Publications by authors named "Gholamreza Masoumi"

28 Publications

  • Page 1 of 1

Effect of Beetroot Consumption on Serum Lipid Profile: A Systematic Review and Meta-Analysis.

Curr Probl Cardiol 2021 May 8:100887. Epub 2021 May 8.

Cardiac Rehabilitation Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Beetroot has recently become very popular among people as a medicinal superfood that decreases blood pressure and improves athletes' performance. The present meta-analysis aimed to investigate the effect of beetroot consumption on serum lipid profile. A literature search was conducted covering PubMed, ISI Web of Science, Scopus, and Google scholar of English human subject randomized clinical trials (RCT) up to December 2020. Pooled results showed that beetroot consumption had no significant effect on any of the variables. The mean difference (95% CI) between intervention and control groups for TC was 1.25 (-0.03, 2.53), for TG -0.47 (-1.16, 0.21), for HDL 0.54 (-0.13, 1.21) and for LDL was -0.48(-1.04, 0.09). Subgroup analysis by the health condition of subjects, the form of beetroot consumption, and type of intervention showed no significant differences. It can be concluded that beetroot cannot be categorized as an effective supplementation for adjustment of lipid profile.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpcardiol.2021.100887DOI Listing
May 2021

Prevalence of Return to Work in Cardiovascular Patients After Cardiac Rehabilitation: A Systematic Review and Meta-analysis.

Curr Probl Cardiol 2021 Apr 17:100876. Epub 2021 Apr 17.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

The present systematic review and meta-analysis aimed to clarify the effects of cardiac rehabilitation (CR) on the prevalence of return to work (RTW) in cardiovascular diseases (CVDs) patients. CR plays a very important role in the management of CVDs and improves the patients' physical activity, quality of life, and a decrease in the cost of healthcare. RTW is the most important goal in the rehabilitation of CVD patients. PubMed, Web of Science, Scopus, and Google scholar were searched systematically from inception up to January 2021 for English published clinical trials and observational studies. In total, 16 studies were analyzed, of them, 8 were controlled studies. Pooled results showed that the mean age of patients was 52.30 (50.04, 54.57). The prevalence of RTW in the CR attending group was 66% (60%, 71%) and in the control group was 58% (47%, 68%). Subgroup analysis showed that the proportion of RTW was higher in white-collars 76% (73%-79%) compared to. blue-collars 63% (56%-70%). Out-patient CR with 72% (61%-81%) RTW was more effective compared to in-patient CR with 62% (44%- 78%) and usual care (control). It can be concluded that CR especially out-patient CR increases the prevalence of RTW but not much. Improved and appropriate CR programs related to each individual's disease and patient condition which follow the valid guidelines might help to increase the effectiveness of CR in terms of RTW.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpcardiol.2021.100876DOI Listing
April 2021

Post-Hospital Discharge Strategy for COVID-19 Treatment and Control: Focus on Fangcang Hospitals.

Disaster Med Public Health Prep 2021 Mar 26:1-3. Epub 2021 Mar 26.

Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: One of the concerns of health managers in Iran in case COVID-19 reached a new peak is a shortage of hospital beds. In response, the country designed and created intermediate treatment centers, known as fangcang hospitals, which are prepared quickly at low cost and with high capacity. The aim of this study is to provide health managers with an effective post-hospital discharge strategy for COVID-19 patients.

Method: The study was conducted from April 2020 to June 2020, with a narrative case study design. Setting up a fangcang hospital was based on a narrative analysis of 2 in-depth interviews with 4 fangcang hospital managers in Iran, a field visit of these places, and a review of their protocols and guidelines.

Result: The patient flow for screening, treatment, and follow-up includes the following: Patients will be hospitalized if their symptoms are severe. If they are infected with mild symptoms, they will be referred to a fangcang hospital and admitted there if necessary, to prevent further spread of the disease. Patients will be monitored regularly and treated with routine health services. At the end of the 14-day quarantine period, patients approved for discharge are sent home.

Conclusion: Traditional hospitals and fangcang hospitals are working together under the supervision of the Iran University of Medical Sciences. Our experience can serve as guidance for other clinics and recovery shelters. Having guidelines in place assists health care workers and managers in responding quickly to patients' needs during times of a disaster.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/dmp.2021.83DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193180PMC
March 2021

Evaluating the disaster preparedness of emergency medical service agencies in the world: A systematic literature review protocol.

J Educ Health Promot 2020 29;9:351. Epub 2020 Dec 29.

MD National Emergency Medical Organization, Tehran, Iran.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jehp.jehp_416_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871916PMC
December 2020

Lessons Learned From a Chlorine Gas Leakage in Dezful City, Iran.

Disaster Med Public Health Prep 2020 Dec 9:1-7. Epub 2020 Dec 9.

Department of Nursing and Emergency Medicine, Dezful University of Medical Sciences, Dezful, Iran.

Dezful is the capital of Dezful County, a city in Khuzestan Province, Iran. On August 12, 2017, after a chlorine gas leakage in Dezful, more than 475 people were affected by chlorine gas, and they all suffered from respiratory complications. A lot of problems were encountered in the preparation of the relief forces and organization of the blueprint on how to respond to the incident, such as lack of knowledge on establishment of danger zone, lack of warning system, lack of proper triage and absence of decontamination plans, lack of special chemical safety outfit and respiratory equipment for rescuers, lack of instructions for proper handling, lack of knowledge in dealing with this type of disaster, and inappropriate evacuation skills and failure to cordon off and insure the location of the incident. Although the initial measures to arrest this crisis was performed based on the health system's instructions of the country with regard to all the possible risks, lack of a comprehensive inter-organizational program and prevention plans, lack of control plans, lack of adequate preparation and response to chemical poisoning, lack of foresight, lack of a risk plan, and lack of an intervention plan for these incidents were the reasons for the damages and problems encountered after the crisis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/dmp.2020.284DOI Listing
December 2020

Disaster Preparedness among Emergency Medical Service Providers: A Systematic Review Protocol.

Emerg Med Int 2020 26;2020:6102940. Epub 2020 Oct 26.

Health in Emergency and Disaster Research Center, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

. 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. . 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." . 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).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2020/6102940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683168PMC
October 2020

A Systematic Review and Meta-analysis on the Prevalence of Smoking Cessation in Cardiovascular Patients After Participating in Cardiac Rehabilitation.

Curr Probl Cardiol 2021 Mar 24;46(3):100719. Epub 2020 Sep 24.

Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Smoking is the most important modifiable cardiovascular risk factor causes around approximately one of every 4 cardiovascular-related deaths worldwide. Cardiac rehabilitation (CR) is the standard way of management of heart diseases after myocardial infraction. This study aimed to determine the prevalence of cardiovascular patients' quit smoking after participation in CR. PubMed, EMBASE, Web of Science, Scopus, and google scholar were searched systematically. In total, 18 studies were analyzed. Results showed that the mean age of smokers' were 54.80 (52.06, 57.55), and of them 53 % (22%, 83%) quit smoking after participating in CR. Subgroup analysis showed that among type of CR the most effective one was the educational along with physical exercise (comprehensive CR) cause 99% (98%, 100%) smoking cessation (SC). Group-based methods with76% (57%, 94%) of quitters showed to be more effective than individual-based. It can be concluded that CR has been effective in terms of smoking cessation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cpcardiol.2020.100719DOI Listing
March 2021

Hospital Preparedness Challenges in Biological Disasters: A Qualitative Study.

Disaster Med Public Health Prep 2020 Nov 5:1-5. Epub 2020 Nov 5.

Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Objective: Identification of hospital preparedness challenges against biological events such as coronavirus disease 2019 (COVID-19) is essential to improve dynamics, quality, and business continuity confidence in the health system. Accordingly, the purpose of the present study is to evaluate the challenges of hospital preparedness in biological events.

Methods: This study used a qualitative method using content analysis in which 20 health-care managers and experts who are experienced in biological events were selected through purposeful sampling. The data collection was done through semi-structured interviews, which continued until data saturation. The data were analyzed using qualitative content analysis as well as the Landman and Graneheim Approach.

Results: Six main concepts (training and practice, resource management, safety and health, patient management, risk communication, and laboratory and surveillance) and 14 subconcepts were extracted on hospital preparedness challenges in biological events through analyzing interviews.

Conclusions: The present study indicated that the health system of the country faces many challenges in response to biological events and threats. Moreover, study participants indicated that Iranian hospitals were not prepared for biological events. It is recommended to design preparedness plans of hospitals based on preparedness standards for biological events. In addition, comprehensive measures are required to enhance their capacity to respond to biological emergencies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/dmp.2020.434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900656PMC
November 2020

Investigation of the relationship between end-tidal carbon dioxide and partial arterial carbon dioxide pressure in patients with respiratory distress.

Med J Islam Repub Iran 2020 24;34:67. Epub 2020 Jun 24.

Department of Internal Medicine, Hazrat Rasool-e-Akram Hospital, Iran University of Medical Sciences and Health Services, Tehran, Iran.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.34171/mjiri.34.67DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500426PMC
June 2020

Combination of liver enzymes, amylase and abdominal ultrasound tests have acceptable diagnostic values as an alternative test for abdominopelvic CT scan in blunt abdominal trauma.

Open Access Emerg Med 2019 22;11:205-210. Epub 2019 Aug 22.

Emergency Medicine Management Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Abdominal trauma accounts for 15-20% of all-cause mortality of trauma. Abdominopelvic CT scan with intravenous contrast is considered the most accurate non-invasive diagnostic tool in detecting intra-abdominal injuries. In previous studies, rise in liver enzymes and amylase was associated with intra-abdominal injuries but the studies were not sufficient. Our aim was to assess the diagnostic values of liver enzymes and amylase for intra-abdominal injuries in blunt trauma patients.

Methods: We included blunt abdominal trauma patients who referred to three teaching hospitals in 2018. The patients who had 14 years old or more and Glasgow Coma Scale above 8 were enrolled the study if the treating physician had high index of suspicion for intra-abdominal injuries and sent the patients for abdominopelvic CT scan with intravenous contrast. Sensitivity, specificity, positive and negative predictive values are calculated for results of liver enzymes, amylase and abdominal ultrasound.

Results: Eventually, 300 patients with blunt abdominal trauma entered the study. Sensitivity, specificity, positive and negative predictive values of concurrent positive results of abdominal ultrasound, amylase and liver enzymes were 81.73 (95% CI, 73.2-88.1), 63.78 (95% CI, 65.36-70.61), 58.38 (95% CI, 56.36-70.61) and 84.89 (95% CI, 77.6-90.19), respectively.

Conclusion: Considering findings of the present study, the combination of liver enzymes, amylase and abdominal ultrasound results can be an alternative method for detecting intra-abdominal injuries in patients in whom treating physicians have limitations such as overweight, instability of hemodynamic and lack of CT scan facility.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OAEM.S207066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709808PMC
August 2019

What structural factors influencing emergency and disaster medical response teams? A comparative review study.

J Educ Health Promot 2019 27;8:110. Epub 2019 Jun 27.

Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jehp.jehp_24_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615133PMC
June 2019

Are serial hematocrit measurements sensitive enough to predict intra-abdominal injuries in blunt abdominal trama?

Open Access Emerg Med 2019 7;11:9-13. Epub 2019 Jan 7.

Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran,

Objective: Routine serial hematocrit measurements are a component of the trauma evaluation for patients without serious injury identified on initial evaluation. We sought to determine whether serial hematocrit testing was useful in predicting the probable injuries in blunt abdominal trauma.

Materials And Method: We performed a prospective study of trauma patients admitted in our observation unit over a 12-month period. Patients routinely underwent serial hematocrit testing in 6-hour intervals (two hematocrit levels). We compared trauma patients with a hematocrit drop of 5 and 10 points or more to those without a significant hematocrit drop.

Results: Five hundred forty-two isolated blunt abdominal trauma patients were admitted to observation unit, and 468 patients (86.35%) had serial hematocrit during their 6-hour stay. Of these patients, 36.11% had a hematocrit drop of 5 or more and 12.61% a drop of 10 or more. Of patients with the hematocrit drop >10, 50.8% have had diagnostic manifestations of intra-abdominal injury in both ultrasonographic and computed tomography scanning (<0.001). There was no significant correlation between hematocrit drop >5 and positive imaging.

Conclusion: Although serial hematocrit testing may be useful in specific situations, routine use of serial hematocrit testing in trauma patients at a level I trauma center's observation unit did not significantly aid in the prediction of occult injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OAEM.S180398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327898PMC
January 2019

Effect of cardiac rehabilitation on inflammation: A systematic review and meta-analysis of controlled clinical trials.

ARYA Atheroscler 2018 Mar;14(2):85-94

Assistant Professor, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22122/arya.v14i2.1489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087630PMC
March 2018

Development and Psychometric Evaluation of the Pre-hospital Medical Emergencies Early Warning Scale.

Indian J Crit Care Med 2017 Apr;21(4):205-212

Department of School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Introduction: The number of requests for emergency medical services (EMSs) has increased during the past decade. However, most of the transports are not essential. Therefore, it seems crucial to develop an instrument to help EMS staff accurately identify patients who need pre-hospital care and transportation. The aim of this study was to develop and evaluate the psychometric properties of the Pre-hospital Medical Emergencies Early Warning Scale (Pre-MEWS).

Materials And Methods: This mixed-method study was conducted in two phases. In the first phase, a qualitative content analysis study was conducted to identify the predictors of medical patients' need for pre-hospital EMS and transportation. In the second phase, the face and the content validity as well as the internal consistency of the scale were evaluated. Finally, the items of the scale were scored and scoring system was presented.

Results: The final version of the scale contained 22 items and its total score ranged from 0 to 54.

Conclusions: Pre-MEWS helps EMS staffs properly understand medical patients' conditions in pre-hospital environments and accurately identify their need for EMS and transportation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijccm.IJCCM_49_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5416787PMC
April 2017

The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery.

J Res Med Sci 2016 7;21:113. Epub 2016 Nov 7.

Department of Perfusion, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Cardiopulmonary bypass is associated with increased fluid accumulation around the heart which influences pulmonary and cardiac diastolic function. The aim of this study was to compare the effects of modified ultrafiltration (MUF) versus conventional ultrafiltration (CUF) on duration of mechanical ventilation and hemodynamic status in children undergoing congenital heart surgery.

Materials And Methods: A randomized clinical trial was conducted on 46 pediatric patients undergoing cardiopulmonary bypass throughout their congenital heart surgery. Arteriovenous MUF plus CUF was performed in 23 patients (intervention group) and sole CUF was performed for other 23 patients (control group). In MUF group, arterial cannula was linked to the filter inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was filtered and returned via cardioplegia line to the right atrium. Different parameters including hemodynamic variables, length of mechanical ventilation, Intensive Care Unit (ICU) stay, and inotrope requirement were compared between the two groups.

Results: At immediate post-MUF phase, there was a statistically significant increase in the mean arterial pressure, systolic blood pressure, and diastolic blood pressure ( < 0.05) only in the study group. Furthermore, there was a significant difference in time of mechanical ventilation ( = 0.004) and ICU stay ( = 0.007) between the two groups. Inotropes including milrinone ( = 0.04), epinephrine ( = 0.001), and dobutamine ( = 0.002) were used significantly less frequently for patients in the intervention than the control group.

Conclusion: Administration of MUF following surgery improves hemodynamic status of patients and also significantly decreases the duration of mechanical ventilation and inotrope requirement within 48 h after surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/1735-1995.193504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331766PMC
November 2016

Heparinized and Saline Solutions in the Maintenance of Arterial and Central Venous Catheters After Cardiac Surgery.

Anesth Pain Med 2015 Aug 22;5(4):e28056. Epub 2015 Aug 22.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Heparinized saline solution is used to prevent occlusion in the arterial catheters and central venous pressure monitoring catheters. Even at low dose, heparin administration can be associated with serious complications. Normal saline solution can maintain patency of arterial catheters and central venous pressure monitoring catheters.

Objectives: The current study aimed to compare the efficacy of normal saline with that of heparinized one to maintain patency of arterial and central venous catheters after cardiac surgery.

Patients And Methods: In the current randomized controlled trial, 100 patients, with an age range of 18 - 65 years of valve and coronary artery surgery were studied in Rajaie heart center, Tehran, Iran. Patients were randomized to receive either heparinized saline (n = 50) or normal saline flush solutions (n = 50). In the study, arterial catheters and central venous pressure monitoring catheters were daily checked for any signs of occlusion in three postoperative days as primary end-point of the study.

Results: According to the information obtained from the study, four (8%) arterial catheters in the saline group (P value: 0.135) and three (6%) arterial catheters in the heparin group (P value = 0.097) were obstructed. Statistical analysis showed that the incidence of obstruction and changes in all other parameters between the two groups during the three-day follow-up was not significant (all P values > 0.05).

Conclusions: It seems that there is no difference in the use of heparinized and normal saline solutions to prevent catheter occlusion of arterial and central venous pressure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/aapm28056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604422PMC
August 2015

Traffic accidents in Iran, a decade of progress but still challenges ahead.

Med J Islam Repub Iran 2014 16;28:96. Epub 2014 Sep 16.

11. MD, Assistant Professor of Emergency Medicine, Injury Control Research Center, Shohada-e-haft Tir hospital , Iran University of Medical Sciences, Iran.

Iran has had incremental incidence of traffic accident mortality since introduction of mechanization about a century ago. But the newest data from Iran show decrease in the absolute number of deaths, death per 10,000 vehicles and death per 100, 000 populations. Despite its huge impact on health and economy, research in the field of traffic crashes is still scant and there are still deficiencies in problem oriented research on traffic accidents. Actual cooperation of policy makers, executive bodies and academician could build platform for intersectoral discussion of different aspects of traffic accidents and could reduce burden of traffic accidents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301220PMC
February 2015

Insulin infusion on postoperative complications of coronary artery bypass graft in patients with diabetes mellitus.

Res Cardiovasc Med 2014 May 1;3(2):e17861. Epub 2014 Apr 1.

Department of Anesthesiology, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.

Background: Cardiovascular events are common in patients with diabetes mellitus (DM), which make coronary artery bypass graft (CABG) a highly demanded surgery in this population. Tight control of blood glucose in patients with DM is beneficial in reducing postoperative complications; however, the adequate range has not been determined yet.

Objectives: This study aimed to investigate the effect of semi-tight (moderate) control of DM on complications and serum glucose levels during and after CABG.

Patients And Methods: In this prospective clinical trial, 18 and 31 patients with and without DM, respectively, who were referred to Shahid Chamran Hospital, Isfahan, Iran, for elective CABG surgery, were enrolled. For DM group, patients with controlled DM (i.e. glycosylated hemoglobin levels [HgA1C] ≤ 7%) were recruited. Blood glucose level (blood sugar, BS) was measured after anesthesia, during pumping, warming, off pumping, six and 12 hours after Intensive Care Unit (ICU) admission, and at discharging from the hospital. The hemodynamic state of the patients, bleeding, need of blood transfusion, infection, and duration of hospitalization were also monitored and recorded.

Results: None of the BS measurements (FBS, after anesthesia, on-pump, warming, off pump, six and 12 hours after ICU admission, and at discharge) were significantly different between study groups (P > 0.05). Frequency of surgery site bleeding and blood transfusion need were not significantly different between these groups (P > 0.05).

Conclusions: Semi-tight control of DM with insulin infusion during operation did not led to any difference in the type and rate of CABG complications between patients with well-controlled and those without DM; however, BS levels in patients with well-controlled DM could be more easily controlled.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/cardiovascmed.17861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253788PMC
May 2014

Effects of Moderate Glycemic Control in Type II Diabetes With Insulin on Arterial Blood Gas Parameters Following Coronary Artery Bypass Graft Surgery.

Res Cardiovasc Med 2014 May 10;3(2):e17857. Epub 2014 May 10.

Department of Anesthesiology, Shahid Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, IR Iran.

Background: Coronary artery bypass grafting (CABG) is one of the common surgeries in patients with coronary artery disease (CAD). It is more probable for patients with diabetes to undergo surgeries due to CAD and they have a higher mortality rate compared to the others.

Objectives: The aim of the present study was to assess the effects of insulin infusion therapy on blood gas parameters in two groups of patients, eligible for CABG, defined as A: well controlled diabetes (HbA1C < 7%) and B: non-diabetic patients.

Patients And Methods: We followed two groups of patients, defined as patients with and without diabetes who were candidates for CABG, between March 2010 and March 2012. Patients with diabetes underwent moderate or semi-tight glycemic control, using continuous intravenous insulin infusion.

Results: There were 13 male and 18 female subjects in the on-diabetic group and 11 male and 7 female patients in the controlled diabetic group. There was no significant difference between the studied participants regarding age, cardiac ejection fraction, blood pH and PO2 and PCO2 levels.

Conclusions: CABG surgery adversely affects arterial blood gas (ABG) determinations. On the other hand, findings showed there is no significant difference in the ABG parameters between patients with well controlled diabetes and the ones without.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5812/cardiovascmed.17857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253793PMC
May 2014

Physiological-social scores in predicting outcomes of prehospital internal patients.

Emerg Med Int 2014 14;2014:312189. Epub 2014 Sep 14.

Emergency Department, 7th Tir Hospital, Iran University of Medical Sciences, Tehran, Iran.

The physiological-social modified early warning score system is a newly developed instrument for the identification of patients at risk. The aim of this study was to investigate the feasibility of using the physiological-social modified early warning score system for the identification of patients that needed prehospital emergency care. This prospective cohort study was conducted with 2157 patients. This instrument was used as a measure to detect critical illness in patients hospitalised in internal wards. Judgment by an emergency medicine specialist was used as a measure of standard. Data were analyzed by using receiver operating characteristics curves and the area under the curve with 95% confidence interval. The mean score of the physiological-social modified early warning score system was 2.71 ± 3.55. Moreover, 97.6% patients with the score ≥ 4 needed prehospital emergency services. The area under receiver operating characteristic curve was 0.738 (95% CI = 0.708-0.767). Emergency medical staffs can use PMEWS ≥ 4 to identify those patients hospitalised in the internal ward as at risk patients. The physiological-social modified early warning score system is suggested to be used for decision-making of emergency staff about internal patients' wards in EMS situations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2014/312189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178906PMC
October 2014

Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities.

Emerg Med Int 2014 7;2014:215329. Epub 2014 May 7.

Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2014/215329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033513PMC
June 2014

Deadly rural road traffic injury: a rising public health concern in I.R. Iran.

Int J Prev Med 2014 Feb;5(2):241-4

Disaster and Emergency Management Center, Ministry of Health and Medical Education, Tehran, Iran.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950751PMC
February 2014

Hospitals safety from disasters in I.R.iran: the results from assessment of 224 hospitals.

PLoS Curr 2014 Feb 28;6. Epub 2014 Feb 28.

Disaster & Emergency Management Center, Ministry of Health & Medical Education, Tehran, Iran.

Background And Objective: Iran's hospitals have been considerably affected by disasters during last decade. To address this, health system of I.R.Iran has taken an initiative to assess disaster safety of the hospitals using an adopted version of Hospital Safety Index (HSI). This article presents the results of disaster safety assessment in 224 Iran's hospitals.

Methods: A self-assessment approach was applied to assess the disaster safety in 145 items categorized in 3 components including structural, non-structural and functional capacity. For each item, safety level was categorized to 3 levels: not safe (0), average safe (1) and high safe (2). A raw score was tallied for each safety component and its elements by a simple sum of all the corresponding scores. All scores were normalized on a 100 point scale. Hospitals were classified to three safety classes according to their normalized total score: low (≤34.0), average (34.01-66.0) and high (>66.0).

Results: The average score of all safety components were 32.4 out of 100 (± 12.7 SD). 122 hospitals (54.5%) were classified as low safe and 102 hospitals (45.5%) were classified as average safe. No hospital was placed in the high safe category. Average safety scores out of 100 were 27.3 (±14.2 SD) for functional capacity, 36.0 (±13.9 SD) for non-structural component and 36.0 (±19.0 SD) for structural component. Neither the safety classes nor the scores of safety components were significantly associated with types of hospitals in terms of affiliation, function and size (P>0.05).

Conclusions: To enhance the hospitals safety for disaster in Iran, we recommend: 1) establishment of a national committee for hospital safety in disasters; 2) supervision on implementation of the safety standards in construction of new hospitals; 3) enhancement of functional readiness and safety of non-structural components while structural retrofitting of the existing hospitals is being taken into consideration, whenever is cost-effective; 4) considering the disaster safety status as the criteria for licensing and accreditation of the hospitals. Key words: Hospital, safety, disaster, emergency, Iran Correspondence to: Ali Ardalan MD, PhD. Tehran University of Medical Sciences, Harvard Humanitarian Initiative, Email: [email protected], [email protected]
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/currents.dis.8297b528bd45975bc6291804747ee5dbDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938570PMC
February 2014

Life recovery after disasters: a qualitative study in the Iranian context.

Prehosp Disaster Med 2013 Dec;28(6):573-9

1 University of Social Welfare & Rehabilitation Sciences, Tehran, Iran.

Introduction: Planned and organized long-term rehabilitation services should be provided to victims of a disaster for social integration, economic self-sufficiency, and psychological health. There are few studies on recovery and rehabilitation issues in disaster situations. This study explores the disaster-related rehabilitation process.

Method: This study was based on qualitative analysis. Participants included 18 individuals (eight male and ten female) with experience providing or receiving disaster health care or services. Participants were selected using purposeful sampling. Data were collected through in-depth and semi-structured interviews. All interviews were transcribed and content analysis was performed based on qualitative content analysis.

Results: The study explored three main concepts of recovery and rehabilitation after a disaster: 1) needs for health recovery; 2) intent to delegate responsibility; and 3) desire for a wide scope of social support. The participants of this study indicated that to provide comprehensive recovery services, important basic needs should be considered, including the need for physical rehabilitation, social rehabilitation, and livelihood health; the need for continuity of mental health care; and the need for family re-unification services. Providing social activation can help reintegrate affected people into the community.

Conclusion: Effective rehabilitation care for disaster victims requires a clear definition of the rehabilitation process at different levels of the community. Involving a wide set of those most likely to be affected by the process provides a comprehensive, continuous, culturally sensitive, and family-centered plan.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1049023X1300900XDOI Listing
December 2013

Higher education initiatives for disaster and emergency health in iran.

Iran J Public Health 2013 1;42(6):635-8. Epub 2013 Jun 1.

Dept. of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Dept. of Disaster & Emergency Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3744261PMC
August 2013

Effect of different dosages of nitroglycerin infusion on arterial blood gas tensions in patients undergoing on- pump coronary artery bypass graft surgery.

J Res Med Sci 2012 Feb;17(2):123-7

Assistant Professor, Department of Cardiology, Shahid Rajaee Hospital, Isfahan University of Medical Science, Isfahan, Iran.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525027PMC
February 2012

2012-2025 Roadmap of I.R.Iran's Disaster Health Management.

PLoS Curr 2012 Jul 16;4:e4f93005fbcb34. Epub 2012 Jul 16.

Objective: In line with Iran's Comprehensive Health Sector Road Map, the National Institute of Health Research at the Tehran University of Medical Sciences developed the 2012-2025 road map of Disaster Health Management (DHM), including goals and objectives, strategies, activities and related prerequisites. This article presents the process and results of this road mapping project.

Methods: The project started with an expanded literature review followed by stakeholder analysis to assess level of interest and impact of related organizations to DHM; STEEP.V methodology to define determinants with a potential impact on Iran's HDM for duration of 2012 to 2025; strength, weakness, opportunity and threat (SWOT) analysis and formulation of goals and objectives, strategies, activities, and prerequisites. Brainstorming, group discussion and interviews with key informants were used for data collection; nominal group technique was used whenever prioritization was necessary, and Delphi panel methodology was applied for consensus development.

Results: STEEP.V analysis revealed the most important Social, Technological, Environmental, Economic, Political and Value-based determinants. Iran's DHM mission and vision were defined respectively as "Mitigation from, preparedness for, response to and recovery from consequences of natural and man-made hazards at the community level as well as to the health facilities and resources of I.R.Iran" and "In 2025, Iran's DHM will be the most developed system in the region resulting in the least vulnerability, the highest readiness in health facilities and resources, and the highest and most effective contribution of the Iranian community to disaster resilience", respectively. Sixteen strategies and related activities, along with the necessary prerequisites, were developed.

Conclusions: This was the first attempt at comprehensive strategic planning in the field of DHM in Iran. The current framework provides Iran's health system with a list of strategies and activities to be considered in operational planning and actions. However, a dynamic process of evaluation and revision is required to ensure that Iran's health system goals are met by 2025. Address for correspondence: Ali Ardalan, No. 78, Italia Ave, Department of Disaster and Emergency Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran. Email: [email protected] or [email protected]

Citation: Ardalan A, Rajaei MH, Masoumi G, Azin A, Zonoobi V, Sarvar M, Vaskoei Eshkevari K, Ahmadnezhad E, Jafari G. 2012-2025 Roadmap of I.R.Iran's Disaster Health Management. PLoS Currents Disasters. 2012 Jul 16.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/4f93005fbcb34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426065PMC
July 2012

Evaluating hemodynamic outcomes of different dosages of intravenous nitroglycerin after coronary artery bypass graft surgery.

J Res Med Sci 2011 Jul;16(7):910-5

Assistant Professor, Department of Cardiac Anesthesiology, Shahid Rajaee Hospital, Isfahan University of Medical Science, Isfahan, Iran.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263104PMC
July 2011