial Infarction (STEMI) were excluded from the survey. Demographic data, the results of two troponin tests, and cardiac ischemia-related findings on ECG, including ST depression and T inversion, were evaluated. Then, the data were statistically analyzed using SPSS version 16 and descriptive and analytical statistical tests. Results: Overall, 180 patients were enrolled. The mean (± standard deviation) of patients’ age was 69.3±15.01 years. 92 patients (51.1%) were male. ST depression and T inversion were found in ECG of 90 (50.0%) and 88 (48.9%) patients, respectively. ST depression and/or T inversion was observed in 168 (93.3%) patients. There was no statistically significant relationship between mean age, gender, and cause of referral with ST depression or T inversion. Two positive troponin test results were observed in 23 (12.8%) and both tests were negative in 59.4% of patients. There was no statistically significant relationship between having at least one positive troponin test and having ST depression or T inversion findings (P-value=0.56 and P-value=0.90, respectively). Conclusion: ST depression and T inversion were present in ECG of half of the patients. Two positive troponin and both negative tests were observed in 23 (12.8%) and 59.4% of patients, respectively. This finding indicates that the matching of ECG findings and multistage troponin test is great important in the final diagnosis of cardiac ischemia, however, ECG changes in patients with non-cardiac complaints do not necessarily is indicated the myocardial infarction.مقدمه: ایسکمی میوکاردی خاموش بعنوان وجود شواهد عینی از ایسکمی قلبی در غیاب ناراحتی قفسه سینه یا یکی از علائم معادل آنژين تعریف میشود. هدف مطالعه حاضر، بررسی یافته های الکتروکاردیوگرافی (ECG) مرتبط با ایسکمی قلبی در بیماران غیرقلبی مشکوک به ایسکمی میوکاردی خاموش مراجعه کننده به اورژانس بود. روش کار: مطالعه حاضر به صورت یک مطالعه مقطعی گذشته نگر (فروردین تا اسفند 1397) بر روی بیماران بزرگسال با شکایت غیرقلبی مراجعه کننده به اورژانس نمازی شیراز، در جنوب ایران با سطح ۱ و ۲ تریاژ و شک به ایسکمی میوکاردی خاموش انجام گرفت که برای ایشان ECG و دو نوبت تست تروپونین پس از ورود به اورژانس، انجام شده باشد. &nbsp;بیماران ترومایی، سطح تریاژ 3-5، بیماران با درد قفسه سینه تیپیک، و بیماران با تشخیصST-Elevation Myocardial Infarction (STEMI) از مطالعه خارج شدند.داده های دموگرافیک، نتیجه دو نوبت آزمایش تروپونین و یافته های مرتبط با ایسکمی قلبی در ECG شامل ST depression و T inversion بررسی شد. تجزیه و تحلیل اطلاعات با استفاده از نرم افزار spss نسخه 16 و آزمون های آماری توصیفی و استنباطی انجام شد. یافته ها: در مجموع، 180 بیمار وارد مطالعه شدند. میانگین سن بیماران 01/15± 3/69 سال بود. 92 بیمار (1/51%) مرد بودند.ST depression &nbsp;و T inversion بترتیب در ECG 90 (50%) و 88 (9/48%) بیمار یافت شد. وجود یکی از یافته های ST depression یا T inversion در 168 (3/93%) بیمار مشاهده گردید. بین میانگین سنی، جنسیت و علت مراجعه با داشتن ST depression یا T inversion ارتباط معنادار آماری دیده نشد. آزمایش مثبت تروپونین در هر دو مرحله در 23 (8/12%) و آزمایش هر دو مرحله منفی در 4/59% بیماران مشاهده گردید. بین داشتن حداقل یک نوبت تروپونین مثبت و داشتن یافته های ST depression و T inversion ارتباط معنادار آماری وجود نداشت (بترتیب P-value برابر با 56/0 و 9/0). نتیجه گیری: ST depression و T inversion در ECG نیمی از بیماران وجود داشت. آزمایش تروپونین دو نوبت مثبت و دو نوبت منفی به ترتیب در 8/12% و 4/59% بیماران مشاهده شد. این یافته بیانگر آن است که تطبیق یافته های ECG و آزمایش تروپونین چند مرحله ای در تشخیص نهایی ایسکمی قلبی از اهمیت بالایی برخوردار می باشد، اما تغيیرات ECG در بيماران با شكايت غيرقلبي حتما نشانگر انفاركتوس قلبي نيست

Prognostic Factors of In-Hospital Mortality in Adult Patients With Aluminum Phosphide (ALP) Poisoning in Southern Iran (2014-2018): Prognostic factors of mortality in ALP poisoning

Background: The suicide with aluminum phosphide, known as rice tablet, has increased significantly. This study aimed to investigate the epidemiology of Aluminum Phosphide (ALP) poisoning and determine the in-hospital mortality prognostic factors in adult people referring to ALP poisoning to one of the main poisoning centers in southern Iran.Methods: This retrospective cross-sectional study (March 21, 2014, to March 21, 2018) was conducted on all adult patients (&gt;16 years) with ALP poisoning who were referred to Ali-Asghar Hospital (affiliated with Shiraz University of Medical Sciences). All data were extracted from the patients’ medical files. The patients were categorized into two groups of survived and non-survived. Univariate and multivariate logistic regression analyses were conducted to determine prognostic factors for in-hospital mortality, and Odds Ratios (ORs) were reported.Results: Totally, 97 patients were enrolled in this study. The patients’ Mean±SD age was 29.3±12.2 years. Both study groups (survived and non-survived) were matched in most demographic and poisoning characteristics. Nausea (62.9%) and vomiting (49.5%) were the most symptoms at the time of admission. Castor oil (66%), N-acetyl cysteine (56.7%), and magnesium sulfate (52.6%) were the most frequent treatment in these patients. The multivariate analysis showed that age (OR=1.12, 95%CI: 1.03-1.22), body temperature (OR=0.02, 95%CI: 0.01-0.48), resistant acidosis (OR=77.10, 95%CI: 5.05-1176.86), and taking sodium bicarbonate (OR=12.35, 95%CI: 1.25-122.10) were the prognostic factors of in-hospital mortality.Conclusion: The in-hospital mortality rate in patients with ALP poisoning was 29.9%. Age, illiteracy, body temperature, resistant acidosis, and taking sodium bicarbonate were the prognostic factors of in-hospital mortality in these patients