دکتر الهام پیش بین

Patient safety remains a critical concern for healthcare systems, particularly in developed nations. A substantial proportion of patients experience complications and adverse events attributable to healthcare delivery, exacerbating their initial health issues. Many adverse events are likely to go unnoticed, unreported, and consequently unaddressed. This issue largely stems from inadequate surveillance methods that require significant improvement to achieve excellence in delivering safe, high-quality care for emergency patients.

This study aimed to develop an emergency department trigger tool (EDTT) to identify adverse events in the emergency department (ED) to enhance patient safety and quality improvement.

Conducted under the supervision of Mashhad University of Medical Sciences, this study comprised four stages: (1) a systematic review, (2) refinement and automation of empirical triggers, (3) a modified Delphi process to compile a list of validated triggers from experts, and (4) final environmental data collection to determine the most effective triggers.

The study included a systematic review of electronic resources, revealing no prior Persian equivalent of a trigger tool. A total of 502 articles were identified in PubMed, 100 in Google Scholar, and 410 in Scopus. After removing duplicates and adding four articles based on reference searches, 1,016 article titles were initially reviewed. Two independent researchers evaluated the articles on the same day in two locations. In cases of disagreement, a third researcher's opinion was sought. Ultimately, 295 articles were selected, with high inter-rater reliability (0.82). Forty-two articles were included in the final analysis. The developed tool contained 50 triggers organized into six groups. In a review of 100 ED cases, an average of 1.2 triggers was identified per patient file, with 99 (79.8%) of these triggers attributed to medical errors.

This study successfully designed an emergency department trigger tool (EDTT) utilizing a systematic review and the Delphi method. The resulting trigger tool can be employed to assess high-risk situations and potential emergency medical errors. A significant advantage of this tool over previous versions is its focus on high-risk conditions without relying solely on the absence of appropriate actions as indicators of danger.

Geriatric trauma refers to injuries sustained by elderly individuals, typically those aged 65 years andolder. The management of geriatric trauma in the Emergency Department requires a comprehensive approachthat takes into account the physiological changes associated with aging, as well as the increased vulnerabilityand complexity of injuries in this population. This is a cross-sectional study aimed at evaluating the etiology of trauma in geriatric patients referredto the ED of level-1 an academic center. All patients with complaints of trauma are evaluated and patients over65 years enrolled in the study. Data were analyzed by SPSS 26. 319 patients were investigated, 49.8% male and 50.2% female. The most common underlying diseasesare high blood pressure, diabetes type 2, and ischemic heart disease. The most common trauma cause wasfalling from the same level (48.9%), followed by a fall from a height (16.6%), accidents with cars (16%), andmotorcycles (9.1%). The most common injury was extremities trauma (71.5%) following head trauma (13.2%)and chest trauma (6%). The severity of injury in extremities was higher in women, and chest trauma was moresevere in men. The fall and subsequent car accident had the highest frequency as a cause of trauma in elderlypatients admitted to our academic trauma center. Hypertension and diabetes have also been the most commonunderlying diseases. Head and neck injuries are life-threatening and critical in a larger number of patients thanother injuries, and protecting them can be effective in reducing mortality and serious injuries in elderly traumapatients.

Cerebral Venous Sinus Thrombosis (CVST), a complex and infrequent cerebrovascular disordercharacterized by the formation of clots within the cerebral venous sinuses, occurs as a result of multiple riskfactors and casualties, and its epidemiological picture should be investigated. This descriptive study was conducted retrospectively on patients with a final diagnosis of cerebralvein thrombosis, who were referred to the emergency room of Ghaem Hospital (Mashhad, Iran) between 2009and 2019. The study included all patients with cerebral vein thrombosis who were older than 18 years. Clinicalsymptoms and causes were documented and contrasted according to demographics. During the 10 years of this study, 749 cases of cerebral vein thrombosis were observed, with womenaccounting for the majority (72.8%). The most prevalent symptom was headache (554 cases; 74.0%), followedby seizures (23.1%), blurred vision (16.0%), nausea (7.5%), vomiting (6.9%), double nose (4.9%), and dizziness(3.3%). There was no significant difference in the frequency of symptoms between the two genders (p<0.05). Themost commonly identified risk factors were OCP (110 cases; 14.7%), followed by infection (103 cases; 13.8%),malignancies (78 cases; 10.4%), and fasting (15 cases; 2.0%). There was no significant difference in risk factorsbetween the two genders, with the exception that all cases of fasting were in women, and the differences weresignificant (p=0.015). The most common site of involvement according to Magnetic Resonance Venography(MRV) was the upper sagittal sinus (427 cases; 57.0%). There was no significant difference in terms of the siteof the conflict between the two genders (p<0.05). The findings of the present study showed that deep vein thrombosis occurred mainly in womenand manifested itself mostly as a headache. Moreover, the upper sagittal sinus was the most common site ofinvolvement.

In emergency departments (ED), human reliability assessment is essential for improving the quality of treatment and preventing medical accidents. A medical accident is expressed as an injury to a patient caused by the negligence of a doctor or nurse who is providing medical care. This study aimed to assess the human reliability in the cardiopulmonary resuscitation (CPR) process and recommend some comments to minimize human errors and improve patient safety.

The main factors in the CPR process (such as rate and depth of chest compression and rate of ventilation) are identified based on the American heart association (AHA) roles. Data were recorded during three months in the evening shifts in the ED and CPR room of Imam Reza Hospital in Mashhad, Iran. In total, 42 samples were collected, and a modified hybrid approach according to the fault tree analysis and Markov method was proposed for the analysis of CPR team (including emergency medicine, medical interns, and nurses) reliability in the resuscitation process. Finally, the important basic events (errors) were selected using the Boruta algorithm by R software.

An FTA-Markov-based hybrid method is considered to compute the human reliability in the CPR process. The obtained results from human reliability analysis using the sensitivity analysis via Boruta algorithm and the proposed hybrid method show that an interrupt between chest compression process for rhythm control, the cycle of CPR, the depth of chest compression, and the discussion about reversible causes are the most effective factors in the human reliability of CPR process.

The human reliability of the CPR process in the ED has been assessed using a hybrid method based on the FTA and Markov method for the first time. To improve the quality of treatment and prevent medical accidents during the CPR process, the main factors in the process are identified, and then, the proposed hybrid method is used to calculate human reliability.

On the basis of the literature, vitamin D is known as an important medium in bodily immune function, and it therefore may play a role in the pathogenesis of sepsis.
In this study, we aimed to evaluate the relationship between vitamin D serum levels and sepsis severity.
Patients and This study was a case-control study that evaluated adult patients admitted to the emergency department of Imam Reza hospital with suspected sepsis. These patients were enrolled in the study as the case group. In addition, healthy individuals without the sepsis diagnostic criteria were included in the control group. For all of the study participants, vitamin D levels were evaluated. The acute physiology age chronic health evaluation (APACHE) was used to evaluate disease severity in the case group. A difference of P A total of 112 patients were assessed: 56 in the control group and 56 in the case group. In the case group, 18 patients had sepsis, 25 patients had severe sepsis, and 13 patients were in septic shock. The mean ages of the patients in the case and control groups were 57.7 ± 15.15 and 58.6 ± 15.05 years, respectively (P = 0.741). Vitamin D levels in the case group were lower than in the control group (16.3 ± 10.7 versus 27.9 ± 11.46 ng/mL), and the difference between the groups was significant (P The results of this study indicated that patients with sepsis had lower serum vitamin D levels than healthy controls. Also, patients with more severe disease had lower serum vitamin D levels, but to evaluate causation and determine whether vitamin D supplementation could be effective in reducing the risk or severity of sepsis, randomized controlled trials should be conducted.

Vitamin D receptors are located in body tissues and cells. In various physiological processes of the body the primary circulating form of vitamin D, 25-hydroxyvitamin D, will become the active form, 1,25-dihydroxyvitamin D, through many enzymatic. Although different functions of vitamin D has been identified, reducing the possibility of several chronic diseases, including common cancers, autoimmune, infectious, and cardiovascular diseases is proposed as the major role of this component. According to various experimental and clinical studies, vitamin D affects the immune system activity. In this review we study the possible effects of vitamin D on sepsis. The purpose of this review is to evaluate and summarize the role of vitamin D in the immune system, with particular focus on infections and sepsis. We studied different areas related to vitamin D in the literature review including its roles sepsis and infection incidence, as well as seasonal and racial variation in sepsis. Based on evidence, vitamin D positively affects the immune system, so it might act as a therapeutic strategy. Despite several experimental studies which demonstrated the beneficial effects of vitamin D on improved functioning of the immune system, its association with prevention or management of infections and sepsis is not revealed through clinical investigations.