Decision-Making for Patients Referring to Emergency Department Before and After the Establishment of Emergency Medicine; a Comparative Study

مقدمه: ضرورت وجود تربیت پزشکان متخصص اورژانس در اواسط قرن20 در پاسخ به افزایش انتظارات مردمی برای دسترسی شبانه روزی به مراقبت‌های پزشکی کیفی و تخصصی احساس شد. این مطالعه با هدف مقايسه وضعیت تعیین تکلیف بیماران مراجعه کننده به بخش اورژانس امام رضا (ع) شهر بیرجند قبل و بعد از استقرار طب اورژانس صورت پذیرفته است. روش‌ کار: در این مطالعه مقایسه ای تعداد 800  بیمار بستری شده در اورژانس بیمارستان امام رضا (ع) بیرجند در 6 ماهه اول سال 1390 (قبل از استقرار طب اورژانس) و 6 ماهه اول سال 1396 (بعد از استقرار طب اورژانس) از جهت وضعیت تعیین تکلیف مورد مقایسه قرار گرفتند. اطلاعات بیماران (شامل اطلاعات دموگرافیک، علت مراجعه، مدت زمان بستری و تعیین تکلیف بیماران، ترخیص یا ارجاع بیماران)  از پرونده کاغذی یا سیستم HIS بیمارستان جمع‌آوری شد. داده‌ها پس از جمع‌آوری وارد نرم‌افزار SPSS نسخه 16 شده و از آزمون من‌ویتنی و کای اسکوئر در سطح معناداری برابر با 0.05 استفاده شد. یافته‌ها: میانگین مدت زمان تعیین تکلیف بیماران قبل و پس از استقرار متخصصین طب اورژانس از 73/222 ± 1/343 به 33/174 ± 19/200 دقیقه به طور معناداری کاهش یافت (P<0.001). توزیع فراوانی ترخیص با رضایت شخصی، تعیین تکلیف بیماران زیر 6 ساعت و 12 ساعت بین دو بازه زمانی با یکدیگر اختلاف معناداری داشت (P<0.05). توزیع فراوانی بیماران ارجاع شده به سایر مراکز درمانی و ارجاع شده به سایر بخش‌ها بین دوبازه زمانی مورد بررسی با یکدیگر اختلاف معناداری نداشت (P>0.05). نتیجه‌گیری: حضور متخصصین طب اورژانس به عنوان یک الگوی موفق در نظام سلامت منجر به افزایش سرعت، کیفیت و دقت در ارائه خدمات به بیماران بستری در بخش اورژانس شد.Introduction: The need for the training of emergency physicians was felt in the mid-20th century in response to rising public expectations for access to quality and specialized medical care around the clock. This study was conducted with the aim of comparing the decision-making status of patients referring to Imam Reza Hospital’s Emergency Department in Birjand before and after the establishment of emergency medicine. Methods: In this comparative study, 800 patients who were admitted to the emergency department of Imam Reza Hospital, Birjand, Iran, from March to September in 2011 (before the establishment of emergency medicine) and 2017 (after the establishment of emergency medicine) were compared regarding the status of decision-making. Patient information (including patient demographics, reason for referral, length of hospital stay, and time to assignment, discharge or referral) was collected from a paper file or the hospital information system (HIS). After collecting the data, they were entered in SPSS software version 16 and Mann-Whitney and Chi-square tests were used at a significance level of 0.05. Results: Mean time to decision-making had reduced from 343.1 ± 222.73 minutes to 200.19 ± 174.33 minutes after the deployment of emergency medicine specialists (P<0.001). There was a significant difference between the frequency of discharge against medical advice, and decision-making regarding the patients in less than 6 hours and 12 hours between the two time periods (P<0.05). The number of patients who were referred to other medical centers and other wards was not significantly different between the two time periods (P>0.05). Conclusion: The presence of emergency medicine specialists, as a successful model in the health system, led to an increase in speed, quality, and accuracy of providing services to patients admitted to the emergency department

The relationship between dietary patterns and insomnia in young women

Abstract Aim There is mounting evidence that eating habits affect sleeping patterns and their quality. The goal of this study was to evaluate the associations between major dietary patterns, identified using principal component analysis (PCA) and insomnia in young women. Methods The study subjects comprised 159 healthy young women aged 18–25 years. Neuropsychological assessment was performed using standard instruments, including a cognitive ability questionnaire (CAQ), depression and anxiety stress scales (DASS‐21), insomnia severity index (ISI), Epworth sleepiness scale (ESS), and quality of life questionnaire (QLQ). Dietary patterns were obtained from a 65‐item validated food frequency questionnaire (FFQ) in this study, using PCA. Results Two major dietary patterns were identified that were termed: “Traditional” and “Western.” The Western pattern was characterized by a high intake of snacks, nuts, dairy products, tea, fast foods, chicken, and vegetable oils. Subjects with moderate/severe insomnia were found to have lower scores for total cognitive ability task, nocturnal sleep hours, and physical and mental health, but higher scores for depression, anxiety, stress, and daytime sleepiness compared to those without insomnia (p < 0.05). After adjustment for potential confounders, high adherence to the Western dietary pattern was associated with higher odds of insomnia (OR = 5.9; 95% confidence intervals: 1.9–18.7; p = 0.003). Conclusion Our findings indicated adherence to Western pattern may increase the odds of insomnia. Prospective research is required to determine the feasibility of targeting dietary patterns to decrease the odds of insomnia