Pub Date : 2023-01-01DOI: 10.22037/aaem.v11i1.1839
Marie Kristine Jessen, Anna Drescher Petersen, Hans Kirkegaard
Introduction: Sepsis is a life-threatening and common cause of Emergency department (ED) referrals. Out-of-hour staffing is limited in ED, which may potentially affect fluid administration. This study aimed to investigate fluid volume variation in out-of-hour vs. routine-hour admissions.
Methods: The present study is a post-hoc analysis of a multicentre, prospective, observational study investigating fluid administration in ED patients with suspected infection, from Jan 20th - March 2nd, 2020. Patient groups were "routine-hours" (RH): weekdays 07:00-18:59 or "out-of-hours" (OOH): weekdays 19:00-06:59 or Friday 19:00-Monday 06:59. Primary outcome was 24-hour total fluid volumes (oral + intravenous (IV)). Secondary outcomes were total fluids 0-6 hours, oral fluids 0-6 and 0-24 hours, and IV fluids 0-6 and 0-24 hours. Linear regression adjusted for site and illness severity was used.
Results: 734 patients had suspected infection; 449 were admitted during RH and 287 during OOH. Mean (95% CI) total 24-hour fluid volumes were equal in simple infection and sepsis regardless of admission time: Simple infection RH: 3640 (3410 - 3871) ml and OOH: 3681 (3451 - 3913) ml. Sepsis RH: 3671 (3443;3898) ml and OOH: 3896 (3542;4250) ml. Oral fluids 0-6h were reduced in simple infection and sepsis among OOH vs. RH. Sepsis patients received more 0-6-hour IV fluid when admitted OOH vs. RH. There were no associations between admission time and 0-24-hour oral or IV volumes in simple infection or sepsis.
Conclusion: Admission time did not have an association with 24-hour total fluid volumes. Sepsis patients admitted during OOH received more 0-6-hour IV fluids than RH patients, and simple infection and sepsis patients received less oral fluid in 0-6 hours if admitted during OOH vs. RH.
{"title":"Effect of Out-Of-Hour Admission on Fluid Treatment of Emergency Department Patients with Suspected Infection; a Multicenter Post-Hoc Analysis.","authors":"Marie Kristine Jessen, Anna Drescher Petersen, Hans Kirkegaard","doi":"10.22037/aaem.v11i1.1839","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.1839","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis is a life-threatening and common cause of Emergency department (ED) referrals. Out-of-hour staffing is limited in ED, which may potentially affect fluid administration. This study aimed to investigate fluid volume variation in out-of-hour vs. routine-hour admissions.</p><p><strong>Methods: </strong>The present study is a post-hoc analysis of a multicentre, prospective, observational study investigating fluid administration in ED patients with suspected infection, from Jan 20<sup>th</sup> - March 2<sup>nd,</sup> 2020. Patient groups were \"routine-hours\" (RH): weekdays 07:00-18:59 or \"out-of-hours\" (OOH): weekdays 19:00-06:59 or Friday 19:00-Monday 06:59. Primary outcome was 24-hour total fluid volumes (oral + intravenous (IV)). Secondary outcomes were total fluids 0-6 hours, oral fluids 0-6 and 0-24 hours, and IV fluids 0-6 and 0-24 hours. Linear regression adjusted for site and illness severity was used.</p><p><strong>Results: </strong>734 patients had suspected infection; 449 were admitted during RH and 287 during OOH. Mean (95% CI) total 24-hour fluid volumes were equal in simple infection and sepsis regardless of admission time: Simple infection RH: 3640 (3410 - 3871) ml and OOH: 3681 (3451 - 3913) ml. Sepsis RH: 3671 (3443;3898) ml and OOH: 3896 (3542;4250) ml. Oral fluids 0-6h were reduced in simple infection and sepsis among OOH vs. RH. Sepsis patients received more 0-6-hour IV fluid when admitted OOH vs. RH. There were no associations between admission time and 0-24-hour oral or IV volumes in simple infection or sepsis.</p><p><strong>Conclusion: </strong>Admission time did not have an association with 24-hour total fluid volumes. Sepsis patients admitted during OOH received more 0-6-hour IV fluids than RH patients, and simple infection and sepsis patients received less oral fluid in 0-6 hours if admitted during OOH vs. RH.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e21"},"PeriodicalIF":5.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/e3/aaem-11-e21.PMC10008217.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9617183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.22037/aaem.v11i1.1774
Mohammad Reza Asgary, Sayid Mahdi Mirghazanfari, Ebrahim Hazrati, Vahid Hadi, Mojgan Mehri Ardestani, Faeze Bani Yaghoobi, Saeid Hadi
<p><strong>Introduction: </strong>Effective parenteral and enteral amino acid replacement is crucial for critically ill patients with altered amino acid metabolism. This study aimed to assess the effects of l-citrulline supplementation on the clinical and laboratory outcomes in critically patients.</p><p><strong>Methods: </strong>This was a double-blind placebo-controlled randomized clinical trial. 82 critically ill patients who were expected to receive mechanical ventilation for more than 72 hours were selected. The patients were assigned to either a placebo or an intervention group. The patients in the placebo group received 10 gr of microcrystalline cellulose and the ones in the intervention group were given l-citrulline daily for 7 days. Serum levels of fasting blood sugar (FBS), lipid profile, hepatic enzymes, serum electrolytes, urea nitrogen, creatinine, and C-reactive protein (CRP) were evaluated before and after the intervention. Duration of invasive ventilation, intensive care unit (ICU) length of stay, ventilator-free days, and 28-day mortality rate were recorded and compared between groups.</p><p><strong>Results: </strong>Eighty-two patients completed the trial. No statistically significant differences were observed between the two groups in terms of age (p = 0.46), sex (p = 0.49), body mass index (BMI) (p = 0.41), Sequential Organ Failure Assessment (SOFA) Score (p = 0.08), Clinical Pulmonary Infection Score (CPIS) score (p = 0.76), Acute Physiology and Chronic Health Evaluation (APACHE II) score (p = 0.58), risk factors (p = 0.13), ICU stay before randomization (p = 0.32), and reason of admission (p = 0.50) before the intervention. Citrulline group had a notable reduction in FBS (p = 0.04), total cholesterol (TC) (p = 0.02), low density lipoprotein (LDL-C) (p <0.001) and high-sensitivity CRP (hs-CRP) (p <0.001). Also, a significant increase in lactate dehydrogenase (LDH) concentration (p <0.001) was observed in the intervention group at the end of the trial. Total duration of invasive ventilation and the mean SOFA score on 7th day were significantly lower in the citrulline group compared to the control group. Moreover, a significant increase in days alive and ventilator-free days within 28 days after admission was found in the citrulline group at the end of the trial. Also, there were no significant differences between the groups in terms of mortality rate during intervention, serious adverse events, endotracheal intubation, the use of tracheotomy or non-invasive ventilation after extubation, length of ICU stay, ICU-free days at 28 days, and CPIS and APACHE II scores. For mortality, in the citrulline group, there was two deaths compared to eight deaths in the control group. This resulted in an absolute risk reduction (ARR) of 14.05% (95% CI: 0.39-27.71%) and a number needed to treat (NNT) of 7.1 (95% CI: 3.6-29.5), regarding mortality.</p><p><strong>Conclusions: </strong>The results of the present study demonstrated the probable pos
{"title":"The Effect of L-Citrulline Supplementation on Outcomes of Critically Ill Patients under Mechanical Ventilation; a Double-Blind Randomized Controlled Trial.","authors":"Mohammad Reza Asgary, Sayid Mahdi Mirghazanfari, Ebrahim Hazrati, Vahid Hadi, Mojgan Mehri Ardestani, Faeze Bani Yaghoobi, Saeid Hadi","doi":"10.22037/aaem.v11i1.1774","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.1774","url":null,"abstract":"<p><strong>Introduction: </strong>Effective parenteral and enteral amino acid replacement is crucial for critically ill patients with altered amino acid metabolism. This study aimed to assess the effects of l-citrulline supplementation on the clinical and laboratory outcomes in critically patients.</p><p><strong>Methods: </strong>This was a double-blind placebo-controlled randomized clinical trial. 82 critically ill patients who were expected to receive mechanical ventilation for more than 72 hours were selected. The patients were assigned to either a placebo or an intervention group. The patients in the placebo group received 10 gr of microcrystalline cellulose and the ones in the intervention group were given l-citrulline daily for 7 days. Serum levels of fasting blood sugar (FBS), lipid profile, hepatic enzymes, serum electrolytes, urea nitrogen, creatinine, and C-reactive protein (CRP) were evaluated before and after the intervention. Duration of invasive ventilation, intensive care unit (ICU) length of stay, ventilator-free days, and 28-day mortality rate were recorded and compared between groups.</p><p><strong>Results: </strong>Eighty-two patients completed the trial. No statistically significant differences were observed between the two groups in terms of age (p = 0.46), sex (p = 0.49), body mass index (BMI) (p = 0.41), Sequential Organ Failure Assessment (SOFA) Score (p = 0.08), Clinical Pulmonary Infection Score (CPIS) score (p = 0.76), Acute Physiology and Chronic Health Evaluation (APACHE II) score (p = 0.58), risk factors (p = 0.13), ICU stay before randomization (p = 0.32), and reason of admission (p = 0.50) before the intervention. Citrulline group had a notable reduction in FBS (p = 0.04), total cholesterol (TC) (p = 0.02), low density lipoprotein (LDL-C) (p <0.001) and high-sensitivity CRP (hs-CRP) (p <0.001). Also, a significant increase in lactate dehydrogenase (LDH) concentration (p <0.001) was observed in the intervention group at the end of the trial. Total duration of invasive ventilation and the mean SOFA score on 7th day were significantly lower in the citrulline group compared to the control group. Moreover, a significant increase in days alive and ventilator-free days within 28 days after admission was found in the citrulline group at the end of the trial. Also, there were no significant differences between the groups in terms of mortality rate during intervention, serious adverse events, endotracheal intubation, the use of tracheotomy or non-invasive ventilation after extubation, length of ICU stay, ICU-free days at 28 days, and CPIS and APACHE II scores. For mortality, in the citrulline group, there was two deaths compared to eight deaths in the control group. This resulted in an absolute risk reduction (ARR) of 14.05% (95% CI: 0.39-27.71%) and a number needed to treat (NNT) of 7.1 (95% CI: 3.6-29.5), regarding mortality.</p><p><strong>Conclusions: </strong>The results of the present study demonstrated the probable pos","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e11"},"PeriodicalIF":5.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/65/c3/aaem-11-e11.PMC9807954.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10500462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Differentiating the soft tissue abscess from other types of skin and soft tissue infections (SSTIs) poses a particular challenge because they have similar physical evaluation findings, but each disease has a different course, outcome, and treatment. This meta-analysis aimed to investigate the diagnostic accuracy of point-of-care ultrasonography for diagnosis of soft tissue abscess in the emergency departments.
Methods: A comprehensive literature search of MEDLINE, Scopus, Web of Science, Embase, and Google Scholar, from inception to January 2023, was conducted to identify relevant studies investigating the diagnostic performance of point-of-care ultrasonography for identification of abscess. Methodological quality of the included studies was assessed using a revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2).
Results: The pooled estimates of diagnostic parameters of ultrasonography for diagnosis of abscess were as follows: sensitivity, 0.93 (95% CI: 0.92-0.94); specificity, 0.87 (95% CI: 0.85-0.89), and the area under the summary receiver-operating characteristic (SROC), 0.95. The pooled sensitivity, specificity, and area under the SROC of studies in adult patients were 0.98 (95% CI: 0.92-1), 0.92 (95% CI: 0.86-0.95), and 0.99, respectively. The pooled sensitivity, specificity, and area under the SROC of studies in pediatric patients were 0.9 (95% CI: 0.87-0.92), 0.78 (95% CI: 0.73-0.82), and 0.91, respectively.
Conclusion: Our meta-analysis demonstrated that the point-of-care ultrasonography has excellent diagnostic value for the abscess in the emergency department. Furthermore, we found that the diagnostic performance of point-of-care ultrasonography for diagnosis of abscess was higher for adult cases than for pediatric patients.
{"title":"Point-Of-Care Ultrasonography for Identification of Skin and Soft Tissue Abscess in Adult and Pediatric Patients; a Systematic Review and Meta-Analysis.","authors":"Erfan Rahmani, Ehsan Fayyazishishavan, Arian Afzalian, Sanaz Varshochi, Reza Amani-Beni, Seyed-Amirabbas Ahadiat, Zeynab Moshtaghi, Seyyed-Ghavam Shafagh, Roya Khorram, Elnaz Asadollahzade, Raihaneh Atbaei, Mohammad Saeed Kahrizi, Atoosa Rahbari, Negar Baharlouie, Farzaneh Mostanbet, Bahamin Amirabadiquchani, Moein Kiani, Mozhdeh Memarizadeh, Shahin Keshtkar Rajabi, Reza Barati, Hengame Hajinouri, Shahrzad Najafi, Zeynab Abdollahi, Nahid Dadashzadehasl, Atousa Moghadam Fard, Mozhgan Afshar, Atefeh Abedi, Sara Saeidi, Adeleh Mansourirad, Pedram Emami Shahrezaei, Sepideh Shah Hosseini, Zahra Rostami Ghotbabadi, Reza Vafadar, Roozbeh Roohinezhad, Nogol Ghalamkarpour, Mehrdad Farrokhi","doi":"10.22037/aaem.v11i1.2021","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.2021","url":null,"abstract":"<p><strong>Introduction: </strong>Differentiating the soft tissue abscess from other types of skin and soft tissue infections (SSTIs) poses a particular challenge because they have similar physical evaluation findings, but each disease has a different course, outcome, and treatment. This meta-analysis aimed to investigate the diagnostic accuracy of point-of-care ultrasonography for diagnosis of soft tissue abscess in the emergency departments.</p><p><strong>Methods: </strong>A comprehensive literature search of MEDLINE, Scopus, Web of Science, Embase, and Google Scholar, from inception to January 2023, was conducted to identify relevant studies investigating the diagnostic performance of point-of-care ultrasonography for identification of abscess. Methodological quality of the included studies was assessed using a revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2).</p><p><strong>Results: </strong>The pooled estimates of diagnostic parameters of ultrasonography for diagnosis of abscess were as follows: sensitivity, 0.93 (95% CI: 0.92-0.94); specificity, 0.87 (95% CI: 0.85-0.89), and the area under the summary receiver-operating characteristic (SROC), 0.95. The pooled sensitivity, specificity, and area under the SROC of studies in adult patients were 0.98 (95% CI: 0.92-1), 0.92 (95% CI: 0.86-0.95), and 0.99, respectively. The pooled sensitivity, specificity, and area under the SROC of studies in pediatric patients were 0.9 (95% CI: 0.87-0.92), 0.78 (95% CI: 0.73-0.82), and 0.91, respectively.</p><p><strong>Conclusion: </strong>Our meta-analysis demonstrated that the point-of-care ultrasonography has excellent diagnostic value for the abscess in the emergency department. Furthermore, we found that the diagnostic performance of point-of-care ultrasonography for diagnosis of abscess was higher for adult cases than for pediatric patients.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e49"},"PeriodicalIF":5.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c4/10/aaem-11-e49.PMC10440756.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10055732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.22037/aaem.v11i1.2001
Ali Kabiri, Pantea Gharin, Seyed Ali Forouzannia, Koohyar Ahmadzadeh, Reza Miri, Mahmoud Yousefifard
Introduction: Several scoring systems have been proposed to predict the outcomes of patients with ischemic heart disease. Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk Factors, and Troponin (HEART) scores are two of the more widely used risk prediction tools in patients with acute coronary syndrome (ACS). The present systematic review and meta-analysis aimed to compare the value of GRACE and HEART scores in the outcome prediction of ACS patient.
Method: The online databases of Medline, Embase, Web of Science, and Scopus were search until September 2022 for articles directly comparing GRACE and HEART scores value in prediction of outcome in patients with ACS. GRACE score cut-offs were categorized into two groups of less than and equal to 100 and more than 100, and HEART score cut-offs were categorized into three groups of less than 4, equal to 4, and more than 4. Investigated outcomes were major adverse cardiovascular events (MACE), acute myocardial infraction (AMI) and all-cause mortality.
Results: 25 articles were included. The sensitivity and specificity of the GRACE score for prediction of MACE were 0.96 and 0.26 for cut-offs of ≤ 100, and 0.58 and 0.69 for cut-offs of >100, respectively. The sensitivity and specificity of the HEART score for prediction of MACE were 0.99 and 0.16 for cut-offs less than 4, 0.93 and 0.47 for equal to 4, and 0.77 and 0.78 for cut-offs greater than 4. GRACE score was shown to be predictive of AMI with sensitivity and specificity of 0.95 and 0.29, respectively. The analysis for the value of HEART score in the prediction of AMI a sensitivity and specificity of 0.94 and 0.48, respectively. The risk scores were not found to be suitable predictors of all-cause mortality.
Conclusion: The results demonstrated the low specificity of GRACE and HEART scores in predicting the MACE, AMI and all-cause mortality, irrespective of the utilized cut-off. Considering the acceptable sensitivity of two scores in predicting the MACE and AMI, these scores were more suitable to be used as a rule-out tool for identification of ACS patients with low risk of developing adverse outcomes.
已经提出了几种评分系统来预测缺血性心脏病患者的预后。全球急性冠状动脉事件登记(GRACE)和病史、心电图、年龄、危险因素和肌钙蛋白(HEART)评分是急性冠状动脉综合征(ACS)患者中两种更广泛使用的风险预测工具。本系统综述和荟萃分析旨在比较GRACE和HEART评分在ACS患者预后预测中的价值。方法:检索Medline、Embase、Web of Science和Scopus等在线数据库,检索到2022年9月前直接比较GRACE和HEART评分对ACS患者预后预测价值的文章。GRACE评分截止点分为小于等于100分和大于100分两组,HEART评分截止点分为小于4分、等于4分和大于4分三组。研究结果为主要不良心血管事件(MACE)、急性心肌梗死(AMI)和全因死亡率。结果:共纳入25篇文章。GRACE评分预测MACE的敏感度和特异度在临界值≤100时分别为0.96和0.26,在临界值>100时分别为0.58和0.69。cut off小于4时,HEART评分预测MACE的敏感性和特异性分别为0.99和0.16;cut off等于4时,敏感性和特异性分别为0.93和0.47;cut off大于4时,敏感性和特异性分别为0.77和0.78。GRACE评分预测AMI的敏感性和特异性分别为0.95和0.29。HEART评分预测AMI的敏感性和特异性分别为0.94和0.48。风险评分不适合作为全因死亡率的预测指标。结论:结果显示GRACE和HEART评分在预测MACE、AMI和全因死亡率方面的特异性较低,与使用的截止值无关。考虑到两种评分在预测MACE和AMI方面的可接受敏感性,这两种评分更适合作为一种排除工具,用于识别发生不良结局风险较低的ACS患者。
{"title":"HEART versus GRACE Score in Predicting the Outcomes of Patients with Acute Coronary Syndrome; a Systematic Review and Meta-Analysis.","authors":"Ali Kabiri, Pantea Gharin, Seyed Ali Forouzannia, Koohyar Ahmadzadeh, Reza Miri, Mahmoud Yousefifard","doi":"10.22037/aaem.v11i1.2001","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.2001","url":null,"abstract":"<p><strong>Introduction: </strong>Several scoring systems have been proposed to predict the outcomes of patients with ischemic heart disease. Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk Factors, and Troponin (HEART) scores are two of the more widely used risk prediction tools in patients with acute coronary syndrome (ACS). The present systematic review and meta-analysis aimed to compare the value of GRACE and HEART scores in the outcome prediction of ACS patient.</p><p><strong>Method: </strong>The online databases of Medline, Embase, Web of Science, and Scopus were search until September 2022 for articles directly comparing GRACE and HEART scores value in prediction of outcome in patients with ACS. GRACE score cut-offs were categorized into two groups of less than and equal to 100 and more than 100, and HEART score cut-offs were categorized into three groups of less than 4, equal to 4, and more than 4. Investigated outcomes were major adverse cardiovascular events (MACE), acute myocardial infraction (AMI) and all-cause mortality.</p><p><strong>Results: </strong>25 articles were included. The sensitivity and specificity of the GRACE score for prediction of MACE were 0.96 and 0.26 for cut-offs of ≤ 100, and 0.58 and 0.69 for cut-offs of >100, respectively. The sensitivity and specificity of the HEART score for prediction of MACE were 0.99 and 0.16 for cut-offs less than 4, 0.93 and 0.47 for equal to 4, and 0.77 and 0.78 for cut-offs greater than 4. GRACE score was shown to be predictive of AMI with sensitivity and specificity of 0.95 and 0.29, respectively. The analysis for the value of HEART score in the prediction of AMI a sensitivity and specificity of 0.94 and 0.48, respectively. The risk scores were not found to be suitable predictors of all-cause mortality.</p><p><strong>Conclusion: </strong>The results demonstrated the low specificity of GRACE and HEART scores in predicting the MACE, AMI and all-cause mortality, irrespective of the utilized cut-off. Considering the acceptable sensitivity of two scores in predicting the MACE and AMI, these scores were more suitable to be used as a rule-out tool for identification of ACS patients with low risk of developing adverse outcomes.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e50"},"PeriodicalIF":5.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/13/7b/aaem-11-e50.PMC10440758.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10061426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: To identify the strengths and weaknesses of emergency medicine residency curriculum in Iran, and to benefit from the experiences of successful universities, comparative studies are crucial. This study compared the components of the national curriculum of emergency medicine in the United States, Canada, the European Union, Australia, and Saudi Arabia with Iran.
Method: Data for this research was collected by searching the websites of different universities and also contacting them for requesting curriculums. The leading countries in emergency medicine and one of the countries in the Middle East region (Saudi Arabia) along with the World Federation of Emergency Medicine were selected as the sample. The model used in this field is a range model that identifies four stages of description, interpretation, proximity, and comparison in comparative studies.
Results: In the curriculum of the United States, Canada, the European Union, Australia, and Saudi Arabia, there were lots of similarities in expressing the general characteristics of the curriculum, mission elements, vision, values, and beliefs of the discipline, educational strategy, techniques, expected competencies, rotation programs, and evaluation method, which were also similar to the Iranian curriculum. However, the duration of residency for emergency medicine in Iran is three years, which is shorter than other countries. As expected, the number and duration of rotations are less than other countries. Also, the process of entering into this field is different in Iran and is based on an exam for entrance, while most other countries use self-requested residency program.
Conclusion: Considering the results of comparing the Iranian curriculum with the curriculums of the United States, Canada, the European Union, Australia, and Saudi Arabia, it seems that Iran's program is comprehensive and complete; but, a reappraisal of the course duration and entering options are necessary to eliminate or improve the inadequacies.
{"title":"Comparing the Emergency Medicine Residency Programs in Iran and around the World; a Descriptive Study.","authors":"Mahdi Talebi, Morteza Talebi Doluee, Mohamadali Jafari, Hamid Zamani Moghaddam, Mahdi Foroughian, Mojtaba Moazzami, Hassan Gholami, Hamidreza Reihani","doi":"10.22037/aaem.v11i1.1867","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.1867","url":null,"abstract":"<p><strong>Introduction: </strong>To identify the strengths and weaknesses of emergency medicine residency curriculum in Iran, and to benefit from the experiences of successful universities, comparative studies are crucial. This study compared the components of the national curriculum of emergency medicine in the United States, Canada, the European Union, Australia, and Saudi Arabia with Iran.</p><p><strong>Method: </strong>Data for this research was collected by searching the websites of different universities and also contacting them for requesting curriculums. The leading countries in emergency medicine and one of the countries in the Middle East region (Saudi Arabia) along with the World Federation of Emergency Medicine were selected as the sample. The model used in this field is a range model that identifies four stages of description, interpretation, proximity, and comparison in comparative studies.</p><p><strong>Results: </strong>In the curriculum of the United States, Canada, the European Union, Australia, and Saudi Arabia, there were lots of similarities in expressing the general characteristics of the curriculum, mission elements, vision, values, and beliefs of the discipline, educational strategy, techniques, expected competencies, rotation programs, and evaluation method, which were also similar to the Iranian curriculum. However, the duration of residency for emergency medicine in Iran is three years, which is shorter than other countries. As expected, the number and duration of rotations are less than other countries. Also, the process of entering into this field is different in Iran and is based on an exam for entrance, while most other countries use self-requested residency program.</p><p><strong>Conclusion: </strong>Considering the results of comparing the Iranian curriculum with the curriculums of the United States, Canada, the European Union, Australia, and Saudi Arabia, it seems that Iran's program is comprehensive and complete; but, a reappraisal of the course duration and entering options are necessary to eliminate or improve the inadequacies.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e13"},"PeriodicalIF":5.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1f/05/aaem-11-e13.PMC9807940.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10507413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.22037/aaem.v11i1.2056
Shadi Ashtari, Alireza Hasanzadeh, Alireza Bahmani, Ali Abdolrazaghnejad
Introduction: Distal forearm fractures' realignment and fixation is a painful procedure. This study aimed to compare the efficacy of periosteal nerve block and intravenous morphine in distal radius and ulna fractures' pain management.
Methods: In the present randomized, parallel, double-blind, controlled clinical trial, patients with distal radius or ulna fractures were divided into two groups. In the first group, for periosteal nerve block, 1% lidocaine was injected at a distance of 6 to 8 cm near the wrist from the lateral radius and medial ulna. In the second group, morphine sulfate at a dose of 0.1 mg/kg was slowly injected through the peripheral vein within 5 minutes. The visual analog scale (VAS) score was evaluated before the intervention and every 15 minutes until 90 minutes after the intervention and was compared between the two groups.
Results: 75 subjects were studied (39 in the periosteal nerve block and 36 in the intravenous morphine group). There were no significant differences between the groups in terms of mean age (p = 0.384), gender distribution (p = 0.464), past medical history (p = 0.106), trauma type (p = 0.836), fracture type (p = 0.613), and baseline pain severity on VAS (p = 0.987). Both methods reduced the VAS scores during the 90 minutes of the study. The mean pain scores of the patients in the periosteal nerve block group with 2.56±1.44, 2.15±1.11, 2.66±1.26, and 3±1.27 at 15, 30, 45, and 60 minutes after the analgesic injection, respectively, were significantly lower than those of the intravenous morphine group with 4.75±1.27, 4.22±1.22, 3.97±1.27, and 4.13±1.35, respectively (p < 0.001 for all comparisons). In the present study, no local or systemic complications were observed in the periosteal nerve block group, while the complications of dyspnea, vomiting, and pruritus were reported by 5.5%, 2.8%, and 2.8%, respectively, in the intravenous morphine group. Moreover, the percentage of need for additional analgesia in the intravenous morphine group was higher than that of the periosteal nerve block group.
Conclusion: In the first hour after the intervention, pain reduction in periosteal block was significantly higher than intravenous morphine administration. Also, the incidence of complications and the need for additional analgesia were lower in the periosteal block group compared to intravenous morphine administration.
{"title":"Periosteal Nerve Block Vs. Intravenous Morphine in Pain Relief of Distal Radius and Ulna Fracture; a Double-Blind Randomized Clinical Trial.","authors":"Shadi Ashtari, Alireza Hasanzadeh, Alireza Bahmani, Ali Abdolrazaghnejad","doi":"10.22037/aaem.v11i1.2056","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.2056","url":null,"abstract":"<p><strong>Introduction: </strong>Distal forearm fractures' realignment and fixation is a painful procedure. This study aimed to compare the efficacy of periosteal nerve block and intravenous morphine in distal radius and ulna fractures' pain management.</p><p><strong>Methods: </strong>In the present randomized, parallel, double-blind, controlled clinical trial, patients with distal radius or ulna fractures were divided into two groups. In the first group, for periosteal nerve block, 1% lidocaine was injected at a distance of 6 to 8 cm near the wrist from the lateral radius and medial ulna. In the second group, morphine sulfate at a dose of 0.1 mg/kg was slowly injected through the peripheral vein within 5 minutes. The visual analog scale (VAS) score was evaluated before the intervention and every 15 minutes until 90 minutes after the intervention and was compared between the two groups.</p><p><strong>Results: </strong>75 subjects were studied (39 in the periosteal nerve block and 36 in the intravenous morphine group). There were no significant differences between the groups in terms of mean age (p = 0.384), gender distribution (p = 0.464), past medical history (p = 0.106), trauma type (p = 0.836), fracture type (p = 0.613), and baseline pain severity on VAS (p = 0.987). Both methods reduced the VAS scores during the 90 minutes of the study. The mean pain scores of the patients in the periosteal nerve block group with 2.56±1.44, 2.15±1.11, 2.66±1.26, and 3±1.27 at 15, 30, 45, and 60 minutes after the analgesic injection, respectively, were significantly lower than those of the intravenous morphine group with 4.75±1.27, 4.22±1.22, 3.97±1.27, and 4.13±1.35, respectively (p < 0.001 for all comparisons). In the present study, no local or systemic complications were observed in the periosteal nerve block group, while the complications of dyspnea, vomiting, and pruritus were reported by 5.5%, 2.8%, and 2.8%, respectively, in the intravenous morphine group. Moreover, the percentage of need for additional analgesia in the intravenous morphine group was higher than that of the periosteal nerve block group.</p><p><strong>Conclusion: </strong>In the first hour after the intervention, pain reduction in periosteal block was significantly higher than intravenous morphine administration. Also, the incidence of complications and the need for additional analgesia were lower in the periosteal block group compared to intravenous morphine administration.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e51"},"PeriodicalIF":5.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/a1/aaem-11-e51.PMC10475742.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10170198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.22037/aaem.v11i1.2097
Payam Emami, Karim Javanmardi
The emergency medical dispatcher (EMD) serves as a crucial link between individuals in need of emergency medical assistance and the emergency medical services (EMS) resource delivery system. Through their expertise and training, EMDs are able to accurately assess emergency situations, provide appropriate guidance over the phone, and dispatch the necessary EMS personnel to the scene. With adequate training, program management, supervision, and medical guidance, the EMD can accurately assess the caller’s needs, choose an appropriate response approach, furnish relevant information to responders, and offer suitable assistance and guidance to patients through the caller. By diligently adhering to a written and medically approved EMD protocol, informed decisions regarding EMS responses can be made in a reliable, replicable, and fair manner (1, 2). Artificial intelligence (AI) is the concept of a computer program that utilizes existing information to make decisions and enhances its performance based on accumulated experience. Machine learning (ML), a crucial aspect of AI,
{"title":"Enhancing Emergency Response through Artificial Intelligence in Emergency Medical Services Dispatching; a Letter to Editor.","authors":"Payam Emami, Karim Javanmardi","doi":"10.22037/aaem.v11i1.2097","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.2097","url":null,"abstract":"The emergency medical dispatcher (EMD) serves as a crucial link between individuals in need of emergency medical assistance and the emergency medical services (EMS) resource delivery system. Through their expertise and training, EMDs are able to accurately assess emergency situations, provide appropriate guidance over the phone, and dispatch the necessary EMS personnel to the scene. With adequate training, program management, supervision, and medical guidance, the EMD can accurately assess the caller’s needs, choose an appropriate response approach, furnish relevant information to responders, and offer suitable assistance and guidance to patients through the caller. By diligently adhering to a written and medically approved EMD protocol, informed decisions regarding EMS responses can be made in a reliable, replicable, and fair manner (1, 2). Artificial intelligence (AI) is the concept of a computer program that utilizes existing information to make decisions and enhances its performance based on accumulated experience. Machine learning (ML), a crucial aspect of AI,","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e60"},"PeriodicalIF":5.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/67/a9/aaem-11-e60.PMC10475749.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10225842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.22037/aaem.v11i1.1850
Razan I Nassar
Introduction: One type of the developed COVID-19 vaccines that received emergency permission and was approved by the food and drug administration (FDA) is the mRNA-based vaccine. The aim of this study is to gather information on the Jordanian population's experience with the vaccine's side effects.
Methods: The study objectives were addressed through a cross-sectional study, which collected information regarding the short-term side effects experienced by the vaccinated individuals within one month following the injection of an mRNA-based COVID-19 vaccine. Data collection was carried out in August 2021. Participants were invited to take part in a self-administered web-based survey created using Google Forms.
Results: Among the study's participants (n= 533), about 56% experienced side effects after the first dose of the mRNA-based COVID-19 vaccine. The most commonly reported side effects after the first dose were sore arm at the injection site (91.6%), and fatigue (83.06%). The female gender was significantly associated with experiencing fatigue, discomfort, chills, and hair loss. Being over 30 years old was significantly associated with experiencing cough. Being a smoker was significantly associated with experiencing shortness of breath and gastrointestinal symptoms.
Conclusion: The mRNA-based COVID-19 vaccine side effects were common, yet, mild, local, and self-limited. The local pain at the injection site was the most commonly reported side effect. Hopefully, the study's findings will aid in lowering resistance to vaccination.
{"title":"Short-term Side Effects of mRNA-based COVID-19 Vaccine Among Jordanian Population; a Cross-sectional Study.","authors":"Razan I Nassar","doi":"10.22037/aaem.v11i1.1850","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.1850","url":null,"abstract":"<p><strong>Introduction: </strong>One type of the developed COVID-19 vaccines that received emergency permission and was approved by the food and drug administration (FDA) is the mRNA-based vaccine. The aim of this study is to gather information on the Jordanian population's experience with the vaccine's side effects.</p><p><strong>Methods: </strong>The study objectives were addressed through a cross-sectional study, which collected information regarding the short-term side effects experienced by the vaccinated individuals within one month following the injection of an mRNA-based COVID-19 vaccine. Data collection was carried out in August 2021. Participants were invited to take part in a self-administered web-based survey created using Google Forms.</p><p><strong>Results: </strong>Among the study's participants (n= 533), about 56% experienced side effects after the first dose of the mRNA-based COVID-19 vaccine. The most commonly reported side effects after the first dose were sore arm at the injection site (91.6%), and fatigue (83.06%). The female gender was significantly associated with experiencing fatigue, discomfort, chills, and hair loss. Being over 30 years old was significantly associated with experiencing cough. Being a smoker was significantly associated with experiencing shortness of breath and gastrointestinal symptoms.</p><p><strong>Conclusion: </strong>The mRNA-based COVID-19 vaccine side effects were common, yet, mild, local, and self-limited. The local pain at the injection site was the most commonly reported side effect. Hopefully, the study's findings will aid in lowering resistance to vaccination.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e22"},"PeriodicalIF":5.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/dc/aaem-11-e22.PMC10008238.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9128877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 25-year-old female with no significant past medical history presented to the emergency room with complaints of worsening, sharp, periumbilical pain for two days, with an intensity of 8 out of 10 based on the visual analogue scale. She complained of fever, nausea, anorexia, and multiple episodes of non-bloody, non-bilious emesis. The patient appeared unwell and diaphoretic. Her vital signs were as follows, blood pressure of 108/66 mmHg, heart rate of 106 beats/minute and body temperature of 39.3°C. Physical examination showed a distended abdomen with localized tenderness and guarding in the periumbilical region.
{"title":"An Adult Female with Periumbilical Pain and Intractable Vomiting; a Photo quiz.","authors":"Hamzah Adel Ramawad, Amirmohammad Toloui, Adelaide Viguri","doi":"10.22037/aaem.v11i1.1849","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.1849","url":null,"abstract":"A 25-year-old female with no significant past medical history presented to the emergency room with complaints of worsening, sharp, periumbilical pain for two days, with an intensity of 8 out of 10 based on the visual analogue scale. She complained of fever, nausea, anorexia, and multiple episodes of non-bloody, non-bilious emesis. The patient appeared unwell and diaphoretic. Her vital signs were as follows, blood pressure of 108/66 mmHg, heart rate of 106 beats/minute and body temperature of 39.3°C. Physical examination showed a distended abdomen with localized tenderness and guarding in the periumbilical region.","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e7"},"PeriodicalIF":5.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/81/c3/aaem-11-e7.PMC9807944.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10514379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.22037/aaem.v11i1.2006
Kazım Ersin Altınsoy, Mehmet Murat Oktay
In this study, a patient who developed acute hepatitis due to drinking Pistacia vera L. bud tea is presented. A twenty-eight-year-old woman who had just come out of the postpartum period applied to our clinic with complaints of nausea, vomiting, loss of appetite and weakness. Blood serum alanine aminotransferase and aspartate aminotransferase levels were increased. All serological tests were negative for viral hepatitis and autoimmune diseases. She had been drinking an herbal tea containing Pistacia vera L. bud every day for four weeks to increase milk production. Three weeks after discontinuation of herbal tea, liver enzymes returned to normal. Based on our knowledge, this is probably the first hepatitis report due to the use of an herbal tea containing Pistacia vera L. bud.
{"title":"Acute Hepatitis Associated with Intake of Pistacia Vera L. Bud Tea; a Case Report.","authors":"Kazım Ersin Altınsoy, Mehmet Murat Oktay","doi":"10.22037/aaem.v11i1.2006","DOIUrl":"https://doi.org/10.22037/aaem.v11i1.2006","url":null,"abstract":"<p><p>In this study, a patient who developed acute hepatitis due to drinking Pistacia vera L. bud tea is presented. A twenty-eight-year-old woman who had just come out of the postpartum period applied to our clinic with complaints of nausea, vomiting, loss of appetite and weakness. Blood serum alanine aminotransferase and aspartate aminotransferase levels were increased. All serological tests were negative for viral hepatitis and autoimmune diseases. She had been drinking an herbal tea containing Pistacia vera L. bud every day for four weeks to increase milk production. Three weeks after discontinuation of herbal tea, liver enzymes returned to normal. Based on our knowledge, this is probably the first hepatitis report due to the use of an herbal tea containing Pistacia vera L. bud.</p>","PeriodicalId":8146,"journal":{"name":"Archives of Academic Emergency Medicine","volume":"11 1","pages":"e35"},"PeriodicalIF":5.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/74/fc/aaem-11-e35.PMC10197915.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9557406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}