Glasgow Coma Scale and Its Components on Admission: Are They Valuable Prognostic Tools in Acute Mixed Drug Poisoning?

Introduction. The verbal, eye, and motor components of Glasgow coma scale (GCS) may be influenced by poisoned patients' behavior in an attempted suicide. So, the values of admission GCS and its components for outcomes prediction in mixed drugs poisoning were investigated. Materials and Methods. A followup study data was performed on patients with mixed drugs poisoning. Outcomes were recorded as without complications and with complications. Discrimination was evaluated by calculating the area under the receiver operating characteristic curves (AUC). Results. There was a significant difference between the mean value of each component of GCS as well as the total GCS between patients with and without complication. Discrimination was best for GCS (AUC: 0.933 ± 0.020) and verbal (0.932 ± 0.021), followed by motor (0.911 ± 0.025), then eye (0.89 ± 0.028). Conclusions. Admission GCS and its components seem to be valuable in outcome prediction of patients with mixed drug poisoning

Effect of Antioxidants on the Outcome of Therapy in Paraquat-intoxicated Patients

Purpose: The present study was conducted to determine the effect of vitamins C and E administration on the outcome of therapy in patients with paraquat intoxication admitted in the Poisoning EmergencyDepartment (PED) of Noor Teaching General Hospital, Isfahan, Iran.Methods: We studied retrospectively medical records of 186 patients admitted to the PED in two different study periods: 157 patients were evaluated from 1985 to 2001 (first study period) in which patients received conventional treatment protocol consisting of fluid replacement, oral absorbents, haemodialysis, etc, Also, 29 other patients were assessed from 2001 to 2005 (second study period) in which vitamins C and E had been administered to the patients, in addition to the conventional protocol.The patients' mortality rate after the first study period was compared to that of the second one, with regard to the impact of the additional therapeutic intervention (use of antioxidant vitamins).Results: Most of the patients (40.5 %) had ingested more than 20 mL of 20 % paraquat solution and were admitted to the hospital during the first 4 h after exposure. Paraquat poisoning was more common in men (76.6 %), young adults in the age group 19 - 34 (47 %) and during summer (43.3 %). Mean (± SE) length of hospital stay was 62.6 ± 15.6 h. Overall mortality rates were 31 and 55.2 % in the first and second periods, respectively.Conclusion: Although the addition of antioxidants (vitamins C and E) to the conventional therapy did not reduce the mortality rate, other dependent variables including different doses of antioxidants may beconsidered for future studies

Glasgow Coma Scale and Its Components on Admission: Are They Valuable Prognostic Tools in Acute Mixed Drug Poisoning?

Introduction. The verbal, eye, and motor components of Glasgow coma scale (GCS) may be influenced by poisoned patients' behavior in an attempted suicide. So, the values of admission GCS and its components for outcomes prediction in mixed drugs poisoning were investigated. Materials and Methods. A followup study data was performed on patients with mixed drugs poisoning. Outcomes were recorded as without complications and with complications. Discrimination was evaluated by calculating the area under the receiver operating characteristic curves (AUC). Results. There was a significant difference between the mean value of each component of GCS as well as the total GCS between patients with and without complication. Discrimination was best for GCS (AUC: 0.933 ± 0.020) and verbal (0.932 ± 0.021), followed by motor (0.911 ± 0.025), then eye (0.89 ± 0.028). Conclusions. Admission GCS and its components seem to be valuable in outcome prediction of patients with mixed drug poisoning

The rank reversal problem in multi-criteria decision making : a literature review

Despite the importance of multicriteria decision-making (MCDM) techniques for constructing effective decision models, there are many criticisms due to the occurrence of a problem called rank reversal. Nevertheless, there is a lack of a systematic literature review on this important subject which involves different methods. This study reviews the pertinent literature on rank reversal, based on 130 related articles published from 1980 to 2015 in international journals, which were gathered and analyzed according to the following perspectives: multicriteria technique, year and journal in which the papers were published, co-authorship network, rank reversal types, and research goal. Thus our survey provides recommendations for future research, besides useful information and knowledge regarding rank reversal in the MCDM field

An empirical analysis of the financial benefits of health information exchange in emergency departments

Abstract Objective To examine the impact of health information exchange (HIE) on reducing laboratory tests and radiology examinations performed in an emergency department (ED). Materials and Methods The study was conducted in an ED setting in Western New York over a period of 2 months. The care of the patients in the treatment group included an HIE query for every encounter, while the care of other patients in the control group did not include such queries. A group of medical liaisons were hired to query the medical history of patients from an HIE and provide it to the ED clinicians. Negative binomial regression was used to analyze the effects of HIE queries on the number of performed laboratory tests and radiology examinations. The log files of the HIE system since 1 year before the ED admission were used to analyze the differences in outcome measures between the 2 groups of patients. Results Ceteris paribus, HIE usage is associated with, respectively, 52% and 36% reduction in the expected total number of laboratory tests and radiology examinations ordered per patient at the ED. Conclusions The results indicate that access to additional clinical data through the HIE will significantly reduce the number of laboratory tests and radiology examinations performed in the ED settings and thus support the ongoing HIE efforts.</jats:p

Analyzing human impacts on the quality and quantity of river water

Abstract Human activities endanger the role of rivers as one of the most valuable freshwater sources and essential ecosystem service providers. Dam construction, agriculture, mining, industry, and land-use change can alter river water quality and the seasonal variability of river discharge, thereby deteriorating the ecological status of rivers. This doctoral thesis explores the impact of each of these activities on river water quality and quantity, and suggests new frameworks and indicators which can be used to enhance the understanding of human impacts on rivers. Two case studies presented here investigated the impact of small reservoirs and multiple dam construction — in connection with land-use change — on river flow characteristics in arid/semi-arid and Mediterranean climates (Iran and Turkey). A third case study analyzed the impact of mining on river water quality in a pristine river in an Arctic region (Finnish Lapland) and proposed a new indicator to enhance the monitoring system. This thesis brings awareness to the potential impact of multiple activities on river systems and delivers new methods to quantify those impacts with minimum cost and maximum effectiveness. The framework presented here could be used by researchers and authorities to monitor river health in different climates.Tiivistelmä Ihmistoiminnan vaikutukset jokisysteemeihin vaarantavat niiden aseman tärkeinä makean veden lähteinä ja ekosysteemipalvelujen tarjoajina. Jokien padottaminen, maatalous, kaivostoiminta, teollisuus ja eri maankäyttömuodot vaikuttavat jokivesien laatuun ja virtaamiin, täten muuttaen niihin liittyvien ekosysteemien tilaa. Tämän väitöskirjatyön tarkoituksena on tutkia näiden tekijöiden vaikutusta vedenlaatuun ja määrään sekä tarjota uusia näkymiä ja työkaluja, joiden avulla pystytään lisäämään tietoa ja ymmärrystä ihmistoiminnan vaikutuksista jokisysteemeihin. Tulokset saatiin kolmen Case-tapauksen avulla, joissa kahdessa tarkasteltiin lukuisten pienpatoaltaiden ja itse patojen rakentamisen sekä maankäytön muutoksen vaikutusta jokien virtaamien dynamiikkaan kuivalla/puolikuivalla sekä välimerellisellä ilmastovyöhykkeellä (Turkki ja Iran). Kolmas case-tapaus käsitteli kaivostoiminnan vaikutuksia luonnontilaiseen jokeen ja sen vedenlaatuun arktisella alueella (Suomen Lappi). Vaikutuksia tarkasteltiin käyttäen jatkuvatoimisesti mitattua sähkönjohtavuutta indikaattorina vedenlaatumuutoksille. Tämä väitöstyö lisää tietoisuutta monien eri toimintojen vaikutuksista jokisysteemeihin ja tarjoaa uusia keinoja määrittää näitä vaikutuksia kustannustehokkaasti. Työssä luotua kehikkoa voidaan käyttää tutkijoiden ja viranomaisten toimesta monissa eri ympäristöissä ja ilmasto-oloissa

Assessing the impacts of artificial groundwater recharge structures on river flow regime in arid and semi-arid regions

In dry and semi-dry climate, Artificial Groundwater Recharge Structures are used for flood control and managed aquifer recharge. These damps basin runoff response decrease the maximum flows and increase the runoff duration through wet seasons. In this study, a framework to quantify the role of AGWRS in headwater tributaries on the total water balance of major basin and alteration of flow pattern in the main river has been presented. The study contains four main subroutines: rainfall-runoff model, reservoir flood routing, river analysis system and seepage analysis. The flood hydrographs with different return periods are estimated based on the climatic data and the characteristics of headwater basin. River flow analysis below the structure is carried out for two unsteady flow scenarios, first with the hydrographs of the natural system (as pre-impact: quick flood with significant peak flow) and second the altered flow hydrographs due to detention process in the reservoir (as post-impact: damped flood lower peak with longer duration time). Two sets of dynamic water surface along the river (from the location of detention structure (x=0) to the confluence point with the main river (x=L) are developed based on two hydrologic conditions as results of river analysis system. The results of framework define the impact of flood detention structure by comparing the timing, magnitude, and variability of flow. The Kamal Abad artificial groundwater recharge in Mahrlou Lake basin in Southern Iran was selected as case study to demonstrate the application of the created framework. Through the probability analysis, the return period for hydrological drought has been compared to the pre-impact and post-impact condition. The results clearly showed how embankments influence floods in tributaries and in some cases the flow reduced significantly and disappear in tributaries