The Effect of Intravenous Ketamine in Suicidal Ideation of Emergency Department Patients

Introduction: Suicidal ideation is an emergent problem in the Emergency Department (ED) that often complicates patient disposition and discharge. It has been shown that ketamine possesses fast acting antidepressant and anti-suicidal effects. This study was conducted to examine the effects of a single intravenous bolus of ketamine on patients with suicidal ideations in ED. Methods: Forty-nine subjects with suicidal ideations with or without an unsuccessful suicide attempt, received 0.2 mg/kg of ketamine. Scale for suicidal ideation (SSI) and Montgomery-Abserg depression rating scale (MADRS) were evaluated before and 40, 80 and 120 minutes after drug intervention. The results were compared using the paired t-test and patients were followed up 10 days after ED admission for remnant suicide ideation. Results: SSI (df: 3, 46; F=80.7; p<0.001) and MADRS (df: 3, 46; F=87.2; p<0.001) scores significantly dropped after ketamine injection; the SSI score before and after 20, 40, and 80 minutes of ketamine injection were 23.0±6.7, 16.2±5.2, 14.3±4.3, and 13.6±4.0 respectively. The MADRS scores were 38.2±9.3, 25.6±7.1, 22.7±6.3, and 22.1±5.95 at the same time intervals. 25.5% of patients were hospitalized, 63.3% received medications and 12.2% discharged. 6.2% of patients had suicidal ideations ten days after ED disposition.  Conclusion: It seems that Ketamine couldn't be a good choice for fast reduction of suicidal ideations in ED patients. Further studies are needed to determine the optimal dose of ketamine for different patients

Diagnostic performance of ocular ultrasonography compared to fundoscopy to predict papilledema

BAC KGR OUND: The aim of this study was to determine the association between the diameters of optic nerve sheath assessed by ultrasonography, grading of papilledema in fundoscopy among patients suspected to raising intracranial pressure and determining the sensitivity and specificity of ultrasonography to detect optic nerve sheath dilatation. MET HODS: This prospective blinded cohort study was performed on 223 consecutive patients with clinical suspicion to optic papilledema. The patients were assessed using direct fundoscopy. The diameter of the optic nerve sheath was determined by ocular ultrasonography. RESULTS: In fundoscopy, 46 patients were revealed to have papilledema in at least one of the two eyes. A significant correlation was found between diameter of optic nerve sheath and age in total population as well as in those without papilledema, but not in the group with papilledema. The mean diameter of optic nerve sheath in bilateral assessment was significantly higher in the group with papilledema. The association between the mean diameter of optic nerve sheath and grade of papilledema was strongly significant. The assessment of the area under ROC analysis showed that measuring diameter of optic nerve sheath could effectively discriminate papilledema from normal condition. CONCL USIONS: Ultrasonography can effectively discriminate papilledema from normal condition by measuring diameter of optic nerve sheath. (Cite this article as: Namdar P, Yousefian S, Farzaneh Khanshir Z, Zohal MA, Kazemifar AM, Torabi Goodarzi Z. Diagnostic performance of ocular ultrasonography compared to fundoscopy to predict papilledema. Minerva Oftalmol 2017;59:1-6. DOI: 10.23736/S0026-4903.17.01770-6) Key words: Ultrasonography - Papilledema - Intracranial hypertension - Optic nerve. Minerva Oftalmol 2017 March;59(1):1-6 DOI: 10.23736/S0026-4903.17.01770-6 © 2017 EDIZIONI MINER VA MEDICA Online version at http://www.minervamedica.it COPYRIGHT© 2017 EDIZIONI MINERVA MEDICA This documen

Natural Disasters in the Middle-East and North Africa With a Focus on Iran: 1900 to 2015

Background: Many types of natural disasters are sudden and calamitous events that create a large socioeconomic burden with significant negative impact on health care, social infrastructure, and the environment; especially in the low and middle income countries; therefore, it is necessary to reduce or control this kind of disasters by understanding the specific risks and negative impacts. Recognition of disaster events helps us to plan effectively, coordinate and invest on disaster risk reduction projects. Materials and Methods: The current article was a narrative review of the epidemiological data available on natural disasters in MNA countries (Egypt, Jordan, Lebanon, Morocco, Oman, Tunisia,and Yemen) and their trends from 1900 to 2015. The statistical data were obtained from international disaster sources (EM-DAT, DesInventar and Gapminder) and literature reviews of international reports and journals. To find related articles from journals, data bases such as Pubmed, Escopus, Google Scholar, and SID were searched for the following key words: natural disasters, Middle-East, disasters and Middle-East, disasters and North Africa, natural disasters and Middle-East, natural disasters and North Africa, and disaster and trend. Results: In the last century, more than 80% of natural disaster events occurred in MNA and concentrated in just 9 countries as Afghanistan, Pakistan, Iran, Sudan, Somalia, Algeria, Morocco, Yemen, and Egypt. Hydrological disasters (flood and landslide) with 63% had the largest share in 2015 and were more than that of the last century. In 2015, mortality rate of flood with 11% and landslides with 32% had increasing trend compared to last century. In the last 2 years, conversely, damages and victims from flood were about 85%, which were more than those of the last century, but in landslides no change was observed. In 2015, meteorological disasters such as storms and extreme temperatures represented 19% of the total disaster occurrence that had an increasing trend compared to that of the last century with 12%. Extreme temperatures with 57% of all deaths and storm with 72% of total victims had the highest levels among other natural disasters in this period. In the previous years, the total number of death, affected people, and damages of metrological disasters had increasing trend compared to the last century. In addition, in 2015, the frequency of climatological disasters (drought) and geophysical disasters (earthquake) did not change significantly, but the number of affected people, deaths, and damages from drought and earthquakes had a noticeable decrease compared to those of the last century. Conclusion: The trends of natural disasters frequency from 1900 to 2015 in MNA has increased and effective mitigation and preparedness is necessary, both at individual and governance levels. This issue in the middle income and developing countries in MNA should be considered as a high priority in national planning

Assessment of hospitals preparedness in road traffic crashes with mass casualty: the case of Iran

INTRODUCTION: Road traffic crashes (RTCs) annually cause about 1.35 million deaths and 20–50 million injuries. Hospitals have the main role in responding to road traffic injuries (RTIs) and decreasing the number of disabilities and deaths.This study aimed to assess the preparedness of selected Iranian hospitals in responding to road traffic crasheswith mass casualties.MATERIAL AND METHODS: This cross-sectional study was carried out among 13 hospitals in four provinces including Tehran, Alborz, West Azerbaijan, and Hamedan in 2019. the valid and reliable questionnaire of hospital preparedness assessment in RTIs was used for data collection (Kappa coefficient = 0.89; CVR: 0.98; CVI: 0.97). Using SPSS 16, the level of hospital preparedness was categorized into three parts as weak (less than 34%), moderate (34–66%), and high (more than 66%).RESULTS: Preparedness of the selected hospitals was at a moderate level (= 65.25%). Although the level of preparedness in the aspects of command and control (72.7%), safety and security (71.54%), infrastructure and medical equipment (74.12%), and coordination (71.15%) was satisfactory, hospitals were weak in the training and exercise aspect (48.46%). The level of access to specific equipment needed for responding to trauma injuries was high (79.56%).CONCLUSIONS: Based on the findings, a response plan is required to make hospitals more prepared to respond to road traffic injuries. The plan may include training and development, as well as health facilities preparedness in terms of structure, equipment, and human resources. In addition, assessing the effectiveness of all response plans requires exercise and practice

The Relationship between Nurse’s Job Stress and Patient Safety

BACKGROUND: Patient safety is a key element of the quality of health services. Nurses are the largest group that care for patients, observing safe in nursing care would reduce injuries, disability, morbidity and mortality. However, high stress can lead to a decline in the quality of nursing care. AIM: This study aimed to investigate the relationship between job stress of the nurses and patient safety in a teaching hospital of Hamadan in 2017. MATERIAL AND METHODS: This is a cross-sectional study. The data was gathered by a questionnaire of Nurse’s job stress prepared by the researcher that after confirming the validity and reliability was completed by 198 nurses of three teaching hospitals of Hamadan city that were selected by simple random sampling and the checklist of patient safety that was collected by the researcher. Data analysis was done in the two levels of descriptive and analysis statistics. RESULTS: The results showed that the job stress of the nurses and patient safety (mean = 1.75 and SD = 0.114) have been at an average level. There was no statistically significant relationship between Nurse’s job stress and patient safety because the Spearman correlation coefficient showed that r = 0.007 and p = 0.919. Among the demographic factors, there was only a significant relationship between marital status and Nurse’s job stress (p < 0.05). CONCLUSION: Because of nursing job stress is affected by different working conditions, further studies in the many hospitals are needed. Moderate levels of patient safety are not acceptable; Therefore, heath’s policymakers should focus on providing the safety of all patients at the optimal level, with more effort to reduce the stress of their nurses at the lowest level. e optimal level, with more effort to reduce stress of their nurses at the lowest level

Rationale, design, implementation, and baseline characteristics of patients in the DIG trial: A large, simple, long-term trial to evaluate the effect of digitalis on mortality in heart failure

This article provides a detailed overview of the rationale for key aspects of the protocol of the Digitalis Investigation Group (DIG) trial. It also highlights unusual aspects of the study implementation and the baseline characteristics. The DIG trial is a large, simple, international placebo-controlled trial whose primary objective is to determine the effect of digoxin on all cause mortality in patients with clinical heart failure who are in sinus rhythm and whose ejection fraction is less than or equal to 0.45. An ancillary study examines the effect in those with an ejection fraction > 0.45. Key aspects of the trial include the simplicity of the design, broad eligibility criteria, essential data collection, and inclusion of various types of centers. A total of 302 centers in the United States and Canada enrolled 7788 patients between February 1991 and September 1993. Follow-up continued until December 1995 with the results available in Spring 1996