Development and evaluation of an e-learning course in oxygen therapy

BACKGROUND

Respiratory problems are among the most challenging situations in emergency care services. Different oxygen therapy methods are usually used to deal with these problems. In recent years, oxygen therapy has been recognized as one of the most widely used therapeutic processes in emergency departments (ED) mainly due to the Covid-19 pandemic. The aim of this study was to develop and evaluate an e-learning course in oxygen therapy for the ED clinicians.

METHODS

This was a pre-post study conducted in three phases in 2021. Initially, the educational requirements of clinicians (n = 181) were investigated using a questionnaire, and in the second phase, an interactive e-learning course was developed. In the third phase, the course was assessed in terms of maintaining the principles of developing an e-learning course, affecting participants' knowledge, and supporting usability requirements.

RESULTS

The findings revealed that training in oxygen therapy was essential for the ED clinicians. Therefore, an e-learning course was developed. The content production experts and the participants evaluated the content and usability of the online course at a good level. In addition, there was a statistically significant difference between the nurses' (p < 0.001) and general practitioners' (p < 0.002) pre- and post-test scores suggesting that the course improved their knowledge.

CONCLUSION

It seems that the e-learning course developed in the current study can improve health care professionals' knowledge and quality of care. However, more evaluation studies are needed to investigate the effectiveness of the course for other clinicians, such as nurses who work in intensive care units.

The Value of Lactate Dehydrogenase in Predicting Rhabdomyolysis-Induced Acute Renal Failure; a Narrative Review

Introduction

Determining the diagnostic value of available biomarkers in predicting rhabdomyolysis-induced acute kidney injury (AKI) is a priority. This study aimed to review the current evidence about the value of lactate dehydrogenase (LDH) in this regard.

Methods

In this narrative review, the papers in PubMed, Embase, and web of science were studied. The keywords prognosis, prognoses, prognostic, LDH, rhabdomyolysis, emergency patients, and acute kidney failure or AKI had been selected from MeSH medical dictionary. Related papers written in English and published from November 2007 to December 2020 were selected.

Results

Finally, 14 articles were accepted for analysis. Among the selected articles, four were randomized clinical trials, seven were cross-sectional, and three were case-control studies. The results of the present review showed that abuse of illegal drugs is the most common cause of rhabdomyolysis. AKI is the most serious complication of rhabdomyolysis reported in the studies. These studies have shown a three-fold increase in AKI following drug-induced rhabdomyolysis. The review of the included articles shows that high LDH can predicts AKI, especially in critical and emergency situations such as rhabdomyolysis where there is a risk of death if diagnosed late. These studies show that LDH increases in the presence of renal failure and tissue damage.

Conclusion

Serum LDH is an appropriate and cost-effective prognostic indicator that can be used for risk classification of patients at risk for rhabdomyolysis-induced AKI.

Comparison of serum lead level of opium dependent patients with a healthy control group

Introduction: The prevalence of multiple symptoms, including mental illness, symptoms that mimic diseases such as pancreatitis, nonspecific abdominal pain and cholecystitis, are high in drug-dependent patients. Objectives: The aim of this study was to consider the clinical signs and serum lead levels of individuals referred to four university hospitals with various complaints. Patients and Methods: In this study, 128 sample cases in two groups, the case group and control group, have been examined. The case group included 64 persons using oral opium who were suffering from various complaints and referred to emergency department of mentioned hospitals. The control group included 64 patients without any history of addiction. Results: Mean of blood serum lead level in opium users and control group was 76.34±17.82 mg/dL and 7.68±3.72 mg/dL respectively, and the difference between these groups was significantly meaningful (P<0.001). The most prevalent complaints were abdominal pain and pulmonary complaints. Conclusion: Findings of the current study showed high levels for an average serum lead level for oral opium addicts among the studied statistical population. In addition, results show that ultimate diagnosis of lead poisoning is a factor justifying symptoms for addicts with nonspecific symptoms, the subject that confirms several previous reports. This finding asserts the necessity of screening of serum lead level for patients addicted to opium compounds in order to prevent more severe side effects.

Assessment of Laser Effects on Skin Rejuvenation

Laser skin resurfacing has changed the approach of facial skin rejuvenation over the past decade. This article evaluates the laser effects on skin rejuvenation by the assessment of laser characteristics and histological and molecular changes, accompanied by the expression of proteins during and after laser-assisted rejuvenation of skin. It is important to note that different layers of skin with different cells are normally exposed to the sun's UV radiation which is the most likely factor in aging and damaging healthy skin. To identify the expression of proteins, using validated databases and reviewing existing data could reveal altered proteins which could be analyzed and mapped to investigate their expression and their different effects on cell biological responses. In this regard, proteomics data can be used for better investigation of the changes in the proteomic profile of the treated skin. Different assessments have revealed the survival and activation of fibroblasts and new keratinocytes with an increase of collagen and elastin fibers in the dermis and the reduction of matrix metalloproteinases (MMPs) and heat shock proteins (HSPs) as a result of different low-power laser therapies of skin. There are a wide range of biological effects associated with laser application in skin rejuvenation; therefore, more safety considerations should be regarded in the application of lasers in skin rejuvenation.

Evaluation of Laser Effects on the Human Body After Laser Therapy

Lasers have wide applications in the treatment and diagnosis of diseases and various medical fields. Laser therapy like the other methods has advantages and disadvantages. Some risks such as bleeding, pain, and infection are created after laser therapy. Explanation and evaluation of laser effects on cell function, tissue, and the body are the aims of this study. We reviewed papers available from 1986 to 2019 about the effects of lasers on cells and tissue. An online search of PubMed, Science Direct and Google scholar using such keywords as "laser", "cell", "tissue", "body" and "side effects" was performed. The laser photons are absorbed by chromophores, resulting in the target heating and localized damage. Laser irradiation alters cellular metabolism and cellular functions. These alterations may be accompanied by undesired side effects which can be monitored via metabolites level change in the body. Based on this finding, laser therapy may be associated with several side effects and complications; therefore, before treatment, the determination of laser types and their properties is necessary to avoid creating side effects. The advantages and disadvantages of the treatment type should be considered in order to choose the best treatment with the least side effects. The patients' awareness of possible side effects before treatment and also an effective follow-up and management of patients after action are two important points in laser therapy. Training curriculum definition should be determined for laser applicant qualifications in different medical fields.

A Review of Various Methods of Management of Risk in the Field of Emergency Medicine

BACKGROUND:

The main concept of risk management in the emergency department (ED) contains a broader meaning, so that; it’s known as a sudden event or situation which would happen at an uncertain future that has some negative or positive impacts which could be called threat or opportunity respectively. However, the knowledge of risk management could cover the overall procedures involved with administering the planning of risk management, identification, investigation, monitoring and also step by step clinical examination. One of the main tools for preventing adversities is evaluating and management of possible risks.

AIM:

One of the main objectives of the present study is recognising the most frequent types of the risk happening in the EDs. Moreover, the present study is trying to evaluate the possible risks which could happen among various ED sections.

METHODS:

Six databases of EMBASE, HubMed, Cochrane Library, MEDLINE, PubMed, CHBD and Goggle scholar were chosen for discovering much-related articles from the year 2005 to 2019. A total number of 68 were chosen finally to be reviewed more precisely based on the main objective of the present study.

RESULTS:

Precise planning, preparing sufficiently and conducting the process of continuous monitoring are needed for ensuring the fact that any possible risks could be managed through these planned strategies. On the other hand, by modifying the patients’ beliefs, anticipations and the available social culture about the importance of risk management issue, the overall objective of the present study could be achieved at higher rates.

CONCLUSION:

Moreover, because the potential of occurrence of risk in EDs is high and approximately more than half of them are fatal, more precise adequate systematic plans for management of them should result.

Evaluation of Clinical Symptoms and Serum Lead Level in Patients with History of Oral Opium Use being Admitted to Hazrat Rasoul Akram, Firoozgar, Firoozabadi and Haft Tir Hospitals, Tehran

Introduction: Drug abuse and its complications is a socio-health problem in Middle Eastern countries such as Iran. Smugglers may add lead to drug during drug production, which is in order to increase its weight for greater benefit. Considering the frequency of the patients with various complaints among Iranians, this study was designed and conducted to evaluate the clinical symptoms and serum levels of lead in patients being admitted to Hazrat Rasoul Akram, Firoozgar, Firouzabadi and Haft Tir hospitals with any complaints. Materials and Methods: In this case-control study, serum levels of lead were measured in 128 samples in case and control groups. The case group consisted of 64 patients using oral opium who being admitted to Rasoul Akram and Firoozgar, Haft Tir and Firouzabadi hospitals with different complaints in May 2017. The control group consisted of 64 patients with no history of addiction that were homogenized with the case group in terms of age and sex. They were evaluated for serum levels of lead and other variables. Data were analyzed by SPSS software. Results: The mean serum lead level was 76.34±17.82 in the group using opium and was 7.68±3.72 in the control group that the difference was statistically significant (P <0.001). The most common complaints of patients were abdominal pain and symptoms of bowel obstruction. The mean rate of oral opium consumption was 1.73±0.23 in subjects under 50 years old and with a mean of 2.89±0.27 in subjects over 50 years old. Serum lead level was significantly (P = 0.032) increased compared to the amount consumed. Duration of oral opium consumption was 5 months to 30 years with a mean of 15.24 years, which was not significantly correlated to serum lead level (P = 0.213). Also, the hemoglobin range was significantly correlated to different levels of lead in patients consuming oral opium (P = 0.027). Conclusion: The findings of the present study showed a high mean serum lead level in oral opium addicts in the study population. The results also confirm numerous reports suggesting the definitive diagnosis of lead poisoning as a justifying factor in addicted patients with nonspecific symptoms, which may indicate the need for serum lead level screening in opiate addicts to prevent more serious complications.