Background Myocardial dysfunction is frequently described as an underlying cause of mortality in traumatic brain injury (TBI) known as brain-cardiac link. However the impact on prognosis of a disease remains uncertain. Objectives The current study aimed at investigating the correlation between TBI and cardiac troponin I (cTnI) rise and in-hospital mortality rate among patients with TBI. Methods In the current prospective study TBI patients with abbreviated injury scale score (AIS) > 3 and Glasgow coma scale (GCS) score ≤ 8 with cTnI measurement within the first 24 hours of admission were evaluated. Chi-square, Kruskal-Wallis, Mann-Whitney U and Logistic Regression tests were used for data analysis. Results A total of 166 eligible patients were studied .The mean age of the cases was 37.64 ± 17.21 years, largely under 65 (93.4%) and male (86.7%).The most common injuries were cerebral contusion (35.1%), while motor vehicle crash (MVC) was the most common cause of injuries (83.73%); 59 % of the patients showed detectable cTnI concentrations within 24 hours of admission; 65.7% of the patients expired; they showed higher levels of cTnI compared to survivors that showed lower levels, 0.148 ± 0.074 vs 0.057 ± 0.055, respectively (P < 0.001). Moreover, a significant association was observed between mortality rate and lower admission GCS 3.49 ± 1.08 vs 6.79 ± 1.66, respectively (P < 0.001). Conclusions Increased cTnI levels could be a predictor of mortality among patients with TBI. Its measurement and investigation for therapeutic strategies could lead to better management of these cases.

The emergence of SARS-CoV2 in 2019 showed again that the world's healthcare system is not fully equipped and well-designed for preventing the transmission of nosocomial respiratory infections. One of the great tools for preventing the spread of infectious organisms in hospitals is the anteroom. Several articles have investigated the role of the anteroom in disease control but the lack of a comprehensive study in this field prompted us to provide more in-depth information to fill this gap. Also, this study aimed to assess the necessity to construct an anteroom area for hospital staff members at the entrance of each ward of the hospital, and specify the equipment and facilities which make the anteroom more efficient. Articles were identified through searches of Scopus, Web of Sciences, PubMed, and Embase for studies published in English until May 2020 reporting data on the effect of the anteroom (vestibule) area in controlling hospital infections. Data from eligible articles were extracted and presented according to PRISMA's evidence-based data evaluation search strategy. Also, details around the review aims and methods were registered with the PROSPERO. From the database, 209 articles were identified, of which 25 studies met the study criteria. Most studies demonstrated that an anteroom significantly enhances practical system efficiency. The results showed that the equipment such as ventilation system, high-efficiency particulate absorption filter, hand dispensers, alcohol-based disinfection, sink, mirror, transparent panel, UVC disinfection, and zone for PPE change, and parameters like temperature, door type, pressure, and size of the anteroom are factors that are effective on the safety of the hospital environment. Studies demonstrated that providing an anteroom for changing clothing and storing equipment may be useful in reducing the transmission of airborne infections in hospitals. Since the transmission route of SARS-CoV2 is common with other respiratory infectious agents, it can be concluded that a well-designed anteroom could potentially decrease the risk of SARS-CoV2 transmission during hospitalization as well.

Objective: This study aimed to evaluate the evidence-based design of the hospital physical space effect on the burnout of nurses and physicians during COVID-19. The research question was to identify the connection between daylight, nature-view windows, and hospital staff burnout during Covid-19. Background: The evidence-based design in the hospital environment affects the health of the medical staff. The promotion of the hospital environment has a significant effect on healthcare system improvement. Methods: This cross-sectional study was performed on 406 nurses and physician’s burnout in Guilan province in 2020. Three questionnaires were used: demographic, physical space of the hospital, daylight, nature-view windows, and Maslach Burnout Inventory. Logistic regression (LR) analysis was used to determine the association between burnout and the hospital environment. The significance level was considered with p < .05. Results: The results showed statistically significant correlations between patient units and the environmental characteristics of the hospitals with staff’s burnout ( p < .001). Of note, 62.9% of physicians and 71.9% of nurses had moderate work-related burnout. The highest burnout score was seen among staffs of emergency departments adjusted multivariate LR model revealed that 27.1% of work-related burnout in nurses and physicians was predictable with age, light, marital status, and hospitals. Our results showed that accessing more daylight could reduce burnout ( p = .018, odds ratio [ OR] = 0.910). Conclusion: Based on the result, the daylight impact on burnout reduction is more significant than other factors. It is suggested that adequate lighting, proper environmental design, and nature-view windows could create appropriate space for enhancing medical staff satisfaction and reducing burnout.

Introduction: Rhino-orbito-cerebral mucormycosis is a progressive angioinvasive fungal disorder which almost always complicates immunocompromised patients. Case presentation: We described a case of fulminant rhino-orbito-cerebral mucormycosis in a 65-year-old woman, who presented with progressive neurological deficits due to involvement of orbital apex and the central nervous system by local invasion of the left inferior frontal lobe, retrograde perineural spreading to the brain stem and middle cerebral arteries thrombosis. Discussion: Early diagnosis is mandatory in managing of this life-threatening disorder. Urgent surgical debridement associated with antifungal agents (amphotericin with posaconazole) is the mainstay of treatment.

Objective: Evaluating the abilities of emergency medical services (EMS) staff who are in the frontline of the diseases could be an excellent reflection of the accuracy of curriculum both before and after graduation. This study was done to determine the clinical competencies of Guilan EMS staff in responding to emergency conditions using Objective Structured Clinical Examination (OSCE). Methods: In this descriptive study, 70 EMS staff from selected Emergency Centres in Guilan were recruited. Data were collected using a questionnaire and a checklist which included 9 different skills. Validity of the checklist was assessed by obtaining the opinions of 10 experts. The content validity index (CVI) and content validity ratio (CVR) of the checklist were 0.7 and 0.8, respectively. The reliability of the checklist was obtained using the test-retest method (r=0.89). In order to collect data, observations were done using the designated checklist. Data were analysed using SPSS software version 22 and descriptive statistical tests. Results: Findings showed that 56.3% of the paramedics got good scores for trauma competency but the mean scores for two competencies of spinal cord immobilization and vehicle extrication were low, indicating major skills problem. There was a statistically significant relationship between education (P=0.02) and work experience (P=0.03) as well as clinical skills in confronting trauma. Conclusion: Although the EMS staff had an acceptable range of performance in most of the skills, it seems that there is a need for training of performance-based competencies in which paramedics had a poor performance.

Objective: Awareness of the changes concerning the clinical guidelines for cardiopulmonary resuscitation (CPR) is essential for nurses. This study aimed at assessing the nurses’ knowledge of the 2015 American Heart Association basic life support guideline algorithm. Methods: In a cross-sectional study, the knowledge of 183 nurses working in emergency departments, intensive care unit (ICU) and coronary care unit (CCU) regarding the 2015 American Heart Association basic life support guideline algorithm was investigated. Data were collected by a 20-item questionnaire regarding the knowledge needed for resuscitation operations as well as the identification of the early stages of cardiac arrest. Nurses with a score of 10 and less were put in the poor group, 11-15 in the fair group, and score of more than 15 in the good group. Results: Results showed that the highest percentage of the right answer was observed in questions 20 (98.4%), 11 (93.4%), and 1 (88%), while the lowest percentage of the correct answer was found in questions 13 (30.6%), 2 (31.1%), and 3 (32.8%). Mean ± SD of knowledge score was 12.3±2.2. A statistically significant difference was observed between knowledge of ICU nurses with an experience of basic life support educational course and those with no experience of such education. The knowledge score of educated and non-educated nurses was 11.5±2.2 and 13.2±2.5, respectively. Conclusion: This study indicated that ICU nurses do not have enough knowledge about basic life support of the 2015 American Heart Association guideline. Development of knowledge is one of the important components of professional expansion in nursing education programs.

Objective In Iran, road traffic accidents were responsible for 14716 deaths in 2015. This study aimed to compare the initial resuscitation of traumatically injured patients to the internationally recognized ATLS standards. Materials and methods As a cross-sectional study, 506 traumatically injured patients who were referred to the tertiary referral major trauma center in Poursina Hospital during the study period, were evaluated. All therapeutic interventions were compared to the ATLS standards. Data on mortality by demographic was compared to those in whom the ATLS standards were met and in those whom it was not met Results Mean age of the patients was 37.37 ± 19.72 and motorcycle was the most common cause of accidents (40.9%). ATLS guideline interventions were completely performed in 18.2% of the patients in their primary hospital, and in rest of 414 cases (81.8%), ATLS algorithms were not fully carried out. The mortality rate was significantly higher in the second group: 10.86% vs 32.36%, respectively. Conclusion Application of ATLS principles in multiple trauma patients can reduce the mortality rate.

Today, The hospital waste is one of the worst environmental problems because it contains dangerous, toxic and pathogenic contaminents such as wastinfection, medical instrument which are dangerous for personnel, patients and others. So, ignoring the management of hospital waste related to the collection type, and their transportation not only can  the society and environmental health but also burden the health system with more cost. These days, With regard to the serious threatened of the environmental contaminents, The importance of some issue like the social responsibility, Environmental training, Proactive environmental strategies have been increased rather than before. So, paying attention to these issues for some organizations, hospitals, gas and oil industries, has more importance rather than other organizations.This research is an applied research and its data collection is based on a descriptive and survey research. The structural equations have been used to analysis the relation between variables. Statistical population of this research has been chosen from the hospital personnel(Doctors, nurses, hospital manager, Technical personnel, procurement personnel of HaftomTir Hospital. The sample selected with Cochran formula is about 132 persons.The result of the research suggested that there is a positive and meaningful relation between environmental training and proactive environmental strategies, Also between social responsibility and the proactive environmental strategies and between environmental training and social responsibility. According to the research result, it is considerable that holding environmental training in hospital can result in increasing the social responsibility of hospital personnel. In the other hand by holding the environmental training, performing the proactive environmental strategies are more successful in an organization. In this research, it was found that if there is any social responsibility in anorganization(ShohadayeHaftomeTir in this research), The proactive environmental strategies will be performed there, successfully. Also, it is possible to add the proactive environmental strategies to the main strategies of the organization.