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Abstract Background Misinformation (infodemics) can hinder effective healthcare delivery. This study assessed Iranian healthcare workers’ (HCWs) knowledge, attitude, and practice (KAP) regarding infodemic management (IM). Method A cross-sectional survey using a self-reported questionnaire (KAPIM) distributed via convenience sampling to 1890 HCWs across all Iranian Medical Sciences Universities. Results The results showed that healthcare workers demonstrated overall KAP scores with a mean of 3.38 out of 5. Knowledge scores were 63.01%, attitude scores were 74.23%, and practice scores were lower at 55.76%. There were positive correlations between age and work experience with both knowledge and attitude scores. Conclusion These findings suggest a gap between HCWs’ knowledge/attitude and practice regarding IM. Targeted interventions emphasizing practical skills are needed. Considering demographics and regional variations is crucial when developing training programs for enhanced infodemic preparedness across the Iranian healthcare system.

Background: Epidemics are threats to communities and their health. The preparedness of makeshift hospitals in epidemics in management, planning, implementation, and structure to provide appropriate and timely services is essential. Studies show that the incidence command system and the operational fact sheet based on task descriptions and instructions in makeshift hospitals are not considered. This study is designed to develop an appropriate organizational structure for makeshift hospitals. Materials and Methods: This was a descriptive-analytical cross-sectional study in two stages, including review and expert panel studies, to develop a national fact sheet guide and the structure of makeshift hospitals. Results: Based on the nature of disasters, makeshift hospitals should have specific structures. In the structure designed for a makeshift hospital, according to the center’s services and time of activation, it is necessary to have a manager, management, and executive staff. A medical specialist, such as an infectious or pulmonary specialist, is essential, depending on the situation. Considering the limited resources in developing countries and the importance of managing resources (financial, human, and equipment) and improving the quality of health services, it will be helpful to formulate a management structure and implement operational worksheets in the least possible time. Conclusion: The use of command and management structure will improve decision-making in critical situations, especially in cases of epidemics, the need for quarantine, and the provision of services to injured patients.

Background: Given the changes caused by COVID-19, modern information technology has gained a higher position, fostering the realistic comprehension of technology, developing an interdisciplinary program, and endorsing scientific and technological activities within the educational environment. Considering the advancement of information technologies after COVID-19, this study was conducted to explore the role of new information technology in shaping education during the pandemic. Materials and Methods: In this systematic review, all relevant studies were searched in Medline/PubMed, Scopus, Web of Science, ProQuest, Iran Medex, Magiran, and Scientific Information Database (SID) databases from 2019 to 2022. The analysis was conducted using a thematic analysis approach. Results: Of the 1966 search results, 15 articles were included in this systematic review. These comprised 9 journal articles, 5 conference studies, and 1 thesis study. Data were extracted under two main categories—education and knowledge management—and four subcategories: Learning, performance quality, infrastructure, and planning. Conclusion: Developing positive and creative skills in using new technologies is a complex process, which, through joint planning in multidisciplinary teams, can enhance technology-driven education. However, using new information technologies requires more support for educational leadership.

Background In the present study, arterial and venous blood was collected from patients who were candidates for elective coronary artery bypass grafting (CABG); the blood was stored for 28 days and cellular, biomechanical, and hematological changes in blood were compared to determine whether stored arterial blood is superior to stored venous blood. Methods The present follow-up comparative study included 60 patients >18 years of age, with hemoglobin >14 mg/dl and ejection fraction >40% who were candidates for CABG. After induction of anesthesia, 250 ml of arterial or venous blood was drawn from patients (arterial blood group and venous blood group). Laboratory blood samples were taken at specified times from the collected blood and re-injected into the patients after CABG. Results Significant differences were observed in pH, partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), bicarbonate (HCO3), and glucose values at several time points between the groups. Other parameters such as urea and creatinine did not show any significant differences between the groups. Conclusions Twenty-eight days of storage can have a negative effect on some of the cellular, biochemical, and hematological components of arterial and venous blood; however, the quality of stored arterial blood and venous blood does not differ significantly.

Background: Measuring end-tidal carbon dioxide (ETCO2) can be a non-invasive, fast, and reliable method to predict partial pressure of carbon dioxide (PaCO2) in patients with respiratory distress. This method, which can be a suitable substitute to measure PaCO2, is being used in many emergency rooms and operating rooms in developed countries, but its exact relationship with PaCO2 has not been confirmed yet. This study aims to investigate the relationship between PaCO2 and ETCO2 in patients with respiratory distress referred to the emergency. Materials and Methods: Arterial blood gases were measured in patients referred to the emergency room of Hazrat Rasool Akram (PBUH) Hospital with the main complaint of respiratory distress, and the ETCO2 of the patient was measured simultaneously with a capnograph. At the same time, the blood pressure and body temperature of the patients were also measured. The obtained information was collected in a sheet and statistically analyzed using SPSS software, version 15. Results: A total of 120 patients were included in the study whose mean age was 48.3. The Mean PaCO2 and ETCO2 were 47.45 and 26.9, respectively. The mean respiratory rate was 37.4 and diastolic (89.9) and systolic (124.9) blood pressure. A total of 48.33% of patients were women. Statistical analysis showed a significant relationship between PaCO2 and ETCO2 (P=0.0001; CC=0.436). Linear regression analysis showed that ETCO2 predicts PaCO2 with R=0.424. Conclusion: A good correlation was found between PaCO2 and ETCO2 and this correlation was higher in diseases such as sepsis and COPD. Variables such as age, sex, and blood pressure did not affect this correlation. Of course, more studies on healthy people are necessary to confirm these findings.

Background: Providing emergency shelter for disaster victims is a part of disaster risk mitigation strategies. International organizations have proposed a framework for appropriate planning and emergency shelter design. These agencies are encouraging local authorities to manage events to use existing structures such as schools, community centers, etc., as emergency shelters for the victims. According to the social religious and spiritual status of mosques in communities, these centers are one of the crucial elements to create a safe and trusted shelter during disasters. This study aims to identify the role of mosques as emergency shelters in disasters. Materials and Methods: This study was a systematic study that searched the words related to the research title (disaster management, emergency shelter, mosque) with AND, OR operators in PubMed, Web of Sciences, Science Direct, and Scopus databases, and the Google scholar search engine, as well as Persian language databases of SID, Magiran, Irandoc, and Iran Medex. A three-step screening process was used to select studies using the Preferred Reporting Items for Systematic Reviews And Meta-Analyses (PRISMA) checklist. Finally, the data were analyzed thematically. Results: Out of a total of 175 articles found, 6 articles were relevant to the purpose of the study and were analyzed. The results of the present study showed that mosques can be suitable shelters for risk management during accidents and disasters. Also, in this regard, a range of strategies for designing programs for public participation and mosques were identified. Conclusion: The services and the role of mosques in disaster occurrence as a shelter are very effective and these valuable services can be further extended using social capital, attracting the attention of religious institutions, and public participation.

Background: At the end of December 2019, a new infectious disease was reported in Wuhan, China. It was a new type of coronavirus named COVID-19. The spread of COVID-19 created an emergency in the global health system and the elderly was identified as a vulnerable group to the disease. Materials and Methods: This is a systematic review conducted to manage the vulnerability of the elderly during the COVID-19 pandemic. Accordingly, all articles published in this field from the beginning of March 2019 to the end of June 2021 have been extracted from the following databases: Web of Science, PubMed, Scopus, Cochrane Library, Google Scholar, Irandoc, Magiran, MedLib, and SID. Results: High incidences of COVID-19 are exacerbated in the elderly with cognitive disorders, immunodeficiency, malnutrition, use of various medicines and social problems, anxiety, distance from the family, lack of healthcare, history of falls, multi-drug use due to old age during the COVID-19 pandemic, in addition to the elderly with underlying diseases, such as kidney failure, diabetes, high blood pressure, arthritis, heart, and respiratory diseases. Conclusion: The prevalence of vulnerability in the elderly was high during the COVID-19 pandemic, which can be a significant risk factor for health. Suffering from several simultaneous diseases, the number of medicines used, the history of falls, underlying diseases, and living alone were some of the vital determinants of vulnerability and considering the adverse consequences of vulnerability, difficulty in designing and implementing appropriate interventions and self-care education for the elderly and their families to manage drug use, treating chronic diseases, and preventing falls, it seems necessary to observe health protocols and stay at home.

Background It is important to determine the proper location of tracheal tube for proper ventilation. In this study, we compared the diagnostic value of tracheal intubation with two methods of palpation and auscultation with chest X-ray (CXR) method in pediatric. Methods In this interventional study, 80 patients under 6 years of age were included. After tracheal intubation appropriate depth of tracheal tube was determined by auscultation and recorded, then by palpation depth of tracheal tube determined and tube was fixed. The length of the tube was calculated with the standard formula based on age. After surgery, CXR was taken and, according to the landmark, the distance from the end of the tube to the anterior lower tooth was recorded. Results Interclass correlation coefficient (ICC) between the palpation method and the standard method in the number of fixing tracheal intubation was 0.573, which shows the average and significant correlation between these two methods in determining the fixed number of tracheal intubation. ICC between the auscultation and the standard method in fixing tracheal intubation number was 0.430, which shows the average and significant agreement between these two methods in determining the fixed number of tracheal intubation. There is no significant relationship between sex and the average number of fixing tracheal intubation in all methods. Conclusions This study has shown that both palpation and auscultation methods are appropriate, but with a slightly higher palpation ICC, the palpation can be considered relatively better.

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new coronavirus, was originally recognized as a pandemic by the WHO on early, a new coronavirus, was originally recognized as a pandemic by the WHO on early 2020, and has infected over 243 million people worldwide, killing about five million people between then and October 2021. Objectives: We investigated the relationship between clinical characteristics, cardiovascular risk factors and echocardiographic findings and in-hospital outcomes of patients who were admitted for COVID-19. Patients and Methods: A retrospective review of 216 hospitalized patients with COVID-19 who were admitted to Chamran hospital from March 2019 to April 2021 was conducted. Patients’ characteristics cardiovascular risk factors, echocardiographic findings, clinical outcomes (discharge (complete recovery/ partial recovery) and in-hospital mortality) were recorded. To analyze risk factors associated with outcomes in patients with COVID-19, univariate and multivariate ordinal logistic regression models were conducted. Results: The most common underlying diseases in patients were hypertension (HTN) (57.9%) and diabetes mellitus (DM) (37.9%), respectively. Cognitive disorders (20.8%) and mitral regurgitation (MR) were the most complication and echocardiographic finding of the patients. In our study, six variables were found to be associated with patient’s outcomes, including age, body mass index (BMI), DM, chronic pulmonary diseases, number of hospitalization days and number of an intensive care unit (ICU) admission days. Conclusion: Our analysis suggests that age, male gender, BMI, number of hospitalization days and ICU admission, chronic pulmonary disease and diabetes are associated with a higher risk of in-hospital mortality and worst prognosis in patients infected by SARS-CoV-2.

Background: Sharing experiences and learning from health measures taken during the outbreak of epidemics is a critical issue that affects the right and timely decisions in health crises. In the present study, an attempt has been made to review the health policies adopted against COVID-19 and extract critical points for resolving the epidemic crisis. Materials and Methods: This article was a comparative study. The study population comprised Canada, Japan, Germany, Korea, Turkey, and Iran. Ten effective indicators in the management of epidemics were extracted by reviewing the literature and interviewing disaster management experts, and the degree of conformity of the research community with them was examined. The study data were collected from articles published in scientific databases (Google Scholar, PubMed, Web of Science, and Scopus search engines) or information from COVID-19 disease management organizations from official sites. The obtained data were processed and analyzed by matrix content analysis. Results: The results showed the importance of 10 effective indicators in the management of epidemics during the outbreak of COVID-19 studied and noticed by the health system of most countries. And the government, local and private organizations have participated in the implementation of the studied indicators according to the conditions of each country’s health system. Therefore, the success rate of countries in managing COVID-19 disease varies according to the time, type, and manner of implementation and monitoring of measures. Conclusion: Speed of action in adopting health policies and integration in its implementation, construction of convalescence, adequate training and access to personal protective equipment, prevention of nosocomial contamination, and voluntary assistance are essential issues in the fight against epidemics. These measures should be considered and used as teachings in managing health crises, especially emerging diseases and pandemics.

Background: Rising trend of emergencies and disasters in the world has caused a lot of damage to the health care facility infrastructures. This has led the health needs of the affected population to be the first and most requirement in emergencies and disasters. In most countries for the timely and appropriate response to the health needs of the affected areas, structured and organized teams are formed. Given the frequent occurrence of events in Iran and the adverse effects of emergencies and disasters on the community health, this study aimed to investigate the obstacles and challenges associated with the organization and preparation of Iran’s Emergencies and Disasters Medical Response Teams (EDMRT). Materials and Methods: In this study, a qualitative approach with a content analysis method was used to explore and extract the obstacles and challenges of the medical response teams in the field of organization and preparation. Data collection was done through 18 in-depth, unstructured, and semi-structured interviews with 16 experts and experienced people who were purposefully selected. Besides the interview, field visits and related reports were used to confirm or reject the findings. Data analysis was done by the qualitative approach recommended by Graneheim. Results: The obstacles and challenges associated with the organization and preparation of teams were obtained under 1 theme, 2 categories, and 10 subcategories. The main theme was “team management”. The categories included unorganized groups and frangible readiness. Concepts of the team; unknown structure, lack of effective leadership/command, poor supervision of proctor organization, membership; complex process, heterogeneous composition are the sub-categories related to the first category. And concepts of local level; disable to establishment a team; disaster medicine, unfamiliar concept; lack of air care team; dependence versus self-sufficiency; non-systematically support; and inappropriate location of deployment are the sub-categories of the second category Conclusion: The results of the study show that the current structures for medical response in emergencies and disasters have numerous challenges in terms of organization and preparedness. This defect harms the performance and effectiveness of medical response teams and an obstacle to the overall policy of reducing damages in disasters. The present study illustrates the need to review and refine the organization and preparedness processes associated with the current structure of medical response teams in emergencies and disasters. Of course, it is recommended that a more comprehensive study be conducted to identify and address the other areas of influence in these teams, such as legal considerations, health and safety, and related security issues.

Background There is no specific tool for measuring the professional resilience of emergency nurses. Therefore, the present study aimed to design and psychometrically evaluate a new tool named the emergency nurses’ professional resilience tool. Method This mixed-method sequential exploratory study was conducted in two phases: (1) item generation using literature review and evaluation of the results of a qualitative study and (2) psychometric evaluation of the developed scale. The face, content, and construct validity (exploratory and confirmatory factor analysis), reliability (internal consistency, relative, and absolute), and accountability were assessed in the population of Iranian nurses (N = 465) during March 2019-June 2020. Results The tool designed for assessing the professional resilience of Iranian nurses included 37 items. The average scale content validity index (S-CVI/Ave) was equal to 0.94. The exploratory factor analysis revealed five factors, including professional competencies, emotional-cognitive characteristics, external support, in addition to behavioral and cognitive strategies, and explained 75.59% of the whole variance. Cronbach’s alpha and intraclass correlation were 0.915 and 0.888, respectively. Construct validity for five factors was established with acceptable model fit indices [Chi–square/df = 1336.56/619, p < .001]; [Comparative Fit Index [CFI] = 0.96]; [Non-Normed Fit Index [NNFI] = 0.96]; [Root Mean Square Error of Approximation (RMSEA) = 0.074 and 90 Percent Confidence Interval = (0.069; 0.080)]; and [SRMR = 0.095]. Conclusions According to the findings of the current study, the emergency nurses’ professional resilience tool can be used by healthcare managers as a valid and reliable scale to evaluate the professional resilience of nurses to designate them as nurses working in emergency and disaster situations.

BACKGROUND: The public hospital preparedness is essential for epidemic disaster like COVID-19 pandemic. This study was conducted to present a hospital management preparedness model of Iran's public hospitals for the epidemic. MATERIALS AND METHODS: The method of this study was an exploratory sequential mix method study (qualitative–quantitative). In this study, qualitative and quantitative methods were used in four stages. (1) Interviews with hospital managers to identify hospital management experiences during the COVID-19 epidemic and categorize the results in themes and subthemes, (2) assessing the performance of public hospitals in managing the coronavirus epidemic in a quantitative method, (3) present the initial hospital management model for a public hospital in epidemic conditions using an expert panel, and (4) validation of the model using the Delphi method. RESULTS: Experiences of hospital managers and specialists were categorized into eight themes: information gathering and environmental analysis, general and operational planning, provision of equipment and physical and financial resources, training and empowerment of human resources, a compilation of instructions and job descriptions, review and ensuring maximum readiness, monitoring and follow-up of service provision and existing problems, evaluation and feedback of performance problems and level of preparation and 51 sub-themes. The quantitative study indicated that all the investigated indicators had a significant decrease in the first month and an increase in the epidemic's continuation. The results were categorized in nine themes and 59 sub-themes, and finally, the model was validated in one round by the Delphi method. CONCLUSION: In Iran, managers have valuable experiences in COVID-19 epidemy management, but these experiences are scattered and not organized. In this study, by a qualitative–quantitative, a model was presented that contains essential points obtained from the experience of hospital managers and experts in actual disaster conditions and is appropriate and fits hospital structure and infrastructure of the health system in Iran.

Backgroud: Because of the important role of adhering to treatment to reduce major adverse cardiovascular events and mortality, studying the factors affecting treatment adherence (TA) is warranted. This study aimed to identify the impact of psychosomatic factors on adhering to treatment among patients with acute myocardial infarction. Materials and Methods: This is a cohort study as a part of the Isfahan ST-segment-elevated Myocardial Infarction Cohort Study. Psychosomatic factors such as health anxiety, illness denial, irritable mood, and demoralization were assessed among 867 patients at the first visit. The patients were followed for 2 years; TA and major adverse cardiovascular events were checked annually in survivors. Results: The results from binary logistic regression applied to find the association between TA and psychosomatic factors showed that the patients with health anxiety, irritable mood, and demoralization were significantly poor adherent to treatment (odds ratio [95% confidence interval]: 1.39 [1.02, 2.73], 1.51 [1.02, 2.37], and 1.66 [1.02, 2.91]), respectively. The associations remained the same when adjusted for various potential confounders. Conclusions: Psychosomatic factors played an essential role in adhering to treatment among patients with acute myocardial infarction. As a result, appropriate psychological interventions may help the patients adhere to their treatment better.

Background and purpose: Iran is one of the top ten countries in the world with disaster. Hospitals have a major role in dealing with disaster-related injuries. The purpose of this study was to assess the level of preparedness in Mazandaran province hospitals in dealing with disasters in order to identify the deficiencies and comparing current conditions with national standards. Materials and methods: In this cross-sectional study, all hospitals affiliated with Mazandaran University of Medical Sciences and Mazandaran Social Security Organization (n=28) were evaluated in 2017. Data were collected using the National Standard Toolkit for Hospital Preparedness. The overall score and the scores for every component were recorded and the level of preparedness were presented according to four levels. Results: The relative preparedness level of hospitals in dealing with disasters was moderate (65.5%). The overall levels of disaster preparedness in the hospitals affiliated with Mazandaran University of Medical Sciences and the social-security hospitals were moderate (63%) and favorable (75%), respectively. The hospitals affiliated with Mazandaran University of Medical Sciences, were found to have good (n=4), moderate (n=14), and poor (n= 5) levels of preparedness. The hospitals of the Social Security Organization were ranked as good (n=2) and moderate (n=3) in disaster preparedness. Conclusion: Most of the hospitals in Mazandaran province, like other regions in Iran, have poor level of disaster preparedness. Therefore, more planning is needed to enhance the hospital’s level of readiness in all dimensions.

مقدمه: بخش اورژانس بیمارستانی از پرحجم‌ترین و حساس‌ترین بخش‌ها در هر بیمارستان است که از اهمیت ویژه‌ای برخوردار بوده و یکی از پرخطرترین بخش‌های درمانی محسوب می‌شود. طب اورژانس تمرین طب در یک جایگاه حاد و تحت حاد است. یک پزشک اورژانس آموزش‌دیده نه‌تنها قادر است تروما را رهبري کند، بلکه همچنین می‌تواند اکثر مسائل حاد و غیر حاد قابل‌تصور دیگر را رهبري نماید. این مطالعه باهدف بررسی تأثیر حضور متخصص طب اورژانس بر بالین بیماران مراجعه‌کننده در اورژانس بیمارستان‌های هفت‌تیر، فیروزگر و رسول اکرم طراحی و انجام گردید. نتایج حاصل از این مطالعه می‌تواند در برنامه‌ریزی به‌منظور آموزش پزشکان طب اورژانس در بیمارستان‌های مذکور نقش مهمی ایفا کند. مواد و روش‌ها: در این مطالعه از 30 بیمار مراجعه‌کننده به اورژانس‌های بیمارستان‌های رسول اکرم و شهدای هفتم تیر و فیروزگر در سال 1396، به‌صورت یک مصاحبه نظام‌مند خواسته شد که نحوه حضور متخصص طب اورژانس را بر بالین خود را بیان نمایند. همچنین با 20 نفر از کارکنان بیمارستان‌های مذکور در مورد شرایط اورژانس قبل و بعد از استقرار طب اورژانس مصاحبه به عمل آمد. اطلاعات حاصل توسط نرم‌افزار SPSS مورد تجزیه‌وتحلیل قرار گرفت. یافته‌ها: در مصاحبه با بیماران، آنان بیان کردند که 15/46% توسط پزشک، 76/30% توسط دانشجو و 07/23% توسط پرستار ویزیت شده‌اند، که نشان‌دهنده این است که هیچ‌یک از آنان اطلاع نداشتند که متخصص طب اورژانس آنان را ویزیت کرده است. 16/46% بیان کردند که در زمان مناسب ویزیت شده‌اند و 84/53% از آنان ناراضی بودند و اظهار داشتند که در زمان مناسب برای معاینه و ویزیت بر بالین آنان حاضر نشده‌اند. 92/76% از نحوه برخورد راضی و 08/23% از آنان ناراضی بودند. 57/54% از نحوه معاینه و شرح‌حال گیری راضی و 43/45% از آنان ناراضی بودند. 45/66% از کیفیت تشخیص و اقدامات درمانی راضی و 55/33% از آنان ناراضی بودند. ازنظر 26/44% بیماران، وضعیت رسیدگی مناسب و ازنظر 74/55% بیماران وضعیت رسیدگی نامناسب بود. همچنین مهم‌ترین مزایای استقرار طب اورژانس ازنظر کارکنان کاهش مرگ‌ومیر بیماران در اورژانس، سرعت در تعیین تکلیف بیماران، کاهش مشاوره‌های تخصصی، انجام دستورالعمل‌ها توسط متخصص طب اورژانس، کاهش زمان ماندگاری بیماران در اورژانس و افزایش رضایت بیماران بوده است. نتیجه‌گیری: حضور متخصصین طب اورژانس باعث بهبود کیفیت خدمات درمانی و افزایش میزان رضایت بیماران است و با ارجاع درست و به‌موقع بیماران به بخش‌های مربوطه در زمان و هزینه درمان صرفه‌جویی می‌شود، بنابراین پیشنهاد می‌شود استقرار طب اورژانس در تمامی واحدهای اورژانس بیمارستانی کشور انجام گیرد، و برای آشنایی بیشتر افراد جامعه با این رشته نیز آگاهی‌رسانی‌های لازم انجام شود.

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Background. The emergency medical service (EMS) provides first-line medical care to people who require urgent medical care in emergency and disaster situations. Preparedness is the most effective approach for the management of disaster risks, and it is essential for the emergency medical service (EMS) providers, such as paramedics, emergency medical technicians (EMT), and other EMS personnel. This systematic review will explore evidence on the preparedness of emergency medical service providers in emergency and disaster situations by reviewing peer-reviewed journal articles. Methods/Design. This study will be conducted on peer-reviewed articles published between 2005 and 2019 to explore the preparedness of emergency medical service providers in emergencies and disasters. Scopus, Web of Science, PubMed, and Google Scholar will be thoroughly searched to identify published studies on emergency and disaster preparedness. The following keywords will be used for searching the databases: “Medical Technician,” “Paramedic,” “Emergency Paramedic,” “Emergency Medicine Technician,” “Emergency Medical Technician,” “Emergency Prehospital Provider,” “Emergency Preparedness,” “Disaster Preparedness,” “Hospital Preparedness,” “Disaster management,” “Disaster Competencies,” “Disaster Readiness,” “Disaster,” “Disaster Role,” “Readiness, Preparedness, Terrorist,” “Mass Casualty Incident,” “Major incidents,” “Mass Casualty,” “Mass Gathering,” “CBRNE,” “Weapons of Mass Destruction,” and “Chemical, Biological, Radiological, Nuclear, and Explosive Event.” Discussion. To the best of our knowledge, no comprehensive review study has been conducted on the preparedness of emergency medical service providers in disaster situations. This study is the first attempt to address this gap. It will also explore the key dimensions in disaster preparedness of EMS providers and the strategies to enhance their preparedness. Identifying the key dimensions of disaster preparedness is the first step in designing and developing valid instruments to evaluate EMS provider’s disaster preparedness and as well as adopting appropriate strategies to improve the level of their preparedness (This systematic review is registred in PROSPERO with CRD42020149689).

BACKGROUND: The emergency department is one of the most important parts of all hospitals. For this reason, many simulation programs are performed in this department to increase the knowledge, skills, and productivity of health-care workers. The purpose of this study was to identify the benefits of simulation in hospital emergency departments. MATERIALS AND METHODS: In the present systematic study, using “AND” and “OR” operators, we searched for the keywords “benefits,” “simulation,” and “hospital emergency department” in PubMed, Web of Science, Scopus, Google Scholar as well as Persian language databases such SID, Magiran, Irandoc, and Iran Medex. Then, a three-step screening process was used to select studies relevant to simulation and hospital emergency from 2005 to 2021 using the PRISMA checklist, and finally, the obtained data were analyzed. RESULTS: A total of three main groups, each with several subgroups, were extracted and identified as the benefits of using simulation in hospital emergency departments. They included improving the diagnosis of the disease (rapid prediction of the disease, rapid diagnosis, and patient triage), improving the treatment process (improvement of treatment results, anticipation of admission and discharge of patients, acceleration of interventions, and reduction of medical errors), and improving knowledge and skills (improvement of the speed of decision-making, staff's acquisition of knowledge and skills, simple, convenient, and low-cost training, improvement of staff's preparedness in crisis). CONCLUSION: Based on the results of the present study, it is suggested to develop some training programs in order to help staff upgrade their knowledge and performance as well as acquire practical skills and also to improve the diagnosis and treatment process in hospital emergency departments. Virtual methods are also proposed to be applied as potential and cost-effective platforms for learning, teaching, and evaluating the staff of hospital emergency departments.

Introduction: Emergency medicine specialty has been established in Iran since 2001 due to the need to create a specialized field for responding to patients' vital needs. Since this is a young field and challenges have arisen since the creation of this field, we have studied the importance, needs and challenges of emergency medicine specialists being available in a teaching hospital. Methods: This study was a qualitative one. In this study, purposeful sampling was performed among experienced experts in the field of emergency medicine, the founders of this field, and authorities of the healthcare system. The mentioned groups were interviewed in a semi-structured manner and the sample size was determined via data saturation. Finally, the important codes were selected in groups and subgroups and then analyzed. Results: In this study, after interviewing 12 experts in the field of emergency medicine, information saturation was reached. One of the most important needs for establishing emergency medicine specialty was found to be the need for an expert with a comprehensive view for treatment of critical patients and a comprehensive management for emergency department; and the greatest challenges were financial interference with other disciplines and interference in the area of joint work. Conclusion: Considering the evaluations of the present study and more than 2 million patients and injured people presenting to the emergency department each month, the presence of an emergency medicine specialist in educational hospitals is recommended.

BACKGROUND: This systematic review and meta-analysis aimed to assess the effect of cardiac rehabilitation (CR) on serum C-reactive protein (CRP) as an indicator of the inflammatory state and predictor of recurrent cardiovascular events.METHODS: PubMed, SCOPUS, Cochrane library, and Google Scholar databases were searched up to January 2014 for original articles which investigated the effect of CR on CRP among adult patients with previous cardiovascular events. The random effects model was used to assess the overall effect of CR on the variation in serum CRP levels.RESULTS: In the present systematic review and meta-analysis, 15 studies were included. The analysis showed that CR might significantly reduce high-sensitivity CRP (hs-CRP) levels [Difference in means (DM) = -1.81 mg/l, 95% confidence interval (CI): -2.65, -0.98; P = 0.004). However, the heterogeneity between studies was significant (Cochran's Q test, P < 0.001, I-squared = 84.9%). To find the source of variation, the studies were categorized based on study design (quality) and duration. The negative effect was higher among studies which followed their participants for 3 weeks or less (DM = -2.75 mg/l, 95% CI: -3.86, -1.64; P < 0.001) compared to studies which investigated the effect of CR for 3-8 weeks (DM = -0.89 mg/l, 95% CI: -1.35, -0.44; P < 0.001) and those which lasted more than 8 weeks (DM = -1.71 mg/l, 95% CI: -2.53, -0.89; P < 0.001). There was no evidence of heterogeneity when the categorization was based on the follow-up period.CONCLUSION: Both short- and long-term CR have resulted in improvement in serum hs-CRP levels. CR can be perceived as a beneficial tool to reduce inflammatory markers among patients with previous cardiac events.

Background: This study aimed to determine the demand of maximum amount of blood in cardiac surgeries in Shahid Chamran hospital, Isfahan, Iran. Methods: In this cross-sectional study during 12012-2013, 1125 hospital records were studied. Information of blood bank included amounts and kind of reserved, crossmatched, and prescribed a blood, and transfusion indices were determined by the type of surgery. Findings: Amount of reserved pack cell was more than 3 time of consumed and only 34% of reserved pack cell was used for patients; the difference between reservation and consumption was significant. Crossmatched/transfused index (C/T) in most surgical procedures was not optimum (< 2.5); but transfusion index (TI) was desirable in all patients (1.01). Transfusion probability (T%) was statistically different based on the type of operation. Conclusion: Blood and product reservation was more than the required amount and led to wasting blood and products and increase in hospital costs. Thus, reservation of blood and its products must be calculated based on the type of surgery, and a practical protocol must be provided and implemented in all hospitals.

Background: Tetralogy of Fallot (TOF) refers to a condition in which left ventricular volume is normal or slightly less than normal. Given the differences observed in some Asian patients with TOF, the present study was conducted to investigate left heart by determining Z-scores for the mitral valve in Iranian patients with TOF. Methods: Eligible subjects in this prospective descriptive study comprised all patients with TOF presenting to Shahid Modarres Hospital in Tehran from March 2012 to March 2015 and diagnosed as the candidates for surgery. After determining the need for surgery and the therapeutic method required, the mitral valve size and Z-scores were calculated. We analyzed sex, age, body surface area (BSA), mitral size (in 2-chamber and 4-chamber view), mitral Z-score, other cardiac anomalies, number of surgery and previous surgery. Results: Of a total of 80 patients included in the study over 3 years, 29 (36.3%) were male and 51 (63.8%) were female. The mean age of the patients was 7.15±3.37 years and their mitral size was found to be 10-27 mm (16.2±5.99 mm) using echocardiography. Z-scores of the mitral valve were also obtained as -3.09±2.11, ranging between -7.1 SD and +1.3 SD. 58 (72.5%) patients have only TOF and 22 (27.5%) with other cardiac anomalies. 45 patients were for first time underwent surgery and 22 patients for second time, 12 patients for three time and 1 for forth. Of a total of 35 patients had previous surgery, the most common were shunt 15 (42.9%) and then tetralogy of Fallot total correction (TFTC) in 12 (34.3%). Of a total of 80 patients, 59 (73.8%) underwent TFTC, 17 (21.3%) under pulmonary valve replacement and 4 (5%) shunt. Conclusion: Z-scores of the mitral valve were found to be significantly below the normal value, (i.e. 0±2 SD), in the study patients, suggesting the risk of hypoplastic left heart syndrome in Iranian patients with TOF, nevertheless, the type of TOF examined in these patients might have been different from those observed in other races and regions.

BACKGROUND: Cardiovascular disease (CVD) is one of the most important causes of mortality and morbidity in Iran. Secondary prevention of acute myocardial infarction (AMI) is necessary. The main aim of this cohort is evaluating clinical, paraclinical, management, and 5-year major events of the participants in Isfahan, Iran.METHODS: All consecutive patients with AMI hospitalized in Chamran Hospital, Isfahan, during 1 year from march 2015 were recruited and followed for 5 years. ST-Elevation Myocardial Infarction Cohort Study (SEMI-CI) has been initiated as a longitudinal study to evaluate course of patients with AMI in Iran, adherence to evidence-based secondary prevention drug, and five-year events such as death, re-myocardial infarction (REMI), re-hospitalization, congestive heart failure (CHF), and referring to another procedure [percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and resynchronization therapy].RESULTS: A total of 867 patients with ST-elevation myocardial infarction (STEMI) with mean age of 60.91 ± 12.76 years were recruited. 705 (81.3%) subjects were men with mean age of 59.63 ± 12.59 years. 470 (54.2%) patients had anterior AMI (ant-AMI) and the rest had other types of AMI. The ejection fraction (EF) mean was 37.80 ± 11.74 percent. A total of 30 (3.5%) cases of AMI had not received reperfusion. 445 (51.4%) had primary PCI and 392 (45.2%) had thrombolysis at first revascularization strategy. In-hospital death occurred in 72 participants (8.3%). Drug during hospital included: at discharge, 767 (88.5%) received aspirin, 787 (90.7%) statin, 697 (80.4%) beta-blocker, and 480 (55.4%) angiotensin-converting enzyme (ACE) inhibitor.CONCLUSION: According to the best of our knowledge, it is among few cohorts in Eastern Mediterranean Region (EMR) in patients with AMI. This paper showed methodology of this study in patients with STEMI and its follow-up protocol. We can use this result in policy-making for improving secondary prevention strategies.

Background: Agitation after coronary artery bypass grafting (CABG) operation is a common and life-threatening complication. Recognizing factors affecting it will reduce the incidence of this complication. The aim of this study was to evaluate the incidence of agitation after CABG operation and the factors affecting it. Methods: This study was conducted on 100 patients undergoing CABG operation. Demographics and incidence of postoperative agitation were recorded using Richmond Agitation-Sedation Scale (RASS) criteria for all patients every 24 hours to 72 hours. Analysis was done using t, chi-square, and Mann-Whitney tests. Findings: Overall prevalence of agitation in patients undergoing CABG was 40%. The prevalence of agitation in patients with diabetes (P = 0.050), hypertension (P < 0.001), smoking (P < 0.001), and drug addiction (P = 0.002) was significantly higher than patients without expressed factors. It was also found that the incidence of complications during surgery in agitated patients was significantly higher as compared to other patients (P = 0.045) and they had lower preoperative white blood cells (WBC), higher surgery duration, higher morphine, midazolam, and pethidine, and higher length of stay in intensive care unit (ICU) (P < 0.050 for all). Conclusion: In our study, incidence of agitation had significant correlation with diabetes, hypertension, smoking, drug addiction, surgery complications, and mean WBC count before the surgery, and duration of surgery, and amount of received morphine, midazolam, and pethidine in the first 24 hours, and the length of stay in intensive care unit.

Background: Following coronary artery bypass graft (CABG), T3 level reduces and this situation can affect the function of cardiovascular system. This study aimed to evaluate the effect of oral levothyroxine on need for inotropic agents and bleeding in patients undergoing cardiopulmonary bypass. Methods: In this randomized clinical trial study, 70 patients undergoing CABG randomly divided into two groups. The case group received oral levothyroxine (20 mg: the first dose at the night before surgery and the followings two hours after intensive care unit (ICU) admission and then every 12 hours for 24 hours, a total of 4 doses) and the control group received placebo with the same dose. Hemoglobin levels, requirement to inotropic agents, occurrence of bleeding, and volume of hemorrhage and blood products consumption were determined and compared between the two groups. Findings: No significant differences were detected between the groups in the need for inotropic agents, blood hemoglobin, bleeding, and blood products consumption. But, blood loss volume in the intensive care unit was significantly less in the case group compared to the placebo group (P = 0.005). Conclusion: Our study showed that administration of oral levothyroxine is associated with lower volume of blood loss in intensive care unit; but caused no significant decrease in the need for inotropic support.

Background: One of the most important issues in order to save life in patients with cardiac arrest is cardiopulmonary resuscitation (CPR). This study evaluated the performance of resuscitation team in Chamran hospital, Isfahan, Iran, in 2015. Methods: This cross-sectional study included 211 patients undergone CPR, in or out of the Chamran hospital. The CPR process data were collected from patients' files and the CPR heads filled out the checklists. Findings: The patients were 140 men (66.35%) and 71 women (33.65%). The age, sex, and location of CPR had not significant effect on the outcome of CPR (P > 0.050 for all). Use of advanced life support, the time between cardiac arrest and start of advanced life support, the time between cardiac arrest and applying first shock, use of electroshock, CPR due to basic life support (BLS), CPR due to advanced life support (ALS), and duration of CPR had significant effect in primary survey of CPR (P < 0.050 for all). Unless time between cardiac arrest and apply of first shock, there was no significant relationship between other criteria and 1-month survival after primary successful CPR (P = 0.010). Conclusion: In our study, demographic indices did not have significant effect on primary CPR outcome but need to basic and advanced life supports, applying shock to shockable rhythm and also the time between cardiac arrest and applying first shock had significant effect on primary successful CPR. Incompatibility in the percentage of CPR cases with American Heart Association (AHA) guideline notes the necessity of regular and continuous retraining.

Background: Hospitals need volunteers to help the injured people during disasters. Thus, it is necessary to prepare some criteria for selecting volunteers. The purpose of this study was to determine and prioritize individual and social criteria for selection of local volunteers in hospitals before disasters, the volunteers who provide health services for victims in disasters. Materials and Methods: This was an analytical descriptive study in which a researcher-made questionnaire was used to collect the data in 2015. The statistical population consisted of emergency and health managers and experts in hospitals affiliated to Tehran University of Medical Sciences. The sample were selected using Cochrane methodology and calculated as 180 subjects. The data were analyzed through calculating mean, standard deviation, 1-sample t-test, and Friedman test using SPSS. Results: Based on the results, most personal and social criteria were significant (P≤0.05) and important in volunteers’ selection. The results showed that the most important personal criteria were physical ability and fitness, practical expertise, and voluntary attendance experience with the mean ranks of 4.03, 3.94, and 3.77, respectively. Also among social criteria, prompt response with the mean rank of 7.26, responsibility with 6.25, and conscience with 6.06 have been determined as important factors in the selection of volunteers for health services of hospitals in disasters. Conclusion: Hospitals could select volunteers based on the determined criteria. Personal criteria of physical fitness and practical expertise along with social criteria of prompt response and responsibility were reliable norms that based on them, the best volunteers could be chosen to perform health duties and decrease injuries in relief and health services.

Introduction: Since hospitals provide crucial lifesaving services in societies, hospital resiliency plays an essential role in minimising the impact of disasters on the community. A resilient hospital should be able to resist, absorb, respond to, and recover from the impacts of disasters as well as continues its normal operation. Aim: This study aims to explore the main challenges for providing a resilient hospital in emergencies and disasters in context of Iran. Materials and Methods: This was a qualitative content analysis study. Interviews are in-depth and semi-structured. Each interview begins with open questions and questions become progressively narrowed based on the participants' responses. Six themes were initially formed based on analysing the primary codes. Themes were also composed of 21 categories and 20 sub-categories. Interviews were conducted with 18 experts {9 hospital managers and 3 doctors (Ph.D.) in emergency and disasters, 3 supervisors and 3 matrons} and analysed using qualitative inductive content analysis approach. Finally, an expert panel was conducted by a team of experts including 10 people {3 hospital managers and 2 doctors (Ph.D.) in emergency and disasters, and 5 supervisors}. Results: The main concepts which have been explored in the study include; lack of preparedness, continuity of essential service, non-coherent function, emotional response, developing functionality and non-resilient confrontation. Each concept includes several main categories, and main categories are also divided into several subcategories based on their field and according to their significant characteristics. Conclusion: Exploring the challenges which a hospital faces in emergencies and disasters that affect the normal operation of the hospital helps the disaster managers to improve their plans to handle the disaster situations. Findings show that the challenges of all phases of disaster management (such as prevention, preparedness, response, and recovery) must be considered by the disaster managers together. Since disaster situation is very stressful for both injured peoples and disaster management team, therefore, it is recommended that the psychological challenges of a resilient hospital after a disaster occurs are clarified.

مقدمه: رشته تخصص طب اورژانس در سال 1380 در ایران به دلیل نیاز به ایجاد یک رشته تخصصی برای پاسخ به نیازهای حیاتی بیماران به وجود آمد. با توجه به عمر کم این رشته و چالش‌های به وجود آمده از زمان ایجاد آن تا کنون، در این مطالعه به بررسی اهمیت، نیازها و چالش‌های وجود طب اورژانس در یک بیمارستان آموزشی پرداختیم. روش کار: مطالعه حاضر یک مطالعه کیفی است. در این مطالعه نمونه گیری به صورت هدفمند از بین متخصصین با سابقه رشته طب اورژانس و بنیان گذاران این رشته و مسئولین نظام سلامت صورت گرفت. مصاحبه با گروه‌های فوق به صورت نیمه ساختارمند و ملاک حجم نمونه اشباع در اطلاعات قرار گرفت و در نهایت کدهای مهم به صورت گروه و زیر گروه انتخاب شده و تحت آنالیز قرار گرفتند. یافته ها: در این مطالعه پس از مصاحبه با 12 فرد صاحب نظر در رشته طب اورژانس، اشباع اطلاعات حاصل شد. از مهم‌ترین نیازهای ایجاد رشته طب اورژانس نیاز به یک متخصص با دید جامع برای درمان بیماران بحرانی و یک مدیریت جامع برای اورژانس دیده شد و بزرگ‌ترین چالش‌ها تداخل مالی با سایر رشته‌ها و تداخل در حوزه کاری مشترک بود. نتیجه گیری: با توجه به مطالعه حاضر و بررسی‌های موجود و ورودی ماهانه بیش از 2 میلیون بیمار و مصدوم به بخش اورژانس، وجود متخصص اورژانس در بیمارستان‌های آموزشی پیشنهاد می‌شود.

The Emergency Medical Services (EMSs) are in the frontline between the health-care systems and people in emergencies and disasters. With the increase in the frequency of natural or man-made disasters around the world, the need for prepared EMS services is increasing. This study aimed to evaluate the current disaster preparedness status of the EMS agencies in the literature and exploring the key preparedness elements and the strategies to improve the EMS disaster preparedness. The electronic database such as PubMed, Web of Science, Scopus, and Google Scholar was searched from 2000 to 2019. The searching keywords included: “EMS,” “Disaster,” “Preparedness,” “Emergency” “Preparedness,” “Disaster Preparedness,” “Readiness,” and the terms related to “disaster types” were used in combination with Boolean operators OR and AND. Out of 1412 articles, 7 articles were included in the review. The most important elements of the EMS disaster preparedness include the size and scope of the incident, surge capacity, planning, communication, training and education, policymaking, financial support, coordination, safety and security, early warning system, disaster response experience, and legal considerations. This systematic review showed that the EMS agencies in the world generally are inadequately prepared for an effective response to major emergencies and disasters. This study provides valuable information to EMS educators, EMS administrators to adopt and perform appropriate activities to improve the EMS disaster preparedness.

مقدمه: رایج‌ترین روش کنترل درد بیماران پس از عمل جراحی قلب، استفاده از داروهای مخدر و داروهای ضد التهاب غیر استروئیدی می‌باشد. این مطالعه، با هدف بررسی اثرات بی‌دردی داروی پاراستامول وریدی که دارای حداقل عوارض سیستمیک می‌باشد، انجام شد. روش‌ها: در این کارآزمایی بالینی آینده‌نگر تصادفی و سه سو کور، بیماران در دو گروه مورد (پاراستامول) و شاهد قرار گرفتند. در گروه مورد (51 نفر) 15 دقیقه قبل از القای بیهوشی و سپس، هر 6 ساعت به مدت 3 روز، 1 گرم پاراستامول در 50 سی‌سی سرم نرمال سالین در مدت 15 دقیقه تزریق شد. در گروه شاهد (42 نفر) در کلیه‌ی مراحل تزریق، به جای داروی پاراستامول از نرمال سالین استفاده گردید. یافته‌ها: شدت درد در حالت استراحت در ساعت 24 (002/0 = P) و به دنبال دم عمیق در ساعت‌های 12 (001/0 = P)، 24 (001/0 > P) و 72 (031/0 = P) پس از ورود به بخش مراقبت‌های ویژه در گروه پاراستامول کاهش معنی‌داری داشت. از نظر میزان داروی مخدر تجویز شده حین عمل (246/0 = P) و بعد از عمل (853/0 = P) تفاوت معنی‌داری بین دو گروه وجود نداشت. نتیجه‌گیری: تجویز پاراستامول به صورت پیش‌دستانه، و ادامه‌ی تجویز آن در دوره‌ی بعد از عمل، باعث بهبود کیفیت کنترل درد داروهای مخدر می‌شود. البته قدرت اثر آن به اندازه‌ای نیست که نیاز به داروهای مخدر و آرام‌بخش و پیامدهای ناشی از این داروها را بتواند کاهش دهد.

مقدمه: مطالعه‌ی حاضر با هدف مقایسه‌ی اثرات همودینامیک انفوزیون تری‌نیتروگلیسرین و لابتالول در کنترل فشار خون و ضربان قلب، قبل و حین اینداکشن تا زمان ارست قلبی در بیماران تحت جراحی بای‌پس عروق کرونر (Coronary artery bypass grafting یا CABG) انجام شد. روش‌ها: در این مطالعه‌ی کارآزمایی بالینی، 70 بیمار کاندید عمل جراحی CABG، در دو گروه 35 نفره‌ی دریافت کننده‌ی انفوزیون نیتروگلیسرین و لابتالول قرار گرفتند. تغییرات همودینامیک، سطح گازهای خونی و بروز آریتمی‌های قلبی حین عمل و همچنین، میزان نیاز به داورهای آنتی‌آریتمیک، اینوتروپ، پک‌سل و DC شوک در دو گروه تعیین و مقایسه گردید. یافته‌ها: بروز آریتمی‌های قلبی در گروه نیتروگلیسرین، 9 مورد (7/25 درصد) و در گروه لابتالول 5 مورد (3/14 درصد) گزارش شد (370/0 = P). میزان نیاز به داروهای آنتی‌آریتمیک در دو گروه نیتروگلیسرین و لابتالول به ترتیب 9/22 و 9/2 درصد بود که اختلاف معنی‌داری بین دو گروه مشاهده شد (028/0 = P). نتیجه‌گیری: در عمل جراحی CABG، استفاده از لابتالول نسبت به نیتروگلیسرین ارجحیت دارد و در صورت عدم وجود منع مصرف، استفاده از آن در این عمل جراحی پیشنهاد می‌گردد.

INTRODUCTION: Disasters occur almost everywhere in the world, and preparation is essential. Preparedness is an effective approach for disaster management, and it is crucial for the health systems, especially the Emergency Medical Service (EMS) agencies. This systematic review will be conducted to assess the preparedness levels of EMS agencies in the world for the response to disasters and explore the key dimensions and strategies to enhance it. METHODOLOGY: This systematic literature review will be conducted to search comprehensively the articles published between 2000 and 2019 to explore the disaster preparedness of EMS Agencies. To this end, PubMed, Scopus, Web of Science, and Google Scholar will be thoroughly assessed. The following terms and expression will be used for searching the databases: “EMS” and other keywords “Disaster Preparedness,” “Mass Casualty Incident,” “Mass Gathering,” “Terrorist incident,” “Weapons of Mass Destruction,” and CBRNE, Disaster, included: 'Emergency Preparedness, Preparedness, Readiness. DISCUSSION: To the best of our knowledge, no systematic review study has been conducted on disaster preparedness of EMS agencies in the world. This is the first study to address this gape. It will also explore the key dimensions of disaster preparedness in EMS services and the strategies to enhance their preparedness. CONCLUSION: Identifying the key dimensions of disaster preparedness is the first step in designing valid assessment tools to evaluate disaster preparedness of EMS service. This study will provide valuable guides for EMS administrators and researchers in an attempt to enhance of preparedness of EMS systems in disasters.

Abdominal aortic aneurysm is a condition with a high mortality rate among those presenting to the emergency department. Its common symptoms include abdominal, back, and flank pain and hypotension and syncope are among its other manifestations. However, sometimes these patients present with uncommon manifestations. Considering this important point, we have introduced a patient with atypical manifestations in the present report. Initial diagnosis of this condition is based on high clinical suspicion and performing bedside abdominal ultrasonography. Diagnostic standard is abdominal computed tomography (CT) scan in patients with stable vital signs. The treatment is performing endovascular or open surgery and delay in treatment is accompanied with a high rate of mortality.

پارگی آنوریسم آئورت شکمی عارضه ای با میزان مورتالیتی بالا در مراجعه کنندگان به بخش اورژانس می باشد. علائم شایع آن شامل درد شکم، پشت و پهلوها بوده و هیپوتانسیون و سنکوپ از سایر تظاهرات آن می باشد. ولی گاها این بیماران با تظاهرات نامعمول مراجعه می کنند که با توجه به این مهم، در این گزارش به معرفی بیماری با تظاهرات آتیپیک پرداختیم. تشخیص اولیه این عارضه بر مبنای ظن بالینی بالا و انجام سونوگرافی شکمی بر بالین است. استاندارد تشخیصی سی تی اسکن شکمی در بیماران پایدار از نظر علائم حیاتی است. درمان انجام جراحی باز یا اندوواسکولار است و تاخیر در درمان با مرگ و میر بسیار بالایی همراه خواهد بود.

مقدمه: قسمت عمده ای از زندگی روزانه هر فرد صرف اشتغال به کار می شود و فعالیت کاری از نظر سلامت روانی شخص، امری مهم به حساب می آید. همواره عوامل متعددی به عنوان منابع فشار های روانی (استرس) در محیط کار وجود دارند و با توجه به اهميت مشکل فرسودگي شغلي و عواقب آن مطالعه حاضر با هدف بررسی شيوع و علل فرسودگي شغلي در دستیاران طب اورژانس در بیمارستان های دانشگاه ایران انجام شد. روش کار: این مطالعه مقطعی در بیمارستان حضرت رسول وابسته به دانشگاه علوم پزشکی ایران در طی سالهای 1393 تا 1396 انجام گرفت. نمونه گیری به شیوه سرشماری انجام شد و تمامی دستیاران طب اورژانس دانشگاه علوم پزشکی ایران در طی مدت انجام این در صورت تمایل و داشتن حداقل ٦ ماه سابقه کار در بخش اورژانس وارد مطالعه شدند. خوانا نبودن و یا مخدوش بودن پرسشنامه تکمیل شده به عنوان معیار خروج از مطالعه لحاظ گردید. اطلاعات پس از جمع آوری توسط نرم افزار SPSS-16 تحت روش های آماری مورد تجزیه و تحلیل قرار گرفت. يافته ها: در کل 83 دستیار طب اورژانس با میانگین سنی 4/3 ± 0/33 سال در مطالعه شرکت کردند که 45 نفر (2/54 درصد) زن بودند. از این تعداد 60 نفر (3/72 درصد) به رشته خود ابراز علاقه نمودند. متوسط میزان فرسودگی شغلی دستیاران با میانگین 13/19 ± 32/90 (محدوده بین 124- 26) نمره بود.. نتيجه گيری: میانگین فرسودگی شغلی در بین دستیاران مورد مطالعه در محدوده مطلوب بدست آمد و افزایش سن مهمترین عامل بالا رفتن شاخص فرسودگی شغلی ایشان بود.

Abstract: Background: Disaster management is relied on prediction of problems and providing necessary preparations in right time and place. In this study researchers intended to explore passed experiences of health disaster management. Method: This study conducted using qualitative content analysis methods. Participants were selected purposefully and data were collected through interviews, observation, and other documents. Results: Transcribed data from 18interviews, field notes and other documents were analyzed. In data analysis reactive management was emerged as main theme. It was included some categories such as ‘exposure shock’, ‘non deliberative relief’, ‘lack of comprehensive health disaster plan’, ‘lack of preparedness’, and ‘poor coordination in health service delivery’ and contextual factors. Discussion: The results clarified deep perception of participants’ experiences about health management in disasters. The professionals' and non-professionals' emotion-based reactions and behaviors, if accompanied with deficiencies in planning and preparedness, can lead to ineffective services, and aggravates the damages.

Background: The 5 th Iran National Development Plan, 2011-2015, has emphasized on expansion of rural asphalt roads. This article aims to illustrate the trend of deaths caused by rural road traffic crashes (RTCs) and its association with length of the rural roads in Iran. Methods: We carried out a retrospective analysis on secondary data for the period from 2005 to 2010. The Iranian Forensic Medicine Organization, High Commission for Road Safety and Iran′s Statistical Center were the sources for the number of RTC death, length of the road and population data, respectively. Results: Number of RTC deaths in rural roads increased from 1,672 in 2005 to 2,206 in 2010. This was associated with expansion of the rural asphalt roads (P = 0.04). The construction of urban asphalt roads was also on an increasing trend, but the number of traffic deaths in these roads decreased from 26,083 in 2005 to 21,043 in 2010. Adjusted for 100,000 populations, the number of traffic deaths in urban roads showed a decrease from 37.0 to 28.0, while this number increased from 2.4 to 2.9 in rural roads during the study period. Conclusions: Although expansion of rural roads would contribute to economic development in rural areas, it exposes people to risk of severe RTCs if effective preventive actions are not taken. To prevent this threat, the Iranian policy makers need to take the followings into consideration: Public awareness, improving the safety of roads and vehicles, law enforcement, increasing coverage of police and Emergency Medical Services.

INTRODUCTION: An important indicator increasing the survival chances of patients and injured people immediately after emergency and disaster is the rapid access to medical services. The establishment of Emergency and Disaster Medical Response Teams (EDMRTs) is one of the main strategies to improve response capacity and capability in the field of EDMRT. This study aimed to probe the structural factors influencing of EDMRTs. METHODOLOGY: In this study, a comparative review method was used. The current study was conducted between March 2017 and September 2018. For this, articles, books, formal reports, and information concerning the available websites regarding the structure of EDMRTs were analyzed. To access relevant scientific articles, an extensive search was carried out in several steps using divergent keywords in the Scopus, ProQuest, PubMed, ScienceDirect, and Google Scholar databases. After accessing the resources and documents, the process of analyzing and comparing different team structures was carried out using content analysis. RESULTS: Following the search of relevant databases and websites, the structure of EDMRTs in the United States, Australia, Japan, Turkey, New Zealand, Canada, and the World Health Organization were taken into consideration and compared. Two areas of “Organization and Management” as well as “Capacity and Capability Development” were explored along with multiple subsets. CONCLUSION: The results of this study revealed that the model and structure of EDMRTs have direct relationship with such elements as the structure of the disaster risk management system, risk assessment, impact of the hazards and medical needs of the affected area, population distribution, level of team activity, and timing of the teams' presence after disasters. The research team recommends designing and conducting studies for determine the roles and responsibilities of the teams.

Background: Acute poisoning is one of the most threatening health problems around the world. The purpose of this study was to evaluate the prevalence of intentional and unintentional poisoning in vulnerable groups in order to assist in planning and implementation of preventive measures. Methods: This cross-sectional study included 786 patients in vulnerable groups (children, women of reproductive ages and the elderly) with acute poisoning who attended the Emergency Department of Noor Hospital in Isfahan, Iran, during 2012. Findings: In 89.5% of cases, poisoning was intentional and 20.1% of these patients had a history of previous suicide attempts. Women at the age 19-44 were the most suicidal cases (95.1%). The most common medications were psychiatric drugs (51.9%). No significant difference was found between sexes, ingested drugs, and outcome between intentional and poisoning group compared to unintentional poisoning. Majority of patients recovered and the mortality rate was 0.5%. Conclusion: Our results showed that the women of reproductive ages were the most vulnerable groups at risk of intentional poisoning in our society that commit suicide by using drugs especially with psychiatric drugs. More attention and support for this vulnerable group is suggested.

Iran’s health system is expanding the disaster and emergency higher education programs over the country to enhance the capacity of human resources for effective and efficient disaster mitigation, preparedness, response and recovery. In this article we present an overview about the initiatives and progress of disaster and emergency health higher education in Iran. Following the Bam earthquake, in collaboration with the Ministry of Health & Medical Education and National Institute of Health Research, School of Public Health at the Tehran University of Medical Sciences, Iran took the initiative to develop a Master of Public Health (MPH) with disaster concentration in 2006, a PhD in disaster and emergency health in 2011, and a well constructed certificate course in 2008 entitled Disaster Health Management and Risk Reduction (DHMR). Iran, Kerman and Shahid Beheshti Universities of Medical Sciences and University of Social Welfare and Rehabilitation are other academia that joined this initiative. Regarding the importance of programs evaluation, we have planned for a comprehensive evaluation of MPH and DHMR programs in 2013-4 and the Accreditation and Evaluation Board of Disaster & Emergency Health, based in MOH&ME, is responsible for evaluation of the PhD program in 3-5 years from initiation.

Background: Poisoning is an important medical emergency. The purpose of this study was to portray the pattern of poisoning in Isfahan, Iran. Methods: This cross-sectional study included all patients (n = 402) with acute poisoning who attended the Emergency Department of Noor and Ali-Asghar hospitals in Isfahan, Iran, during 2008. The variables such as age, sex, residential location, educational level, type and cause of poisoning were reviewed and analyzed. Findings: The mean age of the cases was 26.5 ± 11.6 years and 54.7% of the patients were male. The majority of cases (92.8%) lived in urban areas. The main agent of poisoning was drugs and the most frequently involved drug groups were psychological drugs (33.8%). The most overall common route of exposure was ingestion (93.3%). The mortality rate was 2% while 91.3% were admitted due to suicidal attempts. No significant differences were observed in age, sex distribution, poisoning outcome or types between suicidal patients and others. However, the history of psychiatric diseases (P < 0.0001) and addiction (P = 0.02) were significantly more prevalent among suicidal patients. Conclusion: Attempted suicide was the most common route of poisoning which necessitates attention to the risk factors and prognostic factors of poisoning.

Background: On-pump coronary artery bypass graft (CABG) surgery impairs gas exchange in the early postoperative period. The main object on this study was evaluation of changes in arterial blood gas values in patients underwent on pump CABG surgery receiving different dose of intravenous nitroglycerin (NTG). Materials and Methods: sixty-seven consecutive patients undergoing elective on-pump CABG randomly enrolled into three groups receiving NTG 50 μg/min (Group N1, n =67), 100 μg/min (Group N2, n = 67), and 150 μg/min (Group N3, n = 67). Arterial blood gas (ABG) tensions were evaluated just before induction of anesthesia, during anesthesia, at the end of warming up period, and 6 h after admission to the intensive care unit. Results: Pao2 and PH had the highest value during surgery in Group N1, Group N2, and Group N3. No significant difference was noted in mean values of Pao2 and PH during surgery between three groups (P > 0.05). There was no significant difference in HCO3 values in different time intervals among three groups (P > 0.05). Conclusion: our results showed that infusing three different dosage of NTG (50, 100, and 150 μg/min) had no significant effect on ABG tensions in patients underwent on-pump CABG surgery.

Background: vulnerable events could damage structural, non structural and functional components of hospitals that might lead to community crisis, accordingly. Risk assessment is the first step to develop of a hospital disaster plan. In this study, a primary phase of developing a local tool for Iran's hospital disaster risk assessment entitled "Hospital Safety Index (HSI)" was conducted by World Health Organization originally. Materials and Methods: First, the original index was translated into Farsi in five forms and 145 items. Then a group of four experts from the fields of medicine and engineering assessed the items one-by-one for their relevance and applicability. Revised edition tested three times at Shariati hospital in Tehran. An expert panel also evaluated the feature and content validity of the index. They also weighted the items as well. Results: Test-retest of the index by two independent research groups found 93% of agreement. Furthermore, 244 points were revised or added to the original edition. The most important changes included: Combining instruction parts with related items for increasing educational properties, completing the list of hazards, developing a plan to analysis, and to present a quantitative and graphic of the model and finally to prepare an educational package as well. Conclusion: Persian version of HSI, in response to needs of Iranian's health system, represents a rapid no-expensive tool for screening disaster risks at hospitals based on an international template that was tested in several countries. Based on this study, the Farsi index would be evaluated in more hospitals around the country. The assessment results will provide Iranian's health system with evidence-based information for more effective allocated resources and interventions evaluating.

Background: Hemodynamic deterioration is a common postoperative problem. Intravenous nitroglycerin (NTG) is used for prevention of this complication. Nitroglycerin has different doses and is primarily a vasodilator. Applying different doses of intravenous NTG can induce different effects on post-operative cardiac instability, so we aimed to investigate whether there was a difference need for administration of inotrope drugs in patients undergoing CABG as indicators of cardiac instability. Methods: Sixty seven consecutive patients enrolled in this double-blind clinical trial performed in Shahid Rajaee hospital, Shahid Beheshti University of Medical Science, Tehran, Iran. Results: The decrease in blood pressure and the need for administration of epinephrine was more prevalent in warming up period in all three groups. No need for administration of epinephrine was detected before and during anesthesia in groups receiving 100 and 150 μg/min intravenous nitroglycerin, but 6.6 percent (1 patient) of patients receiving 50 μg/min epinephrine, demonstrated a decrease in blood pressure which necessitated the use of epinephrine. Conclusions: It seemed that application of different doses of intravenous nitroglycerin did not exert a significant influence on cardiac instability and the need for use of inotrope drugs.

Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: “degree of perceived risk in EMS staffs and their patients.” This theme consisted of two main categories: (1) patient’s condition’ and (2) the context of the EMS mission’. The patent’s condition category emerged from “physical health statuses,” “socioeconomic statuses,” and “cultural background” subcategories. The context of the EMS mission also emerged from two subcategories of “characteristics of the mission” and EMS staffs characteristics’. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients’ needs for transportation in a prehospital situation.