Background: The intent of this study was to predict conversion of laparoscopic cholecystectomy (LC) to open surgery employing artificial neural networks (ANN).

Using ANN model based on clinical and biochemical variables in patients with moderate to severe traumatic injury, resulted in satisfactory outcome prediction when applied to a test set.

Early one-stage LCBDE is an effective procedure as an initial and definite management of acute gallstone cholangitis, which prevents a second hospitalization and relapse problems.

BACKGROUND:Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents (MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This study aimed to investigate the causes and prevention of death in trauma patients. METHODS:This retrospective, descriptive-analytic study assessed 100 trauma patients referred to our emergency department (ED) from January 2013 to Januanry 2015. The included patients were those with trauma died after arrival at our ED. Age, sex, cause of trauma, clinical causes of death, causes of death defi ned by autopsy, way of transfer to the ED, time of ambulance arrival at the scene of trauma, and time elapsed to enter the ED from the scene of trauma were studied. RESULTS:In the 100 patients, 21 (21%) patients were female and 79 (79%) male. Fortythree patients were older than 60 years. Trauma was largely due to pedestrian accidents in 31% of the patients, and 33% had a hypo-volemic shock. About 80% of deaths were due to intra-cranial hemorrhage (ICH) or intra-ventricular hemorrhage (IVH), and spinal injuries were not preventable. Autopsy revealed that 28% of the patients suffered from internal injuries. Autopsy revealed that 19% of the deaths were not preventable and 81% were considered preventable. In our patients, 76 were transferred to the hospital by emergency medicine services (EMS). Analysis of time for ambulance arrival to the scene and frequency of death revealed that 52.2% of the deaths occurred between 11 and 15 minutes. Analysis of time for admission to the ED from the scene of trauma showed that 74.6% deaths occurred between 6 and 10 minutes. CONCLUSIONS:The rate of hospital preventable deaths is about 80%, a high mortality rate, which denotes a lack of proper diagnosis and treatment. The time for arrival of EMS at the scene of trauma is longer than that in other countries.

Objective: Death from trauma is a major problem for the health system. The determination of preventable deaths is a valuable indicator of quality and efficiency in the management of trauma patients. The purpose of our study was to investigate the cause of preventable death in pre-hospital settings in the city of Tabriz. Materials and Methods:In a cross-sectional study from 2013 to 2014 in Tabriz, all traumatic patients who died at the scene of trauma or during transport and before reaching the hospital were referred to forensics for autopsy studies. For all deaths, data on demographics, mechanism and type of injury, place of death, mode of transportation, injury to the central nervous system (CNS) and results of necropsy were recorded. Preventability of death was defined upon examination of the necropsy report.Results: In this study, 160 pre-hospital deaths were studied. The commonest mechanism of injury was a vehicular traffic accident (83.8%), and blunt trauma in 98.8% was the commonest type of injury. In total, 80.6% of the deaths were at the scene of trauma and 18.8% on arrival to the hospital. CNS injury was recorded in 71.9% of the cases. The commonest cause of death from the necropsy report was CNS injury (60.6%), exsanguination or breathing problems (28.1%), and CNS injury with exsanguination or breathing problems (11.2%). In this study, death was possibly preventable in 25.6% of the cases, and 21.9% of the deaths were definitively preventable. Conclusion:Many deaths occurred at the scene of trauma, and traffic accidents are the main mechanism of injury. A high percentage of deaths as seen in the autopsy had CNS injuries, and this was the main cause of death. The high rate of preventable death in the present study compared to that in similar studies in other countries is a significant finding.

The management of multiply injured trauma patients is a skill requiring broad knowledge and remarkable skills. The aim of the primary trauma care (PTC) module is to orient medical staff to the initial assessment of an injured patient. This workshop was held in the Education Development Center of Tabriz Medical University in April, September, and November 2007. The participants were given lectures, completed practices, and case scenarios about the management of traumatic patients. All participants were given a pretest and a post-test including a questionnaire and procedural skill exams. Finally, the same post-tests were performed 6-12 months later. Sixty-four individuals were interested in attending the workshop from the total of 90 invited, and 53 individuals responded to the late post-test. The mean score in the pretest, early post-test, and late post-test was 18.84, 26.72, and 22.17, respectively (P<0.001). Most of the medical staff did not have sufficient knowledge of basic PTC. We have shown that the incorporation of hands-on patient scenarios into an expanded course on the basis of PTC principles helps medical staff gain the knowledge and skills needed to perform the primary survey sequence correctly. Furthermore, extra educational planning seems to be necessary to retain these abilities as needed.

SUMMARYObjectivesRoad traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a study on the success rate of PHEMS personnel in implementing PHTLS guidelines at the scene of trauma.MethodsSevere trauma patients who had been transferred to the emergency department were included in the study. Evaluations included transfer time, airway management, spinal immobilization, external bleeding management, intravenous (IV) line access, and fluid therapy. All evaluations were performed by an expert emergency physician in the emergency department.ResultsThe mean response time was 17.87±9.1 minutes. The PHEMS personnel immobilized cervical spine in 60.4% of patients, out of whom 16.7% were not properly immobilized. Out of 99 (98%) cases of established IV line access by the PHEMS providers, 57% were satisfactory. Fluid therapy, which was carried out in 99 (98%) patients by the PHEMS personnel, was appropriate in 92% of the cases.ConclusionsPHEMS personnel need more education and supervising to provide services according to PHTLS guidelines.

No abstract