niloufar mohammadzadeh

Stroke remains a significant global health challenge, contributing to mortality and disability burdens. Optimizing stroke care involves understanding the complexities of in-hospital management, especially in regions like East Azerbaijan Province, where stroke incidence is high.

This study evaluates the effectiveness of Emergency Stroke Code (ESC) activation and thrombolytic therapy in acute ischemic stroke care at Imam Reza Hospital, Tabriz, a referral center.

A cross-sectional study was carried out between April 2021 and March 2022, including patients with activated ESC or receiving thrombolysis at Imam Reza Hospital, Tabriz. Data on patient demographics, risk factors, time intervals, thrombolysis administration, adverse events, and outcomes were collected and analyzed using SPSS software.

Among 748 acute stroke patients, 165 received thrombolysis, with 117 having ESC activation. The main reasons for not administering tissue plasminogen activator (tPA) in patients with ESC code activation included mild symptoms (23.6%), exceeding thrombolysis time (14.8%), and hemorrhagic stroke (10.4%). Pre-hospital ESC activation significantly reduced time intervals from hospital arrival to CT-scan and tPA injection (P < 0.001). The incidence of intracranial hemorrhage was 6.7% overall, with rare systemic bleeding (0.6%). Pre-hospital notification did not show significant changes in the National Institutes of Health Stroke Scale (NIHSS) or Modified Rankin Scale (MRS) scores.

While ESC activation streamlines in-hospital processes, it alone may not improve clinical outcomes without efficient out-of-hospital systems. Pre-hospital communication systems like ESC can aid in reducing in-hospital processing time for thrombolysis but must be coupled with efforts to enhance early diagnosis and efficient dispatch systems to optimize stroke care.

Diabetes is one of the most common metabolic diseases in the world, of which one of the most common and painful complications is diabetic foot ulcer. The accuracy and comprehensiveness of the contents of electronic medical record is effective in improving the quality of treatment and the care of diabetic foot ulcer patients. The aim of this study is to determine the minimum data set(MDS) essential for diabetic foot patientschr('39') electronic medical records.

In this descriptive-analytical study, authoritative internet and library resources were studied to collect diabetic foot ulcer information elements. Fourteen physicians and nurses working and collaborating with the Wound Healing Center affiliated to Academic Center for Education, Culture and Research(ACECR) were selected for clinical survey, and 5 health information technology specialists of Tehran University of Medical Sciences(TUMS) were chosen for demographic information survey. The study tools were a researcher-made questionnaire, CVR content validity method and test-retest method for reliability. 

Out of 23 information elements surveyed in demographic section, cases above 99% of the agreement were selected. Also, out of 86 information elements of the clinical section, more than 51% of the cases were selected. Clinical experts included 6 wound specialists, 4 general practitioners and 6 nurses. In the demographic information section, the lowest agreement was related to the element of identity and Education level with 20% agreement. In clinical information, the lowest agreement was related to surgery, leech therapy and MRI of the foot with 0% and PRP, G-CSF, Sono-Doppler liver with 14%.

The minimum information elements of diabetic foot ulcer electronic medical record were divided into history, wound information, lower limb information, paraclinical results, wound management, and follow-up in clinical section; and in demographic information section,  they were divided into identity, admission, finance, reporting, and system capability. The proposed model for manual and electronic medical records is available.

The present study evaluates and optimizes daylight and energy performance of residential buildings in the cold climate of Hamedan. For this purpose, the common pattern of residential buildings in Hamadan city, which has 5-storey residential apartments with eastern and western neighborhoods and as a result of lighting on the north and south, was selected as the base model and annual energy consumption and utilization of natural light were considered as the objective functions. After examining the methods used and the various metrics of daylight and energy performance evaluation, annual energy consumption per unit area (EUI) to evaluate the amount of energy consumed, and daylight illumination (UDI) for assessing the utilization of natural light were selected to find optimum solutions for the design of the main envelope of residential buildings. Then, various components of the envelope of residential buildings were identified; following that the sensitivity analysis was performed using Morris screening method in order to rank the key variables affecting the objective functions. Further, parametric studies on output variables and optimization of solutions were considered using genetic algorithm. Thus, Based on the interaction between the simulation software and the multi-objective optimization method, a number of Pareto optimal solutions were produced that through comparing them with consideration of both aspects of energy and daylight, optimal design was selected. The results show that through Pareto optimization in selected patterns, 17.44% and 23.72% of the EUI metrics and 17.61% and 21.1% of the UDI metrics can be improved. Accordingly, the design of the building envelope in this way can greatly reduce energy consumption and, at the same time, increase the efficiency of natural light.