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Introduction: Identifying and controlling the risk factors is necessary in order to prevent the failure in CBSE. So, this study was performed to determine the effective factors on the results of CBSE in the medical Alumni of Kaums. Material and Methods: All of the alumni whose CBSE results were recorded in the files from 1986 till 2003 (n=305) were selected in this cross-sectional study. Data were gathered by a questionnaire including the results of CBSE, and educational and demographic data. The prevalence of failure in CBSE was calculated. Chi-square, Fisher exact test, independent t-test, multivariate stepwise linear regression, logistic regression, crude and adjusted odds Ratio were used to analyze the status of the probable risk factors. Results: The prevalence of failure in the CBSE was 4.9%. Univariate analysis showed that temporary student transfers to other universities, delay in passing basic sciences courses, low GPA in basic sciences courses and high school, older age and non-regional quota increase the failure risk in CBSE; in this regard, multivariate logistic regression reported that GPA in basic sciences courses is the only significant effective factor. In addition, the basic sciences GPA was reported as the most important influential factor on the score of basic sciences exam. Conclusion: The risk factors of failure in CBSE should be controlled, so it is necessary to plan for the students' preparation, identifying the students at risk and supporting them. [ABSTRACT FROM AUTHOR]

Background: Intra-abdominal great vessel injury is a rare complication of lumbar intervertebral disc operations. However it may be underestimated for its unpredictable clinical manifestations. Delay in proper diagnosis and appropriate management of the sequellae often results in death of the patient. Materials and Methods: A 30-year-old man with aortic injury during L4/L5 posterior discectomy is presented and its management discussed. Conclusion: Attention of the surgical team and rapid intervention is the key factor in treatment, prevention of severe complications and even death. [ABSTRACT FROM AUTHOR]

Background: Athletes participating in sport competitions are faced with the risk of trauma. The purpose of this study was to determine the frequency of trauma injuries in men's sport leagues of Kashan during 2007-8. Materials and Methods: In this descriptive cross-sectional study, all injuries during sport league competitions were recorded by attending the sport arenas during 2007-8. Results: A total of 160 trauma cases were recorded during 146 events. The highest number of trauma was observed in handball and taekwondo competitions with 45 (25.6%) and 35 (21.9%) cases, respectively. Conclusion: Athletes involved in sport leagues require appropriate training and adequate protection through the use of protective devices to avoid injuries. [ABSTRACT FROM AUTHOR]

Aims: To improve the performance of educational institutions, identifying of improper outputs status and influential factors on incidence of relevant indicators is essential. Therefore, this study was carried out in order to assess improper outputs and its related factors. Methods: In this cross-sectional study all the graduates of health faculty of KUMS from 1991 until the end of 2003 (n=1455) were selected by census method. A questionnaire including the determining indicators of improper outputs (unacceptable average, withdrawing, university dismiss, education quit, and major changing) and possible related factors was used for data collection. Data were analyzed using odds ratio and difference percentage by SPSS 16 software. Results: prevalence of unacceptable total average, withdrawing, university dismiss, education quit, and major changing were 9.42, 1.5, 0.1, 1.2, and 0.5%, respectively. Moreover, there was association between improper outputs and the demographic data, educational background and admission criteria. Conclusion: Gender, residence area, diploma type, marital status, admission type and history of taking guest courses in other universities, time period between two educational levels, major, level, education group, the average of former educational levels and age of entering university are effective in improper outputs status. [ABSTRACT FROM AUTHOR]

Objective Nocturnal enuresis is a common childhood problem and has various treatments. This study was carried out to compare oral and nasal vasopressin in the treatment of nocturnal enuresis in 5- to 12-year-old children who were referred to the Shahid Beheshti Clinic in 2008. Materials & Methods This study included 100 children (62 males and 38 females) with nocturnal enuresis. One group (50 patients) received 20 mcg nasal vasopressin which increased up to 40 mcg, depending on the patients' response. The other group (50 patients) received 0.2 mg oral vasopressin which increased up to 0.4 mg. The patients were followed up for one month after response to the last dose of drug. Data were recorded in prepared forms and analyzed using Chi-Square and Fisher Test. Results The success rate with oral and nasal method was 80% and 92%, respectively (P=0.08). Only 2% of the children had complications during the treatment; one child treated orally developed gastroenteritis and another child treated with the nasal method developed convulsions (P=1). Sixteen percent of the children treated with the oral method and 28% of the children treated with the nasal method had recurrence (P=0.148). Conclusion Oral and nasal forms of vasopressin have equal therapeutic effects. However, oral form of the treatment has fewer serious side effects and is easier to use. Therefore, the use of oral medicine is recommended. [ABSTRACT FROM AUTHOR]

Introduction: One of the major problems in educational systems is students' probation during their course of study. With regard to the importance of identifying factors affecting the incidence of probation, this study was performed to determine the status of incidence of probation and its related factors in all graduated students of Kashan Faculty of Nursing and Midwifery. Methods: All graduated students of Kashan Faculty of Nursing and Midwifery (n=1174) during the years 1981 till 2003 were selected through census in this cross-sectional study. The data was gathered by a questionnaire including demographic information and probation status (probation records, probation semester, and the number of probation semesters). Incidence of probation was calculated and odds ratio and difference percentage were used for analyzing the status of probable related factors. Results: Probation record was argued in 46 students (3.9%) that 26 of them (2.2%) were probated just for one semester, 11 of them (0.9%) for two semesters, 8 of them (0.7%) for three semesters, and, 1 of them (0.1%) for four semesters. The utmost frequency was related to the second academic semester and then, the first semester. The average score of high school diploma and age were different in probated and not probated graduated students. The most expectancy of probation risk was related to master program and nursing discipline. Conclusion: Demographic features, educational background, and admission criteria are among factors affecting probation. Therefore, with regard to their role, it is necessary to identify at risk students and support them. [ABSTRACT FROM AUTHOR]

Background: One of the challenges when transitioning from International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) to International Classification of Diseases, 11th Revision (ICD-11) is to ensure clinical coding accuracy., Objective: To determine the accuracy of clinical coding with ICD-11 in comparison with ICD-10 and identify causes of coding errors in real clinical coding environments., Method: The study was conducted prospectively in two general hospitals. Medical records of discharged inpatients were coded by hospital clinical coders with both ICD-11 and ICD-10 on different days. These medical records were recoded by five mentors. Codes assigned by mentors were used as the gold standard for the evaluation of accuracy., Results: The accuracy of ICD-10 and ICD-11 coding for 1578 and 2168 codes was evaluated. Coding accuracy was 89.1% and 74.2% for ICD-10 and ICD-11. In ICD-11, the lowest accuracy was observed in chapters 22 (injuries), 10 (ear) and 11 (circulatory) (51.1%, 53.8% and 62.7%, respectively). In both ICD-10 and ICD-11, the most important cause of the coding errors was clinical coders' mistakes (79.5% and 81.8% for ICD-10 and ICD-11, respectively)., Conclusion: Accuracy of clinical coding with ICD-11 was lower relative to ICD-10. Hence, it is essential to carry out initial preparations, particularly the training of clinical coders based on their needs, as well as the necessary interventions to enhance the documentation of medical records according to ICD-11 before or simultaneous with the country-wide implementation., Implications: Clinical coders need complete training, especially in using extension codes and post-coordination coding. Local ICD-11 guidelines based on the needs of local users and reporting policies should be developed. Furthermore, documentation guidelines based on ICD-11 requirements should be developed., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Coronavirus disease 2019 (COVID-19) is a viral pandemic and a matter of concern. It also mimics viral pneumonia with cough and fever but also causes severe sequels and various complications. Subdural empyema is a very rare brain infection presenting mostly with fever, weakness, and altered level of consciousness, and has been recently noted as a new complication of COVID-19. This report presents 3 cases of subdural empyema with a prior history of COVID-19. The first case is a 17-year-old female presented with a 1-week history of severe progressive headache, right-sided ptosis, and left-sided hemiplegia with a history of COVID-19 in about 40 days before admission. The second one is a 41-year-old female presented with a 2-week history of fatigue, severe progressive headache which deteriorated while sitting, left tarsal swelling, and left-sided hemiparesis accompanied by drowsiness since 1 day before admission and a history of COVID-19 in about 50 days before admission. The third one is a 47-year-old gentleman with a known case of epilepsy, who presented with a 2-day history of headache and fever and an event of Generalized Tonic Colonic (GTC) seizure on the day of admission. The patient had a history of multiple head traumas during past years, which led to craniectomy, and also a history of COVID-19 about 46 days before admission. Emergent surgery was performed to evacuate empyema, and patients underwent subsequent anti-bacterial treatment. All patients showed clinical improvement. This report highlights a potential link between SARS-COV-2 infection and the patient's development of subdural empyema., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Objective: Road traffic injury (RTI) is the second leading cause of death and disability, and motorcycle crashes rank as the first cause of traffic fatality in Iran. We aimed to compare various characteristics between traumatized motorcycle riders and pillion passengers registered with the National Trauma Registry of Iran (NTRI)., Methods: This is a retrospective study of the NTRI, an ongoing multicenter trauma database built on a registry. This study included injured motorcyclists from six major trauma centers nationwide admitted between February 2017 and November 2023. Motorcyclists should have been hospitalized for RTIs and met the NTRI's inclusion criteria. We assessed patients regarding their demographics, clinical features, the pattern of injuries, and diverse in-hospital outcomes., Results: Of 54,342 registered patients in the NTRI, 7,594 motorcyclists were included. Of them, 6,636 (87.4%) were riders, and 958 (12.6%) were pillion passengers. Among all, 7165 (94.5%) were male, and 420 (5.5%) female ( p  < 0.001). Only 656 (9.9%) of riders and 24 (2.5%) of pillion passengers were wearing helmets ( p  < 0.001). Lone motorcyclist crashes led to injuries in 1,394 (21.2%) riders and 332 (35.5%) pillion passengers ( p  < 0.001). Glasgow Coma Scale (GCS) was 3 to 8 in 204 (3.1%) riders and 16 (1.7%) pillion passengers ( p  = 0.016). The most frequent pattern of poly-trauma was "head and thorax," with 43 (32.3%) riders and 5 (25.0%) pillion passengers ( p  = 0.362). Univariable logistic regression analysis showed that Intensive Care Unit (ICU) admission (OR = 0.78, CI 95% = 0.62 to 0.97, p  = 0.028) and mechanical ventilation (OR = 0.58, CI 95% = 0.39 to 0.84, p  = 0.004) were significantly lower in pillion passengers compared to motorcycle riders. After adjustment for age, gender, occupational status, and helmet use, being a rider or a pillion passenger didn't have a significant association with any of the in-hospital outcomes., Conclusions: Motorcycle riders and pillion passengers sustain the same injuries in terms of pattern, severity, and in-hospital outcomes. Therefore, healthcare providers can approach them similarly. Since there is a high number of underage riders and helmets are not used commonly, there should be more police enforcement in this case.

The hip fracture causes significant disabilities in many elderly people. Many studies around the world have identified various risk factors for the hip fracture. The aim of this study was to systematically investigate the risk factors of hip fractures. This study is a systematic review of risk factors for hip fractures. All published papers in English and Persian languages on patients in Iran and other countries between 2002 - 2022 were examined. The search strategy used keywords matching the mesh, including : predictors, hip fracture, and disability. Articles were selected from international databases (PubMed, Proquest ,Web of Sience, Scopus, Google scholar and Persian(Sid,Magiran), and the Newcastle Ottawa Scale was used to assess the risk of bias. The study has identified several factors that were significantly correlated with the risk of hip fracture, including age, cigarette and alcohol consumption, visual and hearing problems, low BMI levels, history of falling, weakness, and diseases such as stroke, cardiovascular disease, high blood pressure, arthritis, diabetes, dementia, Alzheimer's, Parkinson's, liver and kidney diseases, bone density, osteoporosis, vertebral fracture, and hyperthyroidism. However, the study did not find any significant correlations between the consumption of calcium and vitamin D, history of fractures, cognitive disorders, schizophrenia, and household income, and the risk of hip fracture. The results of this study reveal the determining role of some risk factors in hip fracture in older persons. Therefore, it is recommended that health policy makers provide the possibility of early intervention for some changeable factors., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 International Journal of Preventive Medicine.)

Objective: The main objective of this study was to determine various characteristics and outcomes of self-harm and suicide in men and women with data obtained from the National Trauma Registry of Iran (NTRI). Method : This retrospective multicenter study using data from the NTRI included all patients who went to the emergency department (ED) due to self-harm and suicide, considering the NTRI's specific inclusion criteria, from September 2016 to January 2023. We evaluated patients regarding demographics and clinical characteristics, various outcomes, and factors influencing in-hospital death. Statistical analyses were conducted using the STATA software version 15.0. The chi-square test was used to compare the distribution of variables between men and women. Also, the logistic regression models were applied to assess the predictors of in-hospital death. Results: Self-harm and suicide cases were gathered from eleven geographically diverse hospitals across the country, and our study included 511 men and 347 women out of 50,661 registered trauma cases. Among them, 443 men (86.7%) and 267 women (76.9%) were between 18 and 49 years old (P < 0.001). Single women constituted 130 (37.3%) of the female cases, while single men were 313 (61.6%) of the male cases (P < 0.001). The three most common methods among our patients were poisoning with 234 (45.8%) of men and 245 (70.6%) of women cases, stab/cut with 208 (40.7%) of men and 54 (15.6%) of women cases, and fall with 16 (3.1%) of men and 26 (7.5%) of women cases (P < 0.001). The risk of death in patients with a Glasgow Coma Scale (GCS) score of 3 to 8 was 46.22 (95% CI = 18.66 to 114.45) times more than patients with a GCS score of 13 to 15. Conclusion: Data on self-harm and suicide traumatology were gathered from eleven hospitals in Iran. Our findings indicated differences in the distribution of age and marital status between genders. Moreover, both genders used similar methods for self-harm and suicide, and gender did not affect the outcome., Competing Interests: None., (Copyright © 2024 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Background: Injury is one of the leading causes of death worldwide, and the abdomen is the most common area of trauma after the head and extremities. Abdominal injury is often divided into two categories: blunt and penetrating injuries. This study aims to determine the epidemiological and clinical characteristics of these two types of abdominal injuries in patients registered with the National Trauma Registry of Iran (NTRI)., Methods: This multicenter cross-sectional study was conducted with data from the NTRI from July 24, 2016, to May 21, 2023. All abdominal trauma patients defined by the International Classification of Diseases; 10th Revision (ICD-10) codes were enrolled in this study. The inclusion criteria were one of the following: hospital length of stay (LOS) of more than 24 h, fatal injuries, and trauma patients transferred from the ICU of other hospitals., Results: Among 532 patients with abdominal injuries, 420 (78.9%) had a blunt injury, and 435 (81.7%) of the victims were men. The most injured organs in blunt trauma were the spleen, with 200 (47.6%) and the liver, with 171 (40.7%) cases, respectively. Also, the colon and small intestine, with 42 (37.5%) cases, had the highest number of injuries in penetrating injuries. Blood was transfused in 103 (23.5%) of blunt injured victims and 17 (15.2%) of penetrating traumas (p = 0.03). ICU admission was significantly varied between the two groups, with 266 (63.6%) patients in the blunt group and 47 (42%) in penetrating (p < 0.001). Negative laparotomies were 21 (28%) in penetrating trauma and only 11 (7.7%) in blunt group (p < 0.001). In the multiple logistic regression model after adjusting, ISS ≥ 16 increased the chance of ICU admission 3.13 times relative to the ISS 1-8 [OR: 3.13, 95% CI (1.56 to 6.28), P = 0.001]. Another predictor was NOM, which increased ICU chance 1.75 times more than OM [OR: 1.75, 95% CI (1.17 to 2.61), p = 0.006]. Additionally, GCS 3-8 had 5.43 times more ICU admission odds than the GCS 13-15 [OR:5.43, 95%CI (1.81 to 16.25), P = 0.002] respectively., Conclusion: This study found that the liver and spleen are mostly damaged in blunt injuries. Also, in most cases of penetrating injuries, the colon and small intestine had the highest frequency of injuries compared to other organs. Blunt abdominal injuries caused more blood transfusions and ICU admissions. Higher ISS, lower GCS, and NOM were predictors of ICU admission in abdominal injury victims., (© 2024. The Author(s).)

Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice., (© 2024. The Author(s).)

Purpose: This study aimed to implement the Quality of Care (QoC) Assessment Tool from the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to map the current state of in-hospital QoC of individuals with Traumatic Spinal Column and Cord Injuries (TSCCI)., Methods: The QoC Assessment Tool, developed from a scoping review of the literature, was implemented in NSCIR-IR. We collected the required data from two primary sources. Questions regarding health system structures and care processes were completed by the registrar nurse reviewing the hospital records. Questions regarding patient outcomes were gathered through patient interviews., Results: We registered 2812 patients with TSCCI over six years from eight referral hospitals in NSCIR-IR. The median length of stay in the general hospital and intensive care unit was four and five days, respectively. During hospitalization 4.2% of patients developed pressure ulcers, 83.5% of patients reported satisfactory pain control and none had symptomatic urinary tract infections. 100%, 80%, and 90% of SCI registration centers had 24/7 access to CT scans, MRI scans, and operating rooms, respectively. Only 18.8% of patients who needed surgery underwent a surgical operation in the first 24 h after admission. In-hospital mortality rate for patients with SCI was 19.3%., Conclusion: Our study showed that the current in-hospital care of our patients with TSCCI is acceptable in terms of pain control, structure and length of stay and poor regarding in-hospital mortality rate and timeliness. We must continue to work on lowering rates of pressure sores, as well as delays in decompression surgery and fatalities., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Study Design: A retrospective study., Objectives: The quality of care (QoC) for spinal column/cord injury patients is a major health care concern. This study aimed to implement the QoC assessment tool (QoCAT) in the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to define the current state of pre- and post-hospital QoC of individuals with Traumatic Spinal Column and Spinal Cord Injuries (TSC/SCIs)., Methods: The QoCAT, previously developed by our team to measure the QoC in patients with TSC/SCIs, was implemented in the NSCIR-IR. The pre-hospital QoC was evaluated through a retrospective analysis of NSCIR-IR registry data. Telephone interviews and follow-ups of patients with SCI evaluated the QoC in the post-hospital phase., Results: In the pre-hospital phase, cervical collars and immobilization were implemented in 46.4% and 48.5% of the cases, respectively. Transport time from the scene to the hospital was documented as <1 hour and <8 hours in 33.4% and 93.9% of the patients, respectively. Post-hospital indicators in patients with SCI revealed a first-year mortality rate of 12.5% (20/160), a high incidence of secondary complications, reduced access to electrical wheelchairs (4.2%) and modified cars (7.7%), and low employment rate (21.4%)., Conclusion: These findings revealed a significant delay in transport time to the first care facilities, low use of immobilization equipment indicating low pre-hospital QoC. Further, the high incidence of secondary complications, low employment rate, and low access to electrical wheelchairs and modified cars indicate lower post-hospital QoC in patients with SCI. These findings imply the need for further planning to improve the QoC for patients with TSC/SCIs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: This study aimed to compare the prognostic value of Marshall, Rotterdam, and Neuroimaging Radiological Interpretation Systems (NIRIS) in predicting the in-hospital outcomes of patients with traumatic brain injury., Methods: We identified 250 patients with traumatic brain injury in a retrospective single-center cohort from 2019 to 2020. Computed tomography (CT) scans were reviewed by two radiologists and scored according to three CT scoring systems. One-month outcomes were evaluated, including hospitalization, intensive care unit admission, neurosurgical procedure, and mortality. Logistic regression analysis was performed to identify scoring systems and outcome relationships. The best cutoff value was calculated using the receiver operating characteristic curve model., Results: Eighteen patients (7.2%) died in the 1-month follow-up. The mean age and Glasgow Coma Scale of survivors differed significantly from nonsurvivors. Subarachnoid hemorrhage and compressed/absent cisterns were dead patients' most frequent CT findings. All three scoring systems had good discrimination power in mortality prediction (area under the receiver operating characteristic curve of the Marshall, Rotterdam, and NIRIS was 0.78, 0.86, and 0.84, respectively). Regarding outcome, three systems directly correlated with unfavorable outcome prediction., Conclusions: The Marshall, Rotterdam, and NIRIS are good predictive models for mortality and outcome prediction, with slight superiority of the Rotterdam in mortality prediction and the Marshall in intensive care unit admission and neurosurgical procedures., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The purpose of the study was to compare the effect of using volume-controlled ventilation (VCV) versus pressure-controlled ventilation (PCV) on blood loss in patients undergoing posterior lumbar inter-body fusion (PLIF) surgery., Methods: In a randomized, single-blinded, parallel design, 78 patients, candidates for PLIF surgery, were randomly allocated into two groups of 39 to be mechanically ventilated using VCV or PCV mode. All the patients were operated in prone position by one surgeon. Amount of intraoperative surgical bleeding, transfusion requirement, surgeon satisfaction, hemodynamic parameters, heart rate, and blood pressure were measured as outcomes., Results: PCV group showed slightly better outcomes than VCV group in terms of mean blood loss (431 cc vs. 465 cc), transfusion requirement (0.40 vs. 0.43 unit), and surgeon satisfaction (82.1% vs. 74.4%); however, the differences were not statistically significant. Diastolic blood pressure 90 and 105 min after induction were significantly lower in PCV group (P = 0.043-0.019, respectively); however, blood pressure at other times, hemoglobin levels, and mean heart rate were similar in two groups., Conclusions: In patients undergoing posterior lumbar inter-body fusion surgery, mode of ventilation cannot make significant difference in terms of blood loss; however, some minor benefits in outcomes may lead to the selection of PCV rather than VCV. More studies with larger sample size, and investigating more factors may be needed., (© 2023. The Author(s).)

Background: There is little evidence regarding the adoption and intention of using mobile apps by health care professionals (HCP) and the effectiveness of using mobile apps among physicians is still unclear. To address this challenge, the current study seeks two objectives: developing and implementing a head CT scan appropriateness criteria mobile app (HAC app), and investigating the effect of HAC app on CT scan order., Methods: A one arm intervention quasi experimental study with before/after analysis was conducted in neurology & neurosurgery (N&N) departments at the academic hospital. We recruited all residents' encounters to N&N departments with head CT scan to examine the effect of HAC app on residents' CT scan utilization. The main outcome measure was CT scan order per patient for seven months at three points, before the intervention, during the intervention, after cessation of the intervention -post-intervention follow-up. Data for CT scan utilization were collected by reviewing medical records and then analyzed using descriptive statistics, Kruskal-Wallis, and Mann-Whitney tests. A focus group discussion with residents was performed to review and digest residents' experiences during interaction with the HAC app., Results: Sixteen residents participated in this study; a total of 415 N&N encounters with CT scan order, pre-intervention 127 (30.6%), intervention phase 187 (45.1%), and 101 (24.3%) in the post-intervention follow-up phase were included in this study. Although total CT scan utilization was statistically significant during three-time points of the study (P = 0.027), no significant differences were found for CT utilization after cessation of the intervention (P = 1)., Conclusion: The effect of mobile devices on residents' CT scan ordering behavior remains open to debate since the changes were not long-lasting. Further studies based on real interactive experiences with mobile devices is advisable before it can be recommended for widespread use by HCP., (© 2022. The Author(s).)

Background: One of the challenging decision-making tasks in healthcare centers is the interpretation of blood gas tests. One of the most effective assisting approaches for the interpretation of blood gas analysis (BGA) can be artificial intelligence (AI)-based decision support systems. A primary step to develop intelligent systems is to determine information requirements and automated data input for the secondary analyses. Datasets can help the automated data input from dispersed information systems. Therefore, the current study aimed to identify the data elements required for supporting BGA as a dataset., Materials and Methods: This cross-sectional descriptive study was conducted in Nemazee Hospital, Shiraz, Iran. A combination of literature review, experts' consensus, and the Delphi technique was used to develop the dataset. A review of the literature was performed on electronic databases to find the dataset for BGA. An expert panel was formed to discuss on, add, or remove the data elements extracted through searching the literature. Delphi technique was used to reach consensus and validate the draft dataset., Results: The data elements of the BGA dataset were categorized into ten categories, namely personal information, admission details, present illnesses, past medical history, social status, physical examination, paraclinical investigation, blood gas parameter, sequential organ failure assessment (SOFA) score, and sampling technique errors. Overall, 313 data elements, including 172 mandatory and 141 optional data elements were confirmed by the experts for being included in the dataset., Conclusions: We proposed a dataset as a base for registries and AI-based systems to assist BGA. It helps the storage of accurate and comprehensive data, as well as integrating them with other information systems. As a result, high-quality care is provided and clinical decision-making is improved., (© 2022. The Author(s).)

Short messaging system (SMS) works as one of the most popular strategies for physicians' behavior change via sending feedback and reminder messages. One of the areas in which SMS feedback can be effective on physicians' behavior is CT scan ordering. This study investigates the effect of mobile phone SMS feedback on residents' head CT scan ordering at a general teaching hospital in Iran. Through a three-month before-after experimental study, an intervention was conducted, and the CT scans ordered by an individual resident were evaluated every two weeks. Consequently, personal SMS-based feedback was provided to the residents, and the rate of CT per patient in the two phases of the study was analyzed. The mean CT scan ordered per patient decreased from 1.98 ± 1.09 to 1.74 ± 1.45, and this decrease was insignificant (P = 0.106). SMS-based feedback can reduce head CT scan ordering among residents; whereas this decline was not significant further studies are required to investigate its effectiveness.

Background: Trauma is the first leading cause of death and disability in the active population in developing countries. In Iran, traumatic injuries are the second leading cause of death after cardiovascular disease and also the leading cause of years of life lost (YLL). Population-based surveys can estimate all types of injuries. This study aimed to estimate the annual incidence of nonfatal injuries in adults older than 15 years in Kashan. Methods: In a cross-sectional population-based study, people older than 15 years who were living in Kashan during 2018-2019 were studied. A cluster stratified sampling method was used. Data analysis was performed using SPSS 22 software. Chi-square and t tests and ANOVA were used to analyze the data. Significance level was set as P ≤.05 and confidence interval (CI) at 95%. Results: In this study, which included 3880 households residing in Kashan during 2018-2019, the incidence of all injuries was estimated to be 70.61(62.60-78.70) per 1000 people in 1 year. For traffic accidents, the incidence was estimated at 36.08 (30.20-42.00) per 1000 in 1 year. Also, 231 (77.7%) of people with trauma were male, 137 (50.0%) aged 20 to 39 years, and 191 (69.7) were married. The most common cause of injuries (n = 140; 51.1%) was related to traffic accidents, and among the traffic accidents, the highest cause was motorcycle accident (n = 99; 70.71%). Conclusion: The results of this study showed that the highest rate of injuries occurred among men, younger ages, married, and those with primary education. Also, the results showed the most common causes of trauma were injured hand and foot and head, and the most common location in which trauma occurred was street. The findings of this study are important to better explain the epidemiology aspects of injuries in Kashan., Competing Interests: Conflicts of Interest: None declared, (© 2021 Iran University of Medical Sciences.)

Purpose: Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries., Methods: The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset., Results: The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003)., Conclusion: Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions., Competing Interests: Declaration of competing interest The authors declare no competing interest., (Copyright © 2021 Chinese Medical Association. Production and hosting by Elsevier B.V. All rights reserved.)

Purpose: One of the consequences of trauma-related injuries is disability. There are more than one billion people with disabilities worldwide. Disability in people reduces their quality of life. The goal of this study was to determine the rate of post-trauma stress and disability related to trauma in the population over 15 years old in Kashan during a solar year of 2018-2019., Methods: This is a cross-sectional population-based study. A cluster sampling method was used in the city of Kashan, and 3880 persons were interviewed with individuals randomly selected in each household. If a person had trauma during one year ago, the World Health Organization Disability Assessment Schedule 2.0 and Post Trauma Stress Disorder (PTSD) Checklist were applied for further interview. Data were analyzed using Chi-square test or t-test., Results: Among the 3880 participants residing in Kashan, 274 (7.1%) reported a history of traumatic injury during one year ago in 2018-2019. Incidence of all injuries was estimated to be 70.61 (62.60-78.70) per 1000 people. For the trauma population, 213 (77.7%) were male and 75.1% were married. About half of them (50.3%, 138/274) aged 21-39 years. The most common cause of injuries was related to traffic accidents: 140 (51.1%). Of the 274 trauma participants, 47 (17.2%) reported PTSD; 244 (89.1%) had a mild disability, and 30 (10.9%) reported moderate disability., Conclusion: One of the main causes of disability in the human community is the traumatic injuries. According to the results of this study, 89.1% of trauma participants have sustained at last mild disability following trauma. These people require follow-up and post-treatment support. It should be noted that psychological complications such as PTSD are as significant as physical symptoms., (Copyright © 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. All rights reserved.)

Natural killer (NK) cell therapy is one of the most promising treatments for Glioblastoma Multiforme (GBM). However, this emerging technology is limited by the availability of sufficient numbers of fully functional cells. Here, we investigated the efficacy of NK cells that were expanded and treated by interleukin-2 (IL-2) and heat shock protein 70 (HSP70), both in vitro and in vivo. Proliferation and cytotoxicity assays were used to assess the functionality of NK cells in vitro, after which treated and naïve NK cells were administrated intracranially and systemically to compare the potential antitumor activities in our in vivo rat GBM models. In vitro assays provided strong evidence of NK cell efficacy against C6 tumor cells. In vivo tracking of NK cells showed efficient homing around and within the tumor site. Furthermore, significant amelioration of the tumor in rats treated with HSP70/Il-2-treated NK cells as compared to those subjected to nontreated NK cells, as confirmed by MRI, proved the efficacy of adoptive NK cell therapy. Moreover, results obtained with systemic injection confirmed migration of activated NK cells over the blood brain barrier and subsequent targeting of GBM tumor cells. Our data suggest that administration of HSP70/Il-2-treated NK cells may be a promising therapeutic approach to be considered in the treatment of GBM., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Study Design: Descriptive study., Objectives: The aim of this manuscript is to describe the development process of the data set for the National Spinal Cord Injury Registry of Iran (NSCIR-IR)., Setting: SCI community in Iran., Methods: The NSCIR-IR data set was developed in 8 months, from March 2015 to October 2015. An expert panel of 14 members was formed. After a review of data sets of similar registries in developed countries, the selection and modification of the basic framework were performed over 16 meetings, based on the objectives and feasibility of the registry., Results: The final version of the data set was composed of 376 data elements including sociodemographic, hospital admission, injury incidence, prehospital procedures, emergency department visit, medical history, vertebral injury, spinal cord injury details, interventions, complications, and discharge data. It also includes 163 components of the International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) and 65 data elements related to quality of life, pressure ulcers, pain, and spasticity., Conclusion: The NSCIR-IR data set was developed in order to meet the quality improvement objectives of the registry. The process was centered around choosing the data elements assessing care provided to individuals in the acute and chronic phases of SCI in hospital settings. The International Spinal Cord Injury Data Set was selected as a basic framework, helped by comparison with data from other countries. Expert panel modifications facilitated the implementation of the registry process with the current clinical workflow in hospitals.

Glioblastoma multiforme (GBM) is a unique aggressive tumor and mostly develops in the brain, while rarely spreading out of the central nervous system. It is associated with a high mortality rate; despite tremendous efforts having been made for effective therapy, tumor recurrence occurs with high prevalence. To elucidate the mechanisms that lead to new drug discovery, animal models of tumor progression is one of the oldest and most beneficial approaches to not only investigating the aggressive nature of the tumor, but also improving preclinical research. It is also a useful tool for predicting novel therapies' effectiveness as well as side effects. However, there are concerns that must be considered, such as the heterogeneity of tumor, biological properties, pharma dynamic, and anatomic shapes of the models, which have to be similar to humans as much as possible. Although several methods and various species have been used for this approach, the real recapitulation of the human tumor has been left under discussion. The GBM model, which has been verified in this study, has been established by using the Rat C6 cell line. By exploiting bioinformatic tools, the similarities between aberrant gene expression and pathways have been predicted. In this regard, 610 common genes and a number of pathways have been detected. Moreover, while magnetic resonance imaging analysis enables us to compare tumor features between these two specious, pathological findings provides most of the human GBM characteristics. Therefore, the present study provides genomics, pathologic, and imaging evidence for showing the similarities between human and rat GBM models., (© 2019 Wiley Periodicals, Inc.)

Background: Prediction of traumatic brain injury (TBI) among children is of great importance for accurate clinical decision making., Objectives: This study aimed to determine the prognostic value of the Rotterdam scoring system in predicting early outcome among children with TBI., Methods: This study was conducted in 2017 on 506 children with brain injury in Kashan, Iran. A checklist was used to collect demographic and clinical characteristics of patients such as age, sex, mechanism of trauma, Glasgow Coma Scale (GCS) score, need for surgery, and brain injury outcome. Moreover, each participant's computed tomography scan was evaluated and scored using the Rotterdam system. Sensitivity, specificity, positive and negative predictive values, and the best cut-off score were calculated for the Rotterdam system. The relationships of the Rotterdam score with participants' characteristics were examined using the χ 2 test, whereas the predictors of brain injury outcome were identified using the logistic regression analysis., Results: Pediatric death rate was 4.3%. Most deaths were among children who were male, aged <4, had developed brain injury owing to traffic accidents, had a GCS score of 3-8, suffered from compressed skull fracture and frontal lobe injury, had cerebral edema, and had a Rotterdam score of 5. The sensitivity and specificity of a Rotterdam score 3 were 86.4% and 97.9%, respectively. The logistic regression analysis indicated that only GCS and Rotterdam scores were significant predictors of brain injury outcome., Conclusions: At a cut-off score of 3, the Rotterdam system can be used to predict TBI outcome among children with acceptable sensitivity and specificity., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Glioblastoma multiforme (GBM) is among the most incurable cancers. GBMs survival rate has not markedly improved, despite new radical surgery protocols, the introduction of new anticancer drugs, new treatment protocols, and advances in radiation techniques. The low efficacy of therapy, and short interval between remission and recurrence, could be attributed to the resistance of a small fraction of tumorigenic cells to treatment. The existence and importance of cancer stem cells (CSCs) is perceived by some as controversial. Experimental evidences suggest that the presence of therapy-resistant glioblastoma stem cells (GSCs) could explain tumor recurrence and metastasis. Some scientists, including most of the authors of this review, believe that GSCs are the driving force behind GBM relapses, whereas others however, question the existence of GSCs. Evidence has accumulated indicating that non-tumorigenic cancer cells with high heterogeneity, could undergo reprogramming and become GSCs. Hence, targeting GSCs as the "root cells" initiating malignancy has been proposed to eradicate this devastating disease. Most standard treatments fail to completely eradicate GSCs, which can then cause the recurrence of the disease. To effectively target GSCs, a comprehensive understanding of the biology of GSCs as well as the mechanisms by which these cells survive during treatment and develop into new tumor, is urgently needed. Herein, we provide an overview of the molecular features of GSCs, and elaborate how to facilitate their detection and efficient targeting for therapeutic interventions. We also discuss GBM classifications based on the molecular stem cell subtypes with a focus on potential therapeutic approaches., (Copyright © 2019. Published by Elsevier Ltd.)

Background and Objective: Musculoskeletal disorders (MSDs) are one of the most important causes of disability with a high prevalence. The accurate and timely diagnosis of these disorders is often difficult. Clinical decision support systems (CDSSs) can help physicians to diagnose diseases quickly and accurately. Given the ambiguous nature of MSDs, fuzzy logic can be helpful in designing the CDSSs knowledge bases. The present study aimed to review the studies on fuzzy CDSSs to diagnose MSDs., Methods: A comprehensive search was conducted in Medline, Scopus, Cochrane Library, and ISI Web of Science databases to identify relevant studies published until March 15, 2016. Studies were included in which CDSSs were developed using fuzzy logic to diagnose MSDs, and tested their accuracy using real data from patients., Results: Of the 3188 papers examined, 23 papers included according to the inclusion criteria. The results showed that among all the designed CDSSs only one (CADIAG-2) was implemented in the clinical environment. In about half of the included studies (52%), CDSSs were designed to diagnose inflammatory/infectious disorder of the bone and joint. In most of the included studies (70%), the knowledge was extracted using a combination of three methods (acquiring from experts, analyzing the data, and reviewing the literature). The median accuracy of fuzzy rule-based CDSSs was 91% and it was 90% for other fuzzy models. The most frequently used membership functions were triangular and trapezoidal functions, and the most used method for inference was the Mamdani., Conclusions: In general, fuzzy CDSSs have a high accuracy to diagnose MSDs. Despite the high accuracy, these systems have been used to a limited extent in the clinical environments. To design of knowledge base for CDSSs to diagnose MSDs, rule-based methods are used more than other fuzzy methods., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Intracranial hemorrhage is a common complication of traumatic brain injury (TBI). The purpose of this study is evaluation of the effect of tranexamic acid (TXA) on hemorrhagic mass growth in TBI patients., Patients and Methods: In this randomized, double-blind clinical trial, 149 patients with TBI and any kind of blood on their computed tomography scan enrolled in the study and were randomly allocated to receive TXA or placebo. After 24 hours, computed tomography scan was repeated for assessing the changes in hemorrhage, new bleeding, and mass effects of blood on brain tissue. The primary outcome was growth of the hemorrhagic lesion. Data were analyzed by SPSS software using Fisher exact, chi-square, and Mann-Whitney U tests, as well as linear and logistic regression models., Findings: The incidence of hemorrhagic lesion growth was 20.5% in the TXA group and 22.7% in the placebo group. The difference was not significant (P = 0.87, RR = 0.89). The mean (standard deviation) of hemorrhagic lesion growth was 9.4 (15.3) in the TXA group and 10.2 (10.1) in the placebo group without significant difference (P = 0.27). The frequency of deaths (2.7% vs. 4%), adverse outcome at discharge (10.8% vs. 17.3%), and 3 months later (6.8% vs. 14.7%) in the TXA group were lower than the placebo, but the difference was not statistically significant. No side effect was observed with the administration of TXA., Conclusion: Administration of a short dose of TXA does not lead to significant prevention of growth of posttraumatic hemorrhagic lesion or improvement of clinical outcomes., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aim: To determine and compare the patterns of spinal injury in car occupants., Materials and Methods: Retrospective cross-sectional study enrolling all patients with spinal fracture after car accidents, who were admitted to hospital more than 24 h during 2004-2009., Results: The lumbosacral spine was the most commonly involved region (64.8). Six patients had spinal cord injury (6.6%). The majority of the victims were drivers of the vehicle (86.8%) and remaining were passengers. There was a significant difference in lumbar anatomic region ( P = 0.05) and place of accident ( P = 0.05) in car occupants' position ( P = 0.05). Car rollover was the most common mechanism of spinal fractures. There was a significant difference in lumbar anatomic region ( P = 0.05), and two or more associated organ injuries ( P ≤ 0.05) in car accident mechanism ( P = 0.05)., Conclusion: The chance of sustaining serious spine and associated multiple injuries in car accidents is quite high in our today's society. This may be due to the low level of standards for car manufacturing, absence or inadequacy of appropriate safety measures in cars, and poorly designed roads and problems in quality of driving to mention some reasons. Therefore, these victims are prone to significant morbidity and even mortality and need more specific prehospital supportive interventions., Competing Interests: There are no conflicts of interest.

Background: Traumatic brain injury (TBI) is a worldwide problem, especially in countries with high incidence of road traffic accidents such as Iran. Patients with a single occurrence of TBI have been shown to be at increased risk to sustain future TBI., Objectives: The aim of this study was to present the incidence and characteristics of repeated TBI (RTBI) in Iranian patients., Patients and Methods: During one year, all admitted TBI patients with prior TBI history were enrolled into the study. In each patient, data such as age, gender, past medical history, injury cause, anatomic site of injury, TBI severity, clinical findings and CT scan findings were collected., Results: RTBI comprised 2.5% of TBI cases (41 of 1629). The incidence of RTBI per 100,000 individuals per years was 9.7. The main cause of RTBI was road traffic accident (68.3%); 9.7 % of cases had preexisting seizure/epilepsy disorder; 36.6% of patients with RTBI had pervious ICU admission due to severe TBI. Ten patients had Glasgow coma scale (GCS) ≤ 13 (24.4%). Seizure was seen in seven patients (17.1%). Thirty-nine percent of patients with RTBI had associated injuries. Eleven patients had abnormal CT scan findings (26.9%)., Conclusions: Considering the high incidence of trauma in developing countries, RTBI may also be more common compared with that of developed countries. This mandates a newer approach to preventive strategies, particularly in those with a previous experience of head injury.

Background: It is well-known that severe brain injury can make people susceptible to psychological symptoms. However, mild traumatic brain injury (MTBI) is still open for discussion., Objectives: This study aimed to compare psychological symptoms of MTBI patients with those without MTBI considering demographic auxiliary variables., Patients and Methods: This prospective cohort study was conducted on 50 MTBI patients and 50 healthy subjects aged 15 - 65 years. Psychological assessment was carried out six months post-injury using a series of self-report measures including the brief symptom inventory (BSI) scale. Other information of the individuals in the two groups was recorded prospectively. Data were analyzed using the chi-square test, t-test, and multiple linear regression tests., Results: There was a significant difference between the MTBI patients and healthy subjects in all subscales and total score of BSI. Our findings showed that obsession-compulsion and anxiety subscales were significantly more common in the MTBI patients than in the healthy subjects. Also, multivariate regression analysis six months post- injury showed that head trauma and substance abuse can have an effect on psychological symptoms., Conclusions: Mild traumatic brain injuries despite of the normal CT scan and history of substance abuse are closely related to psychological symptoms. Therefore, it is recommended that patients with brain trauma 6 months post-injury and subjects with a history of substance abuse be evaluated for psychological distress to support better rehabilitation.

Objective: Predicting outcomes in patients with traumatic brain injury is critically important for making sound clinical decisions. This study aimed at determining the prognostic value of the Rotterdam scoring system to predict early death among these patients., Materials and Methods: This study was performed prospectively on 150 patients with traumatic brain injury hospitalized in Shahid Beheshti Hospital, Kashan, Iran. Patients' demographic and clinical characteristics such as age, sex, mechanism of trauma, initial Glasgow Coma Scale score, and accompanying lesions were documented. A brain computed tomography was performed for each patient and scored by use of the Rotterdam system. Patients were monitored for 2 weeks after hospital discharge, and their outcomes were documented. Univariate and multiple logistic regression analysis and prognostic values of Rotterdam system were conducted by SPSS software., Results: Nineteen patients (12.7%) died during the course of the study. The mean age of the dead patients was significantly greater than those who survived (P = 0.037). The sensitivity and the specificity of the Rotterdam scoring system at the cutoff score of 4 were 84.2% and 96.2%, respectively. Rotterdam score was significantly correlated with patient outcomes (P < 0.0001). Moreover, logistic regression analyses revealed that factors such as age, sex, Glasgow Coma Scale score, and Rotterdam score significantly contributed to patient outcomes., Conclusions: Rotterdam score is an independent factor for predicting outcomes among patients with traumatic brain injury. At the cutoff score of 4, the Rotterdam system can predict outcomes among patients suffering from traumatic brain injury with acceptable sensitivity and specificity., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Head trauma is associated with multiple destructive cognitive symptoms and cognitive failure. Cognitive failures include problems with memory, attention and operation. Cognitive failures are considered as a process associated with metacognition., Objectives: This study aimed to compare cognitive failures and metacognitive beliefs in mild Traumatic Brain Injured (TBI) patients and normal controls in Kashan., Patients and Methods: The study was performed on 40 TBI patients referred to the Shahid Beheshti Hospital of Kashan city and 40 normal controls in Kashan. Traumatic brain injured patients and normal controls were selected by convenience sampling. Two groups filled out the demographic sheet, Cognitive Failures Questionnaire (CFQ) and Meta-Cognitions Questionnaire 30 (MCQ-30). The data were analyzed by the SPSS-19 software with multivariate analysis of variance., Results: The results of this study showed that there were no significant differences between TBI and controls in total scores and subscales of CFQ and MCQ (F = 0.801, P = 0.61)., Conclusions: Based on these findings, it seems that mild brain injuries don't make significant metacognitive problems and cognitive failures.