مجله دانشکده پزشکی اصفهان
پیاپی 754 (هفته دوم فروردین 1403)

Triage is the process of assessing and categorizing patients to improve management and service delivery. A reliable triage system should be capable of accurately identifying patients who require immediate medical attention. The emergency severity index (ESI) is currently the most widely used method for triage, and it is a validated triage system. This study aimed to assess the ability of emergency department nurses to triage patients utilizing ESI.

A cross-sectional study was conducted on 272 patients who were referred to the emergency department (ED) of Shahid Bahonar Hospital of Kerman in July 2022. The triage of the patients was performed by emergency nurses, and the results were compared with those determined by physicians. Cohen's kappa coefficient was evaluated between the two groups (nurses and physicians) to determine the inter-rater agreement.

The triage group was correctly identified for 72.1% (196) of the 272 patients, while 13.6% (37) were under-triaged and 14.3% (39) were over-triaged. The priority was accurate for only 56.6% of patients, and 7.1% of patients received a lower priority. The agreement level between the two groups was 60.5% (95% CI: 0.532-0.677) measured by the kappa coefficient.

In this study, the agreement that was found in terms of patients’ triage was average. Although the triage was more inefficient than risky, long-term training programs are highly recommended for enhancing the accuracy of the triage.

This study was conducted to determine the effect of zinc and selenium supplements on the incidence of atrial fibrillation after coronary artery bypass surgery.

In this clinical trial, 54 patients were randomly divided into two groups of 27. The intervention group received a daily capsule containing 200 micrograms of zinc and 15 mg of selenium a week before the operation, and the control group received a placebo. 24 hours before the operation, the zinc and selenium levels were checked. All patients after surgery were examined and compared in terms of clinical parameters including atrial fibrillation, cardiac ejection fraction, bleeding, and length of hospitalization in the intensive care unit and hospital.

The mean difference of cardiac ejection fraction in the intervention group was -2.41 ± 0.77% (increased) and in the control group was 2.78 ± 0.86% (decreased), and the difference between the two groups was significant (P < 0.001). During the study, 4 (14.8%) of the control group had ventricular fibrillation, and there was no case of AF in the intervention group, and the difference between the two groups was significant (P = 0.015). The mean volume of bleeding (P = 0.011) and the mean length of hospital stay were significantly different between the two groups.

Prescribing zinc and selenium supplements before coronary artery bypass surgery can lead to a more favorable prognosis and reduce the incidence of ventricular fibrillation, reduce the length of hospital stay, and reduce the amount of bleeding after surgery.

Laparoscopic cholecystectomy has been accepted as a safe and gold-standard procedure in the world and has many advantages. However, one of the common complications after laparoscopic cholecystectomy is chronic and sometimes very severe pain. Considering the patients' need to control postoperative pain with drugs that have the least possible side effects, as well as limited studies on the effect of painkillers on pain caused by laparoscopic cholecystectomy, the purpose of this study is to compare the preemptive effect of two drugs. Apotel and ketorolac were used for the first time in patients undergoing laparoscopic cholecystectomy.

This study was conducted as a three-blind randomized clinical trial on 90 patients aged 18 to 68 years, with ASA class one and two, who underwent general anesthesia for cholecystectomy.

The findings of this study show generally, the need for narcotics after cholecystectomy surgery in patients under anesthesia with ketorolac was less than in Apotel and the control group. These findings were also confirmed in patients' pain intensity and patients' satisfaction, so patients' satisfaction in Ketorolac and then Apotel group was higher compared to the control group, which is in line with previous studies in this field.

Therefore, it seems that the overall need for narcotics was lower in the ketorolac group than in Apotel and lower in Apotel than in control.