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INTRODUCTION: Effective teamwork is vital in providing safe and effective patient care, especially in a high-risk setting such as the emergency ward. The culture of patient safety has a direct impact on the way work is performed and, consequently, on the safety of patients. One of the ways to promote the patient safety culture is to support the hospital's management team and improve the teamwork climate. This study was conducted to investigate the effect of executive managers' walk-round on patient safety culture in emergency ward nurses. MATERIAL AND METHODS: This quasi-experimental study was carried out in four emergency wards (two wards for the experimental group and two wards for the control group) in Darab Hospital. From each group, 32 nurses were selected by stratified random sampling method and participated in the study. For the experimental group, executive managers' walk rounds were conducted for five months. The safety culture questionnaire was completed before and after the intervention in both groups. Data were analysed with SPSS22. RESULTS: The average scores of the patient safety culture of the two experimental and control groups were not statistically different before the intervention. Overall, the total score of the intervention group was 130.44 ± 7.80 and that of the control group was 124.19 ± 8.76 after the intervention, which showed a statistically significant difference (p ≤ 0.001). More specifically, in the intervention group, the scores of "teamwork within hospital units" (p = 0.015), "overall perceptions of safety" (p = 0.042), "communication openness" (p = 0.020), "non-punitive response to the error" (p = 0.001), "feedback and communication about errors" (p = 0.021) were higher compared to the control group. CONCLUSIONS: This study provided further insight into the importance of hospital management's support in improving patient safety culture. Executive managers' walk-rounds increased the culture of patient safety perceptions of emergency ward nurses; thus, it is suggested to regularly conduct executive managers' walk-rounds to improve the level of patient safety and increase the quality of service to patients. [ABSTRACT FROM AUTHOR]

Background Discharge against medical advice indicates the dissatisfaction of patients with the care services of the health system. Additionally, it threatens patient's life and causes negative financial outcomes for hospitals. Objective This study identifies the causes of self-discharge decisions from the emergency department at Kowsar Hospital, Semnan City, Iran. Methods This was a descriptive-analytical study conducted between August 2021 to March 2022. The data were collected by a researcher-made questionnaire containing demographic characteristics and reasons for self-discharge, including the following three main concepts: Personal, staff-related factors, and environmental factors with sub-concepts. Meanwhile, the data were analyzed using the SPSS software, version 22. Results A total of 140 patients with a mean age of 33.52±16.17 years were included, of which 58.6% were men and 41.4% were women. Moreover, 63.6% of patients were married, 42.1% had a diploma education, and 11.4% had a history of taking neuropsychiatric drugs. Also, 42.9% of patients were covered by social security insurance. The highest rate of self-discharge was in the evening (42.1%) and night (37.9%) shifts. The most important reasons for self-discharge decision were problems related to insurance (30%), COVID-19 infection (26.4%), poor communication (17.1%), dissatisfaction with care (15.7 %), disrespectful behavior of staff (12.9%), and inappropriate emergency ward facilities (12.1%). Conclusion Make appropriate decisions to improve the quality of medical services and increase cooperation in health insurance, separating the departments of infectious diseases away from other departments, holding briefing sessions for physicians and medical staff, increasing awareness of patients about possible complications of self-discharge, and improving the amenities of emergency ward can reduce the rate of self-discharge decision. [ABSTRACT FROM AUTHOR]

The immediate spread of COVID-19 posed a great deal of strain on healthcare personnel, particularly emergency personnel. Considering the critical role of frontline health care personnel (HCPs) during the pandemic and the life-threatening effects of COVID-19 on them, the present study aimed to evaluate the hospital database among frontline emergency personnel, and to assess the factors affecting the health status of the emergency HCPs. In the current study, we collected data on coronavirus clinical features from 58 HCPs with confirmed COVID-19 who worked in the emergency ward of Baqiyatallah Hospital, Tehran, one of the most referral hospitals in Iran. We also assessed the factors affecting the health status of the emergency HCPs from February 2020 to November 2020. All of the 58 HCPs infected with COVID-19 were the personnel of the emergency ward with an age range of 20-59 years old. The median (interquartile range) of hospital length of stay (LOS) among all patients was 8 days. Length of stay is a critical factor in predicting hospital resource needs. Twelve (21.8%) patients had groundglass opacity (GGO) alone, and 20 (35.7%) patients had patchy GGO. In our multivariable analysis, high levels of patient liver enzymes (P=0.04) and lymphopenia (P=0.01) were significantly associated with the LOS. In our study, there was an association between high levels of patient's ESR and CRP and longer LOS. We also found that age and gender had no effect on LOS. Nurses contributed to the highest number of COVID- 19 infection. It was also found that HCPs who had more working shifts were more infected, and the intensive care unit of the emergency ward was the most infected area of the Emergency Room. [ABSTRACT FROM AUTHOR]

Background and Objective: In hospitals, the emergency department is a complex healthcare environment, and it is necessary to attention to nosocomial infections. This study aimed to evaluate the implementation of nosocomial infection program in the emergency department. Materials and Methods: This descriptive study was conducted in hospitals of Gorgan, Iran, in 2022, using the WHO checklist with 96 questions in 9 section staff; patients, environment, equipment, drug, prevention of infections wound, urinary, respiratory, and blood. Data were collected via observation and interviews. A checklist containing 45 questions was used to determine the impact of staff awareness on the infection control program, in 4 sections oftheoretical knowledge, performing procedures, immunization, and environmental hygiene. Results: The results show that 82.46% of the infection control program was satisfactory. The percentage of scores for different sections of nosocomial infection program including staff, patients, environment, equipment, drug, infection prevention of wound, urinary, respiratory and blood was 79.31, 77.78, 81.25, 83.34, 100, 44.34, 75.00, 87.88 and 100, respectively. Moreover, the percentage awareness score for emergency medicine specialists, general practitioners, medical interns, and nurses was 100, 95.83, 87.5, and 79.92, respectively. Conclusion: The implementation quality of the infection control program was acceptable and satisfactory. However, some factors were lower than the desired level, which could be dangerous for medical staff, patients, and visitors. The medical staff believed that the support of the senior managers of the University was essential for the implementation of an infection control program, and also holding training courses, and accelerating data sharing.

Abstract Background Malaria is the most deadly parasitic disease and continues to claim more than a half million of deaths across the world each year, mainly those of under-fives children in sub-Saharan Africa. The aim of this study was to determine the epidemiological, clinical and laboratory features of patients with severe malaria at the Centre Hospitalier Régional Amissa Bongo (CHRAB), a referral hospital in Franceville. Methods It was an observational descriptive study conducted at CHRAB over 10 months. All admitted patients at the emergency ward of all ages presenting with positive test to falciparum malaria diagnosed by microscopy and rapid test with clinical signs of severe illness describe by World Health Organization were enrolled. Results During this study, 1065 patients were tested positive for malaria, of them 220 had severe malaria. Three quarters (75.0%) were less than 5 years of age. The mean time to consultation was 3.5 ± 1 days. The most frequent signs of severity on admission were dominated by neurological disorders 92.27% (prostration 58.6% and convulsion 24.1%), followed by severe anemia 72.7%, hyperlactatemia 54.6%, jaundice 25% and respiratory distress 21.82%.The other forms such as hypoglycemia, haemoglobinuria, renal failure were found in low proportions

Background: Distraction is a technique that has had positive effects on reducing children’s pain in painful interventions, such as venipuncture, and replacing the burn dressing. Based on the available data, very few articles exist about the application of this technique when suturing children. Objectives: This study was designed to determine the effect of distraction by watching cartoons on the level of pain during preparation before suturing children in the emergency ward. Methods: This study is a randomized controlled trial. The research population included all children aged 3-12 years who were referred to the emergency ward of Bu Ali Sina Hospital in Sari City, Iran. Forty-three subjects were selected from each group. In the intervention group, playing cartoons on the tablet was initiated from the time of placing the child on the bed for suturing, and continued until the end of the anesthetic injection, and this time was recorded. In the control group, the suturing was performed conventionally. The behavioral reactions of both groups were measured twice based on the pain behavioral reactions scale. The first time was when the child was placed on the bed and before cleaning for the anesthetic agent, while the second time was observed and recorded by the researcher immediately after injecting the anesthetic agent. Results: The comparison of mean pain before injecting the anesthetic agent (after playing the cartoon) showed a significant difference between the intervention and control groups based on Mann-Whitney test (P=0.0001). The comparison of mean pain immediately after termination of anesthetic injection also showed a significant difference in both the intervention and control groups based on the Mann-Whitney test (P=0.0001). Based on the results of the present research, the pain in the intervention group was less before the anesthetic injection and less in the control group immediately after the injection. Conclusions: The results suggested that distraction from watching cartoons has a positive effect on reducing the pain of preparation before suturing children. Therefore, this technique can be used in emergency departments.

Abstract Background Patients with substance use disorder (SUD) suffer from excess mortality compared to the overall population. This study aims to identify patterns in death rates among patients with SUD visiting a SUD emergency ward and to explore whether this knowledge can be used as input to identify patients at risk and increase patient safety. Methods Hospital visit data to a SUD emergency ward were collected between 2010 and 2020 through medical records. Data included gender, age, SUD diagnosis, and the time of death. The Kruskal-Wallis rank sum test was used to test between ordinal variables, and risk ratio was used to quantify the difference in mortality risk. All statistical tests were two-sided, with a 95% confidence interval and a minimum significance level of 0.05. Results The male patients in the study group had 1.41–1.59 higher mortality risk than the female patients. The study revealed an average death rate of 0.14 among all patients during the study period. Although patients with a diagnosed alcohol use disorder constituted 73.7% of the cohort, having an opioid use disorder or sedative hypnotics use disorder was associated with the highest death rates; 1.29–1.52 and 1.47–1.74 higher mortality risk than those without such diagnoses. Conclusion This study demonstrates that data from visits to SUD emergency wards can be used to identify mortality risk factors, such as gender, type of diagnosis, number of diagnoses, and number of visits to the SUD emergency ward. Knowledge about patterns of patient visits and mortality risk could be used to increase patient safety through a decision support tool integrated with the electronic medical records. An improved system for early detection of increased mortality risk offers an opportunity for an adaptive patient safety system.

Background and Objective: In hospitals, the emergency department is a complex healthcare environment, and it is necessary to attention to nosocomial infections. This study aimed to evaluate the implementation of nosocomial infection program in the emergency department. Materials and Methods: This descriptive study was conducted in hospitals of Gorgan, Iran, in 2022, using the WHO checklist with 96 questions in 9 section staff; patients, environment, equipment, drug, prevention of infections wound, urinary, respiratory, and blood. Data were collected via observation and interviews. A checklist containing 45 questions was used to determine the impact of staff awareness on the infection control program, in 4 sections oftheoretical knowledge, performing procedures, immunization, and environmental hygiene. Results: The results show that 82.46% of the infection control program was satisfactory. The percentage of scores for different sections of nosocomial infection program including staff, patients, environment, equipment, drug, infection prevention of wound, urinary, respiratory and blood was 79.31, 77.78, 81.25, 83.34, 100, 44.34, 75.00, 87.88 and 100, respectively. Moreover, the percentage awareness score for emergency medicine specialists, general practitioners, medical interns, and nurses was 100, 95.83, 87.5, and 79.92, respectively. Conclusion: The implementation quality of the infection control program was acceptable and satisfactory. However, some factors were lower than the desired level, which could be dangerous for medical staff, patients, and visitors. The medical staff believed that the support of the senior managers of the University was essential for the implementation of an infection control program, and also holding training courses, and accelerating data sharing. [ABSTRACT FROM AUTHOR]

Background: Malaria is the most deadly parasitic disease and continues to claim more than a half million of deaths across the world each year, mainly those of under-fives children in sub-Saharan Africa. The aim of this study was to determine the epidemiological, clinical and laboratory features of patients with severe malaria at the Centre Hospitalier Régional Amissa Bongo (CHRAB), a referral hospital in Franceville. Methods: It was an observational descriptive study conducted at CHRAB over 10 months. All admitted patients at the emergency ward of all ages presenting with positive test to falciparum malaria diagnosed by microscopy and rapid test with clinical signs of severe illness describe by World Health Organization were enrolled. Results: During this study, 1065 patients were tested positive for malaria, of them 220 had severe malaria. Three quarters (75.0%) were less than 5 years of age. The mean time to consultation was 3.5 ± 1 days. The most frequent signs of severity on admission were dominated by neurological disorders 92.27% (prostration 58.6% and convulsion 24.1%), followed by severe anemia 72.7%, hyperlactatemia 54.6%, jaundice 25% and respiratory distress 21.82%.The other forms such as hypoglycemia, haemoglobinuria, renal failure were found in low proportions < 10%. Twenty-one patients died, coma (aOR = 15.54, CI 5.43–44.41, p < 0.01), hypoglycemia (aOR = 15.37, CI 2.17–65.3, p < 0.01), respiratory distress (aOR = 3.85, CI 1.53–9.73, p = 0.004) and abnormal bleeding (aOR = 16.42, CI 3.57–104.73, p = 0.003) were identified as independent predictors of a fatal outcome. Anemia was associated with decreased mortality. Conclusion: Severe malaria remains a public health problem affecting mostly children under 5 years. Classification of malaria helps identify the most severely ill patients and aids early and appropriate management of the severe malaria cases. [ABSTRACT FROM AUTHOR]

Background: Patients with substance use disorder (SUD) suffer from excess mortality compared to the overall population. This study aims to identify patterns in death rates among patients with SUD visiting a SUD emergency ward and to explore whether this knowledge can be used as input to identify patients at risk and increase patient safety. Methods: Hospital visit data to a SUD emergency ward were collected between 2010 and 2020 through medical records. Data included gender, age, SUD diagnosis, and the time of death. The Kruskal-Wallis rank sum test was used to test between ordinal variables, and risk ratio was used to quantify the difference in mortality risk. All statistical tests were two-sided, with a 95% confidence interval and a minimum significance level of 0.05. Results: The male patients in the study group had 1.41–1.59 higher mortality risk than the female patients. The study revealed an average death rate of 0.14 among all patients during the study period. Although patients with a diagnosed alcohol use disorder constituted 73.7% of the cohort, having an opioid use disorder or sedative hypnotics use disorder was associated with the highest death rates; 1.29–1.52 and 1.47–1.74 higher mortality risk than those without such diagnoses. Conclusion: This study demonstrates that data from visits to SUD emergency wards can be used to identify mortality risk factors, such as gender, type of diagnosis, number of diagnoses, and number of visits to the SUD emergency ward. Knowledge about patterns of patient visits and mortality risk could be used to increase patient safety through a decision support tool integrated with the electronic medical records. An improved system for early detection of increased mortality risk offers an opportunity for an adaptive patient safety system. [ABSTRACT FROM AUTHOR]

Aim: During rapid sequence intubation (RSI), the O2 reserve limits the intubation duration. The study objective was to examine the impact of RSI on arterial blood gases (ABG) during the preoxygenation phase. Methods: This open, prospective clinical study examined samples of patients who had endotracheal intubation (ETI) as RSI between March 2014 and September 2014 in our emergency department. The variations in ABG PaO2 and PaCO2 before and after preoxygenation and after intubation were examined and compared with demographic and clinical variables. Results: The study included 67 patients (46 male, 21 female) with a mean age of 69.9 years. SBP, DBP, and MABP decreased, while pulse rate and SpO2 increased. No difference was observed between PaO2 values and demographic and clinical variables; however, a statistically significant relationship was found between the difference (Δ) between PaO2 values measured after endotracheal tracheal intubation (ETI) and after preoxygenation and the ABG SpO2 and the SpO2 classification before preoxygenation. Conclusion: The relationship between SpO2 and its classification following ETI and increased ABG SpO2 was statistically significant. Our real-life study emphasises that deciding on intubation without desaturating patients could have positive effects on intubation success. Regardless, increasing SpO2 prior to ETI will contribute positively to the O2 reserve by the end of ETI. The ΔPaO2, before and after preoxygenation, was not affected by age; gender; body mass index (BMI) and its classification; GCSS; vital signs and ABG findings gathered before preoxygenation; respiration rate (RR) during preoxygenation; preoxygenation duration; oral air passage usage or air leakage.

Background and purpose: Elder abuse is one of the major challenges in caring and supporting elderly people. Current research aimed to investigate the relationship between loneliness and experiencing abuse in elderly people attending emergency departments in Amol hospitals, Iran 2019. Materials and methods: A descriptive-analytical correlation study was conducted in 220 people aged>60 years selected by convenience sampling. Demographic information of the participants was recorded and Elder abuse questionnaire in the family and the Social and Emotional Loneliness Scale for Adults (SELSA) were used. Data analysis was performed applying descriptive statistics test, Spearman correlation coefficient, multiple regression model and analysis of variance in SPSS V22. Results: The mean age of the elderly was 66.5±5.45 years and 62.7% were female participants. Among the subjects, 50.9% reported at least one type of abuse. Emotional neglect (29.1%) and physical abuse (0.5%) were the most and least frequent types of abuse, respectively. The current study showed significant relationships between all dimensions of abuse and the sense of loneliness (P=0.001) except for authority deprivation (P=0.5) and physical abuse (P=0.1) and financial neglect (P=0.1(. Conclusion: Education and increasing awareness of elderly people and their caregivers can reduce elder abuse and improve their relationship, which will consequently improve the sense of loneliness in elderly people.

Background: Authoritative trauma scoring systems can quickly assess the damage and show its severity plus prognosis. The purpose of this study was to investigate the predictive value of the new Glasgow Coma Scale, age, and systolic blood pressure (GAP) and the new trauma score (NTS) indicators to determine the mortality of trauma patients in hospitals in Sirjan in 2019. Materials and Methods: In a descriptive-analytical study, 2570 patients with multitrauma caused by traffic accidents transferred by the prehospital emergency were enrolled in the study. Demographic variables of patients as well as GAP and NTSs were collected and calculated, with the outcome of patients followed up and recorded during hospitalization. The predictive value of these scores was determined in clarifying the outcome of patients using SPSS software. Results: Of the total number of patients studied, 14 (0.5%) patients died during hospitalization. The mean GAP and NTS scores in dead patients were 12.78 ± 6.92 and 11.64 ± 7.36, respectively. Furthermore, in surviving patients, they were 22.19 ± 1.12 and 22.30 ± 1.22, respectively, with a P < 0.05 in each case. Based on the above tools with 95% confidence level, the area under the curve for the mortality was 0.932 for the GAP system and 0.944 for the NTS (P > 0.001). Conclusions: Both indicators could predict the mortality of patients with multitrauma. It could also be used to determine the priority of dispatch at the scene of the accident and the triage of the injured (people). Based on the results of the receiver operating characteristic curve, the NTS score has a higher accuracy.

Objective To explore the clinical characteristics of 2 668 inpatients in emergency ward, and to provide reference for emergency management. Methods Total of 2 668 patients hospitalized in the emergency department of xuanwu hospital from January 2015 to June 2018 were selected and the study data were retrospectively collected, including gender, age, comorbidities involvement system, hospitalization cost, length of hospital stay, and self-care ability score before hospitalization and before discharge. Results 1)The average age of male patients was younger than that of females (67.2±17.1 vs 70.7±17.2 years old)(P＜0.01). 2)2 408(90.25%) patients admitted to the hospital with more than 3 kinds of co-morbidities, and the co-morbidities involved mainly in respiratory, circulation, and endocrine systems. 3)The immediate living ability score was significantly lower than that before discharge (69.42±25.09 vs 78.12±26.13) (P＜0.001). 4)Barthel score was negatively correlated with length of stay, cost of hospitalization, decreased albumin, and anemia. Conclusions The types of diseases in the emergency ward are complicated, involving multiple disciplines and specialties, and the critical condition is variabl. Comprehensive and comprehensive evaluation is necessary in the process of clinical diagnosis, treatment and nursing care to improve the clinical outcomes of patients.

Background & Aims: Pain management is essential in the emergency room (ER) care plan, and nurses play a key role in this regard. The positive attitude and proper performance of the healthcare staff is critical in pain management, which is an important patients' right. The present study aimed to assess the attitude and performance of nurses regarding pain management in the patients admitted to the ER. Materials & Methods: This cross-sectional, descriptive survey was conducted on 150 nurses employed in the ERs of the hospitals affiliated to Iran University of Medical Sciences, Tehran, Iran in 2018. The eligibility criteria were the minimum of bachelor's degree/higher in nursing and six months of work experience in the ER. Data were collected using a demographic questionnaire and the questionnaire of performance regarding pain management. Data analysis was performed in SPSS version 16 using descriptive and inferential statistics. Results: The mean age of the participants was 31.98±5.52 years, and the majority (82.9%) had no prior training on pain management. Regarding pain management in the ER, the mean scores of attitude and performance were 57.16±5.022 and 6.02±2.53, respectively. No significant differences were observed between the mean scores of attitude and performance with the demographic characteristics. Conclusion: According to the results, the nurses had moderate attitudes toward pain management, and although their self-report indicated proper performance in this regard, they had inadequate knowledge regarding the use of pain management tools. Therefore, it is recommended that proper education and in-service re-training be provided for the promotion of proper pain management in the patients and increasing the quality of care, as well as proper training on the use of pain assessment measures.

The article discusses a study which compared the performance of double-trunk mask (DTM) and non-rebreather mask (NRM) on arterial blood gases in hypoxemic subjects with COVID-19 presenting to emergency department (ED) with acute respiratory distress. Topics covered include the inclusion criterion and sociodemographic description of study participants, the improvement in blood oxygenation with DTM compared to NRM, and the strengths and limitations of the study.

Rationale, aims and objectives: Emergency short‐stay unit (SSU) alleviates emergency department (ED) overcrowding, but may affect in‐hospital indicators. Cardiology patients comprise a substantial part of patients admitted at SSU. This study evaluated whether SSU opening differentially modified in‐hospital indicators at a whole general hospital and at its cardiology division (CARD). Methods: We retrospectively analysed indicators based on 859 686 ED visits, and 171 547 hospital admissions, including 12 110 CARD admissions, from 2007 to 2018 at a general tertiary hospital, and compared global ED indicators and in‐hospital indicators at the hospital and CARD before (2007‐2011) and after (2011‐2018) SSU opening. Results: After SSU opening, monthly ED bed occupancy rate decreased (mean ± SD 200 ± 18% vs 187 ± 22%; P <.001) and in‐hospital admissions from ED increased at the hospital (median [interquartile range] 460 [81] vs 524 [41], P <.001) and CARD (50 [12] vs 54 [12], P =.004). In parallel, monthly in‐hospital elective admissions decreased at CARD (34 [18] vs 28 [17], P =.019), but not at the hospital (712 [73] vs 700 [104], P =.54). Average length of stay (LOS) increased at both hospital (8.5 ± 0.3 vs 8.7 ± 0.4 days, P <.001) and CARD (9.2 ± 1.5 vs 10.3 ± 2.3 days, P =.002) after SSU opening, but percent admissions at SSU showed a direct relationship with LOS solely at CARD. Furthermore, cardiology patients admitted at SSU had greater LOS, prevalence of coronary heart disease and age than those admitted at the conventional cardiology ward. Conclusions: SSU opening improved ED crowding, but was associated with changes in in‐hospital indicators, particularly at CARD, and in the characteristics of hospitalized cardiology patients. These findings suggest that in‐hospital cardiology services may need re‐evaluation following SSU opening at a general hospital. [ABSTRACT FROM AUTHOR]

Background: Using different scores to predict the outcome of patients and determine the severity of their illness could be effective in making better clinical decisions and helping patients. The purpose of this study is to determine the predictive value of the National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) of in-hospital mortality in patients with a suicide attempt. Methods: In a diagnostic study, we included 453 patients with suicide attempts in the poisoning unit and Intensive Care Unit (ICU) poisoning unit of Sina Hospital from December 2019 to September 2021. Patients’ vital signs and level of consciousness were recorded and then analyzed by statistical methods. Results: The mean±SD of patients’ age was 31.82±12.28 and the mortality rate was 7.7%. The median (25%-75%) of NEWS and MEWS in all patients was 4(2-7) and 2(1-3), respectively. Based on the Receiver Operating Characteristic (ROC) curve of NEWS, the Area Under The Curve (AUC) (CI95%), standard error, and cut off point were 0.915(0.876-0.995), 0.020, and 7.5 respectively (85% sensitivity and 81% specificity) (P˂0.001). The results of MEWS based on Receiver Operating Characteristic (ROC) curve were 0.87 (0.805-0.932), 0.033, and 3.5 respectively (74% sensitivity and 84% specificity) (P˂0.001). Conclusion: Based on our study results, we concluded that in hospitalized patients with suicide attempts, the accuracy of NEWS in predicting hospital mortality is higher than MEWS.

The confirmed and suspected cases of the 2019 novel coronavirus disease (COVID-19) have increased in the entire world. There is still no vaccine or definitive treatment for this virus due to its unknown pathogenesis and proliferation pathways. Optimized supportive care remains the main therapy, and the clinical efficacy for the subsequent agents is still under investigation. Enormous demand for handling the COVID-19 outbreak challenged both the health-care personnel and medical supply system. As outbreaks of COVID-19 develop, prehospital workers, emergency medical services personnel, and other emergency responders are potentially asked to follow specific practice guidelines to mitigate the effects of an escalating pandemic. In this article, we have summarized the current guidance on potential COVID-19 management options. The recent experience with COVID-19 provided lessons on strategy and policymaking that the government and ministry of health should be on the alert and concentrate more on capacity to manage an outbreak like COVID-19. It is important to consider the new data that emerge daily regarding clinical characteristics, treatment options, and outcomes for COVID-19. [ABSTRACT FROM AUTHOR]

Background and purpose: Elder abuse is one of the major challenges in caring and supporting elderly people. Current research aimed to investigate the relationship between loneliness and experiencing abuse in elderly people attending emergency departments in Amol hospitals, Iran 2019. Materials and methods: A descriptive-analytical correlation study was conducted in 220 people aged>60 years selected by convenience sampling. Demographic information of the participants was recorded and Elder abuse questionnaire in the family and the Social and Emotional Loneliness Scale for Adults (SELSA) were used. Data analysis was performed applying descriptive statistics test, Spearman correlation coefficient, multiple regression model and analysis of variance in SPSS V22. Results: The mean age of the elderly was 66.5±5.45 years and 62.7% were female participants. Among the subjects, 50.9% reported at least one type of abuse. Emotional neglect (29.1%) and physical abuse (0.5%) were the most and least frequent types of abuse, respectively. The current study showed significant relationships between all dimensions of abuse and the sense of loneliness (P=0.001) except for authority deprivation (P=0.5) and physical abuse (P=0.1) and financial neglect (P=0.1(. Conclusion: Education and increasing awareness of elderly people and their caregivers can reduce elder abuse and improve their relationship, which will consequently improve the sense of loneliness in elderly people. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Prevention and reduction of pain, anxiety, and fear during medical procedures is one of the most important factors that should be considered in pediatric emergencies. The aim of this study was to compare the efficacy of oral versus intranasal midazolam in sedation during radiologic imaging in the largest province of Iran, Kerman. MATERIALS AND METHODS: Eighty children were enrolled in this single-blind clinical trial based on convenience sampling and were divided into two groups receiving 0.5 mg/kg midazolam in oral route administration and 0.2 mg/kg midazolam in intranasal route administration. Finally, 75 patients remained for evaluating medication acceptability, sedation level, onset time of sedation, additional sedative dose, adverse effects of sedation, and provider satisfaction. RESULTS: Children in the intranasal group accepted medication more easily (89.8% vs. 36.9%; P≤ 0.001), while these children received a lower sedation dose, but the sedation level in both methods was similar (P = 0.72). Our findings showed that children in the intranasal sedation group had a faster onset of sedation compared to the oral group (17.94 ± 8.99 vs. 34.50 ± 11.45; P≤ 0.001). The frequency of midazolam side effects had no difference between the groups (29.7% vs. 15.8%; P = 0.15). CONCLUSION: Intranasal midazolam with a lower sedation dose induces a faster onset and better acceptance. Intranasal midazolam can be used as an effective sedative method for pediatric patients, especially in emergency wards.

OBJECTIVES: This study aimed to determine the effect of adding intravenous midazolam to paracetamol in the treatment of patients with primary headache referring to the emergency department. METHODS: In a randomized clinical trial, 120 patients (18–65 years old) with primary headache referring to the emergency department were enrolled. Patients were divided into two groups (case: paracetamol + midazolam and control: paracetamol + placebo), and the treatment was administered based on the treatment group. The severity of pain (according to the initial Visual Analog Scale) and at different times after the treatment onset (15, 30, and 60 min) and the degree of satisfaction with the treatment were compared in two groups of patients. RESULTS: There were no statistically difference between the two groups about the median of pain severity at the time of 0 min (case: 8 vs. control: 8), 15 min (case: 6 vs. control: 6), and 30 min (case: 4 vs. control: 4) with P > 0.05. Headache severity at 60 min after the treatment onset in the case group (median: 1) was less than that of the control group (median: 3). There was also a statistically significant difference in the median of patient satisfaction in the case group (case: 9 and control: 7 with P < 0.001) and satisfaction in the case group was higher. CONCLUSIONS: Based on our primary and secondary outcomes and the results of the study, we conclude that adding intravenous midazolam to paracetamol do not improve the therapeutic response ratio over time, but the effect of this intervention appeared after 1 h.

Background: Stress in jobs such as medicine can cause physiological and psychological damage. Therefore, the aim of this study was to investigate and compare the stress among emergency physicians, identify strategies for managing stress, and ranking these strategies. Methods: This cross-sectional study was conducted on 91 emergency physicians of Shahid Sadoughi, Shohadaye Kargar, Afshar, and Shahid Rahnemoon hospitals in Yazd City, Iran, in year 2017. The participants were selected using convenience sampling method. In this survey, we studied general physicians, emergency medicine specialists, and the residents of internal medicine, general surgery, cardiology, and emergency medicine. The questionnaire used in this article was obtained from Miguel research, and according to the opinion of the professors, its questions reduced from 192 to 125 questions, and after verification of validity and reliability, it was used. Findings: Afshar hospital had the highest mean of stress (325.20 ± 57.30), and hospitals of Shahid Sadoughi (304.9 ± 52.8), Shahid Rahnemoon (288.02 ± 39.01), and Shohadaye Kargar (174.70 ± 21.60) were ranked next. Moreover, the dimensions of communication with the supervisor (17.40 ± 2.29) and communication with the staff had the lowest (20.24 ± 2.60) and medical care in general (18.20 ± 2.73) and family conditions (27.12 ± 2.98) had the highest mean of dimensional stress. The results of ranking stress management strategies also showed that emergency doctors showed negative reactions in stressful situations to reduce stress. Conclusion: Emergency practitioners work in a high-profile environment, which reduces their work efficiency and burnout. Therefore, recognizing the dimensions of stress and its management solutions can improve working conditions.

Several reports showed SARS-CoV-2 rapid antigen tests (RATs) performances among COVID-19 symptomatic subjects in outpatient settings during periods of highest incidence of infections and high rates of hospital admissions, but few data are present for asymptomatic patients. We investigated the role of RATs in an emergency department, as a novel screening tool before admission for COVID-19 asymptomatic patients. A total of 116 patients were screened on admission in a 250-bed community hospital in Morges, Switzerland. RAT detected 2/7 RT-PCR-positive patients and delivered two false-positive results. These data suggest the non-fiability of RATs screening in this clinical scenario.

Objective: To assess the burden of trauma during the last three years (2016-18) caused by road traffic accidents presenting to the trauma centre of tertiary care public hospital in district central, Karachi. Methods: All the accident cases presenting in the trauma center of the hospital in last three years who were defined as accidents occurring on a public road and involving at least one moving vehicle were included in the study. Those with incomplete medical records were excluded. This was a crosssectional study where records of a total of 2857 individuals were retrospectively collected and their socio-demographic information, history of road traffic crashes, clinical history and examination was noted. Data was analyzed through SPSS while descriptive statistical analysis of continuous and categorical variables was performed. Results: The mean age of patients admitted to the trauma centre was 29.3 ± 16.7 years with no significant difference between both gender. Out of 2857 patients with road traffic accident injuries, around 80.9% were males. The most prevalent age group was 16-30 years of age, which was over 40.2%, followed by subjects of 31 - 45 years age group which was 21%. The study results further showed that over 51.3% of the road traffic accident patients were discharged normally, followed by 46.7% subjects who left against medical advice. Overall death rate was 2% (n=57). Conclusion: This study helps to identify the latest accident burden and pattern of injuries to develop plans aimed at prevention of road traffic accidents. Looking at the burden, the most affected was the younger subjects (16-30 years) highlighting the need for targeting this population for educational programs and policies about safe driving. Among the road traffic accidents cases the subjects who left against medical advice cases was gradually decreasing from 2016 to 2018 suggesting better healthcare facilities at the tertiary care hospital and corresponding increasing patient's confidence in them.

Taking right medicine at the right time is vital to ensure safety and speedy recovery of the patient. The aim of this study was to conduct a comprehensive review systematic analysis and outcomes of the medication discrepancies which occur as a result of inappropriate prescribing in a hospital setting. A cross sectional study was performed between July 2018 to April 2019 at Star hospitals, South India. A total of 300 prescriptions were collected from different inpatient departments by two practising clinical pharmacists. We used the standard World Health Organization methodology to achieve the study objectives. A feasible sampling technique was used to collect the prescriptions from various departments. Various clinical drug databases like Medscape, Micromedex, and Pub Med were referred. A total of 300 prescriptions were collected and reviewed which comprised 62 % Documentation discrepancies, 19.6 % of omission errors, 10.3 % of prescriptions exceeding the maximum dose, 0.8 % were of prescriptions contained therapeutic duplications. Drugs prescribed out of the formulary also contributed to medication related errors. Mid-level health care practioners were also involved on this study. The study evidenced the potential of inappropriate prescription occurring in the hospital setting ranging from patient admission to discharge. Several factors such as multiple co-morbidities, ploy pharmacy, hassle at the work environment and poor communication among allied health care professionals were found to be the major causes of potential inappropriate prescribing. Execution of efficient strategies will help in controlling the harmful outcomes as a result of irrational prescribing. [ABSTRACT FROM AUTHOR]

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Objective: To assess the burden of trauma during last three years (2016-18) caused by road traffic accidents presenting to the trauma centre of tertiary care public hospital in district central, Karachi. Methods: All the accident cases presenting in the trauma center of the hospital in last three years who were defined as accidents occurring on a public road and involving at least one moving vehicle were included in the study. Those with incomplete medical records were excluded. This was a crosssectional study where records of a total of 2857 individuals were retrospectively collected and their socio-demographic information, history of road traffic crashes, clinical history and examination was noted. Data was analyzed through SPSS while descriptive statistical analysis of continuous and categorical variables was performed. Results: The mean age of patients admitted to the trauma centre was 29.3 ± 16.7 years with no significant difference between both gender. Out of 2857 patients with road traffic accident injuries, around 80.9% were males. The most prevalent age group was 16-30 years of age, which was over 40.2%, followed by subjects of 31 - 45 years age group which was 21%. The study results further showed that over 51.3% of the road traffic accident patients were discharged normally, followed by 46.7% subjects who left against medical advice. Overall death rate was 2% (n=57). Conclusion: This study helps to identify the latest accident burden and pattern of injuries to develop plans aimed at prevention of road traffic accidents. Looking at the burden, the most affected was the younger subjects (16-30 years) highlighting the need for targeting this population for educational programs and policies about safe driving. Among the road traffic accidents cases the subjects who left against medical advice cases was gradually decreasing from 2016 to 2018 suggesting better healthcare facilities at the tertiary care hospital and corresponding increasing patient's confidence in them. [ABSTRACT FROM AUTHOR]

BackgroundStreptococcus pneumoniae continues to cause a variety of common clinical syndromes, despite vaccination programs for both adults and children. The total U.S. burden of pneumococcal disease is unknown.MethodsWe constructed a decision tree-based model to estimate U.S. healthcare utilization and costs of pneumococcal disease in 2004. Data were obtained from the 2004-2005 National (Hospital) Ambulatory Medical Care Surveys (outpatient visits, antibiotics) and the National Hospital Discharge Survey (hospitalization rates), and CDC surveillance data. Other assumptions regarding the incidence of each syndrome due to pneumococcus, expected health outcomes, and healthcare utilization were derived from literature and expert opinion. Healthcare and time costs used 2007 dollars.ResultsWe estimate that, in 2004, pneumococcal disease caused 4.0 million illness episodes, 22,000 deaths, 445,000 hospitalizations, 774,000 emergency department visits, 5.0 million outpatient visits, and 4.1 million outpatient antibiotic prescriptions. Direct medical costs totaled $3.5 billion. Pneumonia (866,000 cases) accounted for 22% of all cases and 72% of pneumococcal costs. In contrast, acute otitis media and sinusitis (1.5 million cases each) comprised 75% of cases but only 16% of direct medical costs. Patients ≥ 65 years old, accounted for most serious cases and the majority of direct medical costs ($1.8 billion in healthcare costs annually). In this age group, pneumonia caused 242,000 hospitalizations, 1.4 million hospital days, 194,000 emergency department visits, 374,000 outpatient visits, and 16,000 deaths. However, if work loss and productivity are considered, the cost of pneumococcal disease among younger working adults (18-

OBJECTIVES: Prevention and reduction of pain, anxiety, and fear during medical procedures is one of the most important factors that should be considered in pediatric emergencies. The aim of this study was to compare the efficacy of oral versus intranasal midazolam in sedation during radiologic imaging in the largest province of Iran, Kerman. MATERIALS AND METHODS: Eighty children were enrolled in this single-blind clinical trial based on convenience sampling and were divided into two groups receiving 0.5 mg/kg midazolam in oral route administration and 0.2 mg/kg midazolam in intranasal route administration. Finally, 75 patients remained for evaluating medication acceptability, sedation level, onset time of sedation, additional sedative dose, adverse effects of sedation, and provider satisfaction. RESULTS: Children in the intranasal group accepted medication more easily (89.8% vs. 36.9%; P = 0.001), while these children received a lower sedation dose, but the sedation level in both methods was similar (P = 0.72). Our findings showed that children in the intranasal sedation group had a faster onset of sedation compared to the oral group (17.94 ± 8.99 vs. 34.50 ± 11.45; P = 0.001). The frequency of midazolam side effects had no difference between the groups (29.7% vs. 15.8%; P = 0.15). CONCLUSION: Intranasal midazolam with a lower sedation dose induces a faster onset and better acceptance. Intranasal midazolam can be used as an effective sedative method for pediatric patients, especially in emergency wards. [ABSTRACT FROM AUTHOR]

Background: Abdominal pain is a common cause of visits to emergency facilities. It is related to psychiatric disorders in primary care, but it is unclear if this also holds in emergency departments. Objective: Is to explore potential differences between diagnostic groups in patients with acute abdominal pain in an emergency ward regarding concurrent somatic-and psychiatric symptoms, 'Length of stay' (LOS) and perceived health. Method: The patients (N = 137) were divided into three groups; organic dyspepsia, specific abdominal diagnoses, and non-specific abdominal pain. The Prime-MD results for extra gastrointestinal symptoms (outside the gastrointestinal tract), psychiatric symptoms, frequency of symptoms, self-reported health, and LOS within the month before admittance were compared between the diagnostic groups. Results: There was a significant positive correlation between the number of physical extra gastrointestinal and psychiatric symptoms (p <.001), especially regarding anxiety (p <.001) and depression (p =.002). Patients with organic dyspepsia reported significantly more total (p =.016), extragastrointestinal (p =.026) (chest pain; p =.017, dizziness; p =.004, palpitations; p =.005, insomnia; p =.005 and worries; p =.001), and summarized anxiety and depression symptoms (p =.001–0.002) besides poorer general health (p <.001) compared to other abdominal conditions. Also, organic dyspepsia patients needed longer hospital stay than the non-specific abdominal group (p =.002) but similar to the specific abdominal disorders group. Conclusion: Organic dyspepsia is accompanied by more co-occurring physical, anxiety and depression symptoms as well as poorer perceived health than other abdominal pain conditions and comparably increased LOS. This suggests that psychiatric consultations might be beneficial for diagnosing and treating psychiatric comorbidity in emergency care. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study aimed to determine the effect of adding intravenous midazolam to paracetamol in the treatment of patients with primary headache referring to the emergency department. METHODS: In a randomized clinical trial, 120 patients (18-65 years old) with primary headache referring to the emergency department were enrolled. Patients were divided into two groups (case: paracetamol + midazolam and control: paracetamol + placebo), and the treatment was administered based on the treatment group. The severity of pain (according to the initial Visual Analog Scale) and at different times after the treatment onset (15, 30, and 60 min) and the degree of satisfaction with the treatment were compared in two groups of patients. RESULTS: There were no statistically difference between the two groups about the median of pain severity at the time of 0 min (case: 8 vs. control: 8), 15 min (case: 6 vs. control: 6), and 30 min (case: 4 vs. control: 4) with P > 0.05. Headache severity at 60 min after the treatment onset in the case group (median: 1) was less than that of the control group (median: 3). There was also a statistically significant difference in the median of patient satisfaction in the case group (case: 9 and control: 7 with P < 0.001) and satisfaction in the case group was higher. CONCLUSIONS: Based on our primary and secondary outcomes and the results of the study, we conclude that adding intravenous midazolam to paracetamol do not improve the therapeutic response ratio over time, but the effect of this intervention appeared after 1 h. [ABSTRACT FROM AUTHOR]

Background: Data demand deals with queries and answers accustomed treat and lookout of patients in emergency cases. In addition, analyzing patients' needs helps with nursing practice and developing an appropriate care plan. On the opposite hand, acceptable knowledge sources in clinical for designation, care and therapeutic functions are supported patients' scientific criteria and correct info. Purpose: This study was performed to meet the data needs and resources of nursing students in the emergency department of a teaching hospital affiliated to Hormozgan University of Medical Sciences in 2018. Methods: This descriptive-analytical have a look at become performed on one hundred forty nursing students who were educated at the least as soon as within the emergency branch of Shahid Mohammadi medical institution. The sampling approach turn out to be census. The records series instrument become a questionnaire evolved through the researcher which blanketed domains: wishes and information assets. The reliability and validity of the questionnaire were established. The facts were analyzed via SPSS v.19 software program. Findings: The scholar members in this examine had been 43.6% men and 56.4% ladies. Their age ranged among 19-35 years. in line with the findings, 50.7% of the scholars strongly wanted medical records. want for diagnostic and management facts became common. A two-manner and bivariate correlation take a look at showed the best correlation among diagnostic and control needs (p<.001, r=.594). facts wishes confirmed that the most massive correlation amongst guys belonged to diagnostic/therapeutic information wishes and among girls belonged to diagnostic/control information desires. the very best facts need among men turned into diagnostic/therapeutic and amongst ladies become diagnostic/management. The consequences related to information resources discovered that scholars' facts resources cited protected, respectively: patient's document, patient, patient's caregiver and nurses. Conclusion: According to the findings, college students were found to heed a tremendous deal of to diagnostic information desires. college students' data sources had been pretty their files. consequently, it's entreated to maneuver students in the direction of new medical sources to recognise a outstanding deal of statistics. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic ketoacidosis (DKA) is a metabolic derangement consisting of high blood glucose concentration, measurable ketone bodies in blood and/or urine and metabolic acidosis. DKA mainly occurs in patients with type 1 diabetes, but it is not uncommon in patients with type 2 diabetes. DKA is a Medical emergency, responsible for significant amount of admissions in Medical Emergency Ward. It is the most common serious and life threatening acute complication of diabetes. Materials and Methods: The present study was carried out on 60 patients who are k/c/o Diabetes Mellitus (Type 1/Type 2) or newly detected above the age of 12 years presented with DKA and have RBS >250 mg/dl, positive serum and urine ketone test, PH < 7.35, HCO3 level < 18 mmol/L, Respiratory rate < 30 per min, Systolic BP >90 mm of Hg and informed written consent given. Results: Infection and insulin therapy discontinuation being the most common causes of DKA. Incidence of DKA is more common in type 1 DM. DKA, most common presenting symptoms were Nausea/Vomiting. DKA is more common in female as compared to male. The mean blood glucose level at presentation higher in type 1 DM patients as compared to type 2 DM. Type 2 DM patients are less dehydrated than type 1 patients. Conclusion: Infection and insulin therapy discontinuation being the most common causes of DKA. Mortality in patients with DKA can be greatly reduced with early recognition of symptoms and precipitating factors and timely administration of insulin therapy. Proper insulin dosage and administration and prevention from infection can decrease incidence of admission in emergency medical ward. [ABSTRACT FROM AUTHOR]

Following the Swiss Federal Office of Public Health (FOPH) authorization of the rapid antigen test (RAT), we implemented the use of the RAT in the emergency ward of our university hospital for patients’ cohorting. RAT triaging in association with RT-PCR allowed us to promptly isolate positive patients and save resources. Among 532 patients, overall sensitivities were 48.3% for Exdia and 41.2% for Standard Q®, PanbioTM and BD Veritor™. All RATs exhibited specificity above 99%. Sensitivity increased to 74.6%, 66.2%, 66.2% and 64.8% for Exdia, Standard Q®, PanbioTM and BD Veritor™, respectively, for viral loads above 105 copies/mL, to 100%, 97.8%, 96.6% and 95.6% for viral loads above 106 copies/mL and 100% for viral loads above 107 copies/mL. Sensitivity was significantly higher for patients with symptoms onset within four days (74.3%, 69.2%, 69.2% and 64%, respectively) versus patients with the evolution of symptoms longer than four days (36.8%, 21.1%, 21.1% and 23.7%, respectively). Among COVID-19 asymptomatic patients, sensitivity was 33%. All Immunoglobulin-A-positive patients resulted negative for RAT. The RAT might represent a useful resource in selected clinical settings as a complementary tool in RT-PCR for rapid patient triaging, but the lower sensitivity, especially in late presenters and COVID-19 asymptomatic subjects, must be taken into account.

Background: Several factors are related to emergency ward overcrowding and re-hospitalization may probably play a considerable role in this problem. Thus, the aim of this study was to determine re-hospitalization frequency and related factors in patients discharged in less than 12 hours from Alzahra hospital emergency service in Isfahan, Iran. Methods: This is an applied cross sectional study of patients who referred to Alzahra hospital emergency department in Isfahan during 2015 spring and summer. In this study, 400 hospital records were randomly selected and studied for re-hospitalization. Demographic and other information including the interval between two referrals, cause of the first and second hospitalization, kind of discharge and other needed information were collected. If the causes of primary and secondary referrals were the same and the interval between the two was also less than one week, it was regarded as incomplete treatment. Finally, the data was analyzed by SPSS software. Findings: 54 patients (13.5%) had re-hospitalization and the mean interval between the two referrals was 7.4 ± 5.8 days. In 30 of these patients (55.6%), the second referral was in less than 7 days. Re-hospitalization was different based on patients’ age and more frequent in those with less than 50 years. This was also different based on their job, education and types of discharge in the first admit. Conclusion: A considerable part of patients who referred to emergency ward had re-hospitalization which was related to primary diseases in almost 50% of them and this repeated refers leads to emergency overcrowding and increase of hospital cost. On the other hand, a part of this repeated hospitalization is due to incorrect management of patients in emergency ward which is due to factors related to patients and the hospital. Thus, patient who referred to emergency ward must be managed and diagnosed correctly and receive the required treatment on time.

Introduction: We investigated the effect of education on the knowledge and decision-making of medical interns, based on emergency severity index (ESI) triage. Methods: In this pre and post-interventional study, 155 medical students who were passing their internship course of the emergency ward were enrolled with convenience sampling from July 2018 to June 2019. The students were randomly classified into two groups (103 cases and 52 controls). The questionnaire was administered twice in the control group (before initiating the educational class and 1 month after completion of the educational course). In the case group, the test was conducted at three times (before the educational class, immediately after completion of classes, and one month after completion of the educational course). The data were analyzed by using t test and ANOVA. Results: The total score of the students in the case group in the pre- and post-training stage (posttest 1) was 17.13±4.26 and 24.93±3.20 respectively, which had a significant difference (P