علت و پیامد نهایی حوادث قابل پیشگیری در سالمندان؛ یک مطالعه اپیدمیولوژیک

Introduction: With the growing population of the elderly in societies, the medical problems of this age range also increases. Preventable accidents are among these problems. More than 5 million people die as the result of these injuries each year. Therefore, the present study was done aiming to evaluate the causes and outcomes of preventable accidents in the elderly.Methods: The present study is a retrospective cross-sectional one, performed on elderly patients admitted to a hospital during 2 years. Required data were gathered using census method via a checklist consisting of demographic data, cause of the accident, length of hospital stay, number of times revisiting the hospital, and final outcome. Data were then descriptively analyzed using SPSS 16 statistical software.Results: 2336 patients with the mean age of 72.24 ± 9.02 years were evaluated (50.7% female). The most common causes of accidents were falling with 1033 (44.2%) cases, intentional poisoning with 382 (16.4%) cases, and unintentional poisoning with 360 (15.4%) cases, respectively. Mean length of hospital stay was 5 ± 7.7 days. 144 (6.2%) elderly patients died during the study period. Type of accident (p < 0.001) and final outcome (p < 0.001) were significantly different between the sexes.Conclusion: Based on the findings of the present study, falling, intentional poisoning and unintentional poisoning, respectively, were the most common causes of preventable accidents in the studied elderly population. Most cases were discharged after partial recovery and the 3 afore-mentioned causes had higher prevalence in women. The most frequent outcomes were complete recovery in poisoning, partial recovery in falling, and death in poisoning and burn.مقدمه: به موازات افزایش جمعیت سالمندان در جوامع، مشکلات پزشکی این گروه سنی نیز افزایش می‌یابد. از جمله این مشکلات می‌توان به حوادث قابل پیشگیری اشاره نمود. هر ساله بيش از 5 ميليون نفر در نتيجه این گونه آسيب‌ها جان خود را از دست می دهند. لذا مطالعه حاضر با هدف بررسی علل و پیامد حوادث قابل پیشگیری در سالمندان طراحی شده است. روش کار: پژوهش حاضر يک مطالعه مقطعي‎ گذشته نگر بر روی سالمندان بستری شده در بیمارستان طی دو سال می باشد. اطلاعات مورد نياز از طريق سرشماری و با استفاده از چک لیستی مشتمل بر  اطلاعات دموگرافیک، علت حادثه، طول مدت بستری، تعداد دفعات مراجعه و پیامد نهایی جمع آوری و با استفاده از نرم افزار آماری SPSS 16 مورد آنالیز توصیفی قرار گرفت. يافته ها: در مجموع اطلاعات 2336 بیمار با میانگین سنی 02/9 ± 24/72 سال مورد ارزیابی قرار گرفت (7/50 درصد زن). فراوان ترین علل حوادث به ترتیب عبارت بودند از سقوط 1033 (2/44 درصد) مورد، مسمومیت عمدی 382 (4/16درصد) مورد و مسمومیت تصادفی 360 (4/15 درصد) مورد. متوسط طول مدت بستری 70/7 ± 5 روز بود. تعداد سالمندان فوت شده در طی زمان مورد مطالعه 144 (2/6 درصد) نفر بود. از جهت نوع حادثه (001/0 > p) و پیامد نهایی (001/0 > p) تفاوت معنی داری بین دو جنس مشاهده گردید. نتيجه گيری: بر اساس یافته های مطالعه حاضر سقوط، مسمومیت عمدی و مسمومیت تصادفی به ترتیب شایعترین علل بروز حوادث قابل پیشگیری در سالمندان مورد مطالعه بودند. اکثریت موارد بعد از بهبودی نسبی از بیمارستان ترخیص شده بودند و سه عامل فوق الذکر شیوع بالاتری در زنان داشتند. بهبودی کامل درمسمومیت ها، عدم بهبودی کامل در موارد سقوط و فوت در مسمومیت‌ها و سوختگی بیشترین فراوانی ها را داشتند

Traumatic Injuries Caused by Fall in the Elderly Referred to the Emergency Department; an Epidemiologic Study

مقدمه: سقوط و صدمات ناشی از آن از مشکلات مهم سالمندان در سراسر جهان محسوب شده و افزایش بار مالی و مراقبتی قابل توجهی را برای سیستم های بهداشتی و درمانی بدنبال دارد. در راستای دستیابی به اطلاعات صحیح جهت برنامه ریزی های پیشگیرانه و یا درمانی دقیق تر، مطالعه حاضر با هدف بررسی اپیدمیولوژیک آسیب های ناشی از سقوط در سالمندان مراجعه کننده به بخش اورژانس طراحی شده است. روش کار: پژوهش حاضر یک مطالعه مقطعی گذشته نگر می باشد که طی سال های 93- 1392 بر روی سالمندان مراجعه کننده بدنبال سقوط به بخش اورژانس، بیمارستان امام رضا، مشهد، ایران، انجام شده است. نمونه گیری به روش سرشماری و شامل تمامی بیماران با سن 60 سال و بالاتر بود. اطلاعات دموگرافیک، ویژگی های حادثه، طول مدت بستری، نوع آسیب و شکستگی، تعداد دفعات مراجعه و پیامد نهایی بیماران با استفاده از آماره توصیفی گزارش گردید. يافته ها: 1033 بیمار با میانگین سنی 07/9 ± 37/73 (دامنه سنی بین60 تا 106سال) در طی مدت دو سال مورد مطالعه قرار گرفتند. از این بین 8/64 درصد زن و بقیه مرد بودند و نسبت جنسی زن به مرد 83/1 بود (5/69 درصد متاهل). میانگین سنی خانم های آسیب دیده (89/8 ± 07/73) تفاوت معنی داری با میانگین سنی مردان آسیب دیده (36/9 ± 92/73) نداشت (156/0=p). بیشتر آسیب دیدگان (6/56 درصد) در گروه سنی 74-60 سال قرار داشتند. وقوع حادثه در فصل تابستان (6/29 درصد) و در ماه شهریور بیشتر از سایر زمان ها بود. متوسط طول مدت بستری 96/6 ± 05/5 روز (دامنه مدت بستری از یک ساعت تا 98 روز) بود. بیشترین تعداد روز بستری به دلیل شکستگی فمور بود. متوسط تعداد مراجعه مجدد در بین زنان (84/0 ± 34/1) و مردان (43/1± 48/1) تفاوت معنی داری نداشت (078/0=p). بررسی مکان های سقوط نشان داد که در 6/73 درصد موارد سقوط از سطح همتراز، 23 درصد سقوط از ارتفاع و 7/2 درصد نیز سقوط اشیاء روی سالمند و بقیه موارد نامشخص بود. 7/65 درصد از زنان سقوط را از سطح همتراز و 9/78 درصد مردان سقوط اشیاء روی سالمند را تجربه نموده بودند (001/0 >p). در بررسی نوع شکستگی به تفکیک جنسیت به ترتیب شکستگی فمور (4/34 درصد)، شکستگی ساعد (34 درصد) و شکستگی شانه (9/8 درصد) در زنان و در مردان به ترتیب شکستگی فمور (3/48 درصد)، شکستگی ساعد (7/13 درصد) و بعد از آن شکستگی ساق (6/10 درصد) شایعترین علل شکستگی بوده اند (001/0 > p). در مجموع 7/2 درصد از موارد سقوط منجر به فوت شده بود. بررسی میانگین سنی بین افراد زنده مانده (97/8 ± 20/73) و فوت شده (50/10 ± 57/97) نشان دهنده تفاوت معنی دار بین این دو گروه بود (001/0 > p). اغلب فوت شدگان در گروه سنی 75-89 سال (50 درصد) و در میان مردان (6/53 درصد) بوده اند. نتيجه گيری: بر اساس یافته های مطالعه حاضر بیشترین موارد سقوط در سالمندان مربوط به خانم های متاهل با متوسط سنی 73 سال، در فصل تابستان (ماه شهریور)، به دنبال سقوط همتراز و بین ساعات 18 -13اتفاق افتاده بود. شایعترین آسیب ناشی از سقوط در سری حاضر شکستگی اندام فوقانی و تحتانی بود و میزان مرگ و میر ناشی از سقوط 7/2 درصد گزارش گردید.Introduction: Falling and its resulting injuries are among the important problems of the elderly all over the world and bring about a considerable rise in financial and care burdens for health care systems. To gain accurate data for prevention or treatment planning, the present study aimed to epidemiologically assess the injuries resulting from falling in elderly patients presenting to emergency department (ED).Methods: The present study is a retrospective cross-sectional study carried out on elderly patients presenting to ED of Imam Reza Hospital, Mashhad, Iran, during 2011 and 2012 following falling. Consecutive sampling was used and patients over the age of 60 were included. Demographic data, accident characteristics, hospitalization duration, type of injury and fracture, frequency of visits and final outcome of the patients were recorded using descriptive statistics. Results: 1033 patients with the mean age of 73.37 ± 9.07 years (range: 60 – 106) were studied during 2 years. 64.8% were female and the female to male ratio was 1.83 (69.5% married). Mean age of the injured women (73.07 ± 8.89) was not significantly different from that of injured men (73.92 ± 9.36) (p = 0.156). Most patients (56.6%) were in the 60-74 years age group. Frequency of accidents was higher in summer (29.6%) and was the highest in September. Mean duration of hospitalization was 5.05 ± 6.96 days (range: 1 hour-98 days). The longest duration of hospitalization was due to femur fraction. Mean frequency of revisits was not significantly different between women (1.34 ± 0.84) and men (1.48 ± 1.43) (p = 0.078). Evaluation of falling locations revealed falling from the same level in 73.6% of cases, falling from a height in 23% of cases, objects falling on the patient in 2.7% of cases and other cases were undefined. 65.7% of females had fallen from the same level and 78.9% of males had experienced falling of objects (p < 0.001). In assessing the type of fracture based on gender, fractures of femur (34.4%), forearm (34%), and shoulder (8.9%) in women and femur (48.3%), forearm (13.7%), and leg (10.6%) in men were the most common types, respectively (p < 0.001). In total, 2.7% of falling cases had led to death. Comparison of mean age between those who survived (73.20 ± 8.97) and those who died (97.57 ± 10.50) showed a significant difference (p < 0.001). Most patients that died were in the 75-89 years age group (50%) and male (53.6%). Conclusion:Based on the results of the present study, the highest frequency of falling in the elderly happened in married women with the mean age of 73 years, in summer (September), following same level falling between 1pm and 6 pm. The most common injury caused by falling in this population was fraction of upper and lower extremities and mortality rate due to falling was 2.7%

Acupressure has not an analgesic effect in patients with renal colic: a randomized controlled trial

BACKGROUND Easing renal colic (RC) pain is of the most important issues in the emergency departments. This study was conducted to investigate the analgesic effects of intravenous paracetamol in comparison to acupressure and intramuscular diclofenac in patients with RC. METHODS This randomized clinical trial was conducted on 96 eligible patients with RC, visiting the Emergency Department of Imam Reza Hospital of Mashhad, Iran. The participants were selected by consecutive non-random sampling method, and were randomized in three groups, each comprising of 32 participants. The first and second groups received 75 mg intramuscular diclofenac and lg intravenous paracetamol, respectively. In the third group, three acupressure points were manually stimulated for six minutes. The pain score was measured by Visual Analog Scale for pain at baseline and after 10, 30, and 60 minutes. Collected information analyses by SPSS version 20 and interpreted using descriptive statistics (frequency, percentage) and inferential statistics (chi-square test). RESULTS The mean age was 31.60 +/- 7.42 years (range:18-50). The two methods (diclofenac and paracetamol groups) were significantly better in pain reduction compared to acupressure after 10 minutes (p<0.001). Ninety four percent of participants in diclofenac group, 87% of paracetamol group and none of acupressure group were completely satisfied with their treatment method (p<0.001). CONCLUSION This study demonstrated that acupressure did not effectively reduces renal colic pain. It seems that contrary to acupressure, intravenous paracetamol is a safe and effective analgesic medicine for patients with RC.Mashhad University of Medical SciencesOpen access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Process and barriers to organ donation and causes of brain death in northeast of Iran

Introduction: Organ transplantation is the treatment of choice for some diseases. However, the need for cadaveric organ donation has either plateaued or is on a decreasing trend in some countries, especially in developed ones. In this study, we aimed to identify the barriers to organ donation in brain dead patients, who were referred to the organ procurement organizations (OPO) in northeast Iran. Methods: In this cross-sectional study during 2006 to 2013, data were collected from medical records of brain dead patients. Demographic information, cause of brain death, the process of obtaining informed consent, and the reasons for declining organ donation were obtained from the OPO records. The data were analyzed using chi- square test by SPSS 13 software. Results: Of 1034 brain dead patients, 751 cases (72.6%) were eligible for organ donation, and, ultimately, 344 cases underwent organ donation. The rate of organ donation increased during the course of the study; medical and legal reasons as well as family refusal to authorize donation were the main barriers to the process. Conclusion: Based on the pattern of mortality, the need for living donors in developing countries, such as Iran and other countries in the Mediterranean region, can be reduced by improving the quality of healthcare, efficient identification of brain death, and obtaining consent with appropriate strategies

Cause and Outcome of Preventable Accidents in the Elderly; an Epidemiologic Study

Introduction: With the growing population of the elderly in societies, the medical problems of this age range also increases. Preventable accidents are among these problems. More than 5 million people die as the result of these injuries each year. Therefore, the present study was done aiming to evaluate the causes and outcomes of preventable accidents in the elderly.Methods: The present study is a retrospective cross-sectional one, performed on elderly patients admitted to a hospital during 2 years. Required data were gathered using census method via a checklist consisting of demographic data, cause of the accident, length of hospital stay, number of times revisiting the hospital, and final outcome. Data were then descriptively analyzed using SPSS 16 statistical software.Results: 2336 patients with the mean age of 72.24 ± 9.02 years were evaluated (50.7% female). The most common causes of accidents were falling with 1033 (44.2%) cases, intentional poisoning with 382 (16.4%) cases, and unintentional poisoning with 360 (15.4%) cases, respectively. Mean length of hospital stay was 5 ± 7.7 days. 144 (6.2%) elderly patients died during the study period. Type of accident (p &lt; 0.001) and final outcome (p &lt; 0.001) were significantly different between the sexes.Conclusion: Based on the findings of the present study, falling, intentional poisoning and unintentional poisoning, respectively, were the most common causes of preventable accidents in the studied elderly population. Most cases were discharged after partial recovery and the 3 afore-mentioned causes had higher prevalence in women. The most frequent outcomes were complete recovery in poisoning, partial recovery in falling, and death in poisoning and burn

Efficacy of adding acupuncture to Methylphenidate in children and adolescents with attention deficit hyperactivity disorder: A randomized clinical trial

Introduction: Attention deficit hyperactivity disorder (ADHD) is the most prevalent finding in children with behavioral issues. It has been shown that acupuncture, as a complementary medicine, may have some beneficial effects in ADHD treatment; however, the available evidence of its effectiveness are inadequate. This study aimed to investigate the effectiveness of acupuncture treatment in patients with ADHD. Methods: This double blind randomized sham controlled trial was conducted on patients with confirmed ADHD referred to Ibn-e-Sina Psychiatric Hospital, Mashhad, Iran between January 2017 and June 2017. Patients were randomly allocated into either an acupuncture (experimental group) or a sham acupuncture (control group). All patients received a standard treatment of 0.3–1 mg/kg of Methylphenidate (Ritalin) in 2 or 3 divided doses. Within 4 weeks the intervention group received acupuncture treatment 3 times a week. Sham acupuncture was used for the control group within the same duration as acupuncture group. The treatment outcomes were measured using home version of ADHD-rating scale (RS) and the Continuous Performance Test after 3 weeks. Independent-samples t-test, Pearson Chi-square test, and Paired-samples t-test were used for data analysis with SPSS version 16.0. Results: This study was conducted on 59 patients (52 males) with a mean age of 10.64 ± 2.46 years in two groups of experiment (n = 31) and control (n = 28). ADHD-RS total score was significantly more decreased in acupuncture group after 3 weeks (-6.29 ± 7.1 vs. -1.96 ± 6.7; p = 0.007). Also, the hyperactivity and impulsivity was significantly more decreased in the acupuncture group compared to the sham control group (-3.29 ± 3.7 vs. -0.45 ± 4.1; p = 0.005). Furthermore, acupuncture did not considerably change Omission error, Commission error, Reaction Time and Correct hit (p > 0.05). Conclusion: Our study showed that acupuncture can significantly improve the parent-report ADHD-RS. Nevertheless, it did not improve the attention deficit. We recommend further investigations with larger sample sizes and longer follow-up. The adverse effects of acupuncture on ADHD patients were not assessed in this study, but should be measured in future studies