Showing papers in "Trauma monthly in 2016"

Overview of Agents Used for Emergency Hemostasis

Abstract: Context: In today’s modern world, despite the multiple advances made in the field of medicine, hemorrhagic shock is still the main cause of battlefield mortality and the second most prevalent cause of mortality in civilian trauma. Hemostatic agents can play a key role in establishing hemostasis in prehospital situations and preventing hemorrhage-associated death. In this respect, this article aims to review different aspects of known hemostatic agents. Evidence Acquisition: A comprehensive search of the academic scientific databases for relevant keywords was conducted; relevant articles were compiled and assessed. Results: Hemostatic agents can establish hemostasis by means of different mechanisms, including concentrating coagulation factors, adhesion to the tissues, in which traumatic hemorrhage occurred, and delivering procoagulant factors to the hemorrhage site. Presently, these hemostatics have been significantly improved with regard to efficacy and in adverse consequences, resulting from their use. Several hemostatic dressings have been developed to the degree that they have received FDA approval and are being used practically on the battlefield. In addition, there are currently several case reports on the use of such hemostatics in the hospital setting, in conditions where commonly known approaches fail to stop life-threatening bleeding. Conclusions: The use of hemostatic dressings and agents is one of the main advancements achieved in recent decades. However, it can be claimed that the ideal hemostatic has not been recognized yet; therefore, this topic needs to be brought into focus and further addressed.

Blood Loss Estimation Using Gauze Visual Analogue.

Abstract: BACKGROUND Estimating intraoperative blood loss can be a difficult task, especially when blood is mostly absorbed by gauze. In this study, we have provided an improved method for estimating blood absorbed by gauze. OBJECTIVES To develop a guide to estimate blood absorbed by surgical gauze. MATERIALS AND METHODS A clinical experiment was conducted using aspirated blood and common surgical gauze to create a realistic amount of absorbed blood in the gauze. Different percentages of staining were photographed to create an analogue for the amount of blood absorbed by the gauze. RESULTS A visual analogue scale was created to aid the estimation of blood absorbed by the gauze. The absorptive capacity of different gauze sizes was determined when the gauze was dripping with blood. The amount of reduction in absorption was also determined when the gauze was wetted with normal saline before use. CONCLUSIONS The use of a visual analogue may increase the accuracy of blood loss estimation and decrease the consequences related to over or underestimation of blood loss.

Effects of Normobaric Hyperoxia in Traumatic Brain Injury: A Randomized Controlled Clinical Trial.

Abstract: Background: Traumatic brain injury (TBI) is one of the important causes of morbidity and mortality throughout the world, especially in young people. In recent years normobaric hyperoxia has become an important and useful step for recovery and improvement of outcome in TBI. Objectives: The purpose of this study was to evaluate the effects of normobaric hyperoxia on clinical neurological outcomes of patients with severe traumatic brain injuries. We used the Glasgow outcome scale (GOS), barthel index, and modified rankin scale (mRS) to measure the outcomes of patients with TBI. Patients and Methods: Sixty-eight consecutive patients with severe TBI (mean Glasgow coma scale [GCS] score: 7.4) who met the inclusion criteria were entered in this randomized controlled clinical trial. The patients were randomized into two groups, as follows: 1) experimental: received 80% oxygen via mechanical ventilator in the first 6 hours of admission, 2) control: received 50% oxygen by mechanical ventilator in the first 6 hours of admission and then standard medical care. We measured the GOS, Barthel Index, and mRS at the time of discharge from hospital and reassessed these measurements at the 6-month follow-up after injury. Results: According to our study, there were no significant sex or age differences between the two groups (P = 0.595 and 0.074). The number of days in the intensive care unit (ICU) in the control group and experimental group were 11.4 and 9.4 days, respectively (P = 0.28), while the numbers of days of general ward admission were 13.9 and 11.4 days (P = 0.137) respectively. The status of GOS at time of discharge were severe = 13 and 10, moderate = 16 and 19, and low = 5 and 5 in the control and experimental groups, respectively (P = 0.723); 6 months after injury, the scores were as follows: moderate = 16 and 9, low = 15 and 25, and severe = 3 and 0 (P = 0.024). The Barthel index scores in the control and experimental groups were 59.7 and 63.9 at time of discharge (P = 0.369) and 82.7 and 91.3 at 6 months after injury (P = 0.018), respectively. The mRS results were 2.6 and 2.3 at time of discharge (P = 0.320) and 1.6 and 0.7 at 6 months after injury (P = 0.006) for the control and experimental groups, respectively. Conclusions: According to the results of this study, oxygen therapy by mechanical ventilator in the first 6 hours after injury in patients with severe TBI can improve the final GOS, Barthel index, and mRS scores. It could also improve long-term outcomes and enhance rehabilitation and the quality of life.

Relationship Between Air Pollution, Weather, Traffic, and Traffic-Related Mortality.

Abstract: Background: Air pollution and weather are just two of many environmental factors contributing to traffic accidents (RTA). Objectives: This study assessed the effects of these factors on traffic accidents and related mortalities in Ahvaz, Iran. Methods: In this ecological study, data about RTA, traffic-relatedmortalities, air pollution (including NO, CO, NO2, NOx PM10, SO2, and O3 rates) and climate data from March 2008 until March 2015 was acquired from the Khuzestan State Police Force, the Environmental Protection Agency and the State Meteorological Department. Statistical analysis was performed with STATA 12 through both crude and adjusted negative binomial regression methods. Results: There was a significant positive correlation between increase in the monthly average temperature, the number of rainy days, and the number of frost days with the number of RTA (P < 0.05). Increased monthly average relative humidity, evaporation, and number of sunny days were negatively correlated with the frequency of RTA (P < 0.05). We also observed an inverse significant correlation between monthly average relative humidity, evaporation, and wind speed with traffic accident mortality (P < 0.05). Some air pollutants were negatively associated with the incidence rate of RTA. Conclusions: It appears that some weather variables were significantly associated with increased RTA. However, increased levels of air pollutants were not associated with increased rates of RTA and/or related mortalities. Additional studies are recommended to explore this topic in more detail.

Effects of a Sensory Stimulation by Nurses and Families on Level of Cognitive Function, and Basic Cognitive Sensory Recovery of Comatose Patients With Severe Traumatic Brain Injury: A Randomized Control Trial

Abstract: Background: Several lines of evidence suggest that early sensory stimulation and regular family visiting programs are potential nursing interventions to improve the outcomes of head injured comatose patients. However, little is known about the impacts of family involvement in providing sensory stimulation. Objectives: To determine the effects of a sensory stimulation program conducted by nurses and families on the consciousness, level of cognitive function, and basic cognitive sensory recovery of head injury comatose patients. Patients and Methods: This was a randomized clinical trial performed at the Shiraz level I trauma center including 60 head injured comatose patients with an initial Glasgow coma score (GCS) of less than 8. Patients were randomly assigned to receive sensory stimulation by a qualified nurse (nurse group; n = 20), by the family (family group; n = 20), or usual care (control group; n = 20). The sensory stimulation program involving the nurses and patients’ families was conducted, twice daily, in the morning and evening for 7 days. The level of consciousness, level of cognitive function, and basic cognitive sensory recovery of the patients were evaluated and monitored using the GCS, Rancho Los Amigos (RLA), and Western Neuro-Sensory stimulation profile (WNSSP). Data were analyzed by chi square, Kruskal-Wallis, and repeated-measures tests using SPSS. Results: All the patients were comparable regarding their baseline characteristics, level of consciousness, level of cognitive function, and basic cognitive sensory recovery determined by GCS, RLA, and WNSSP. Although the two intervention groups of the study improved, those who received the sensory stimulation program from their families had significantly higher GCS (P = 0.001), RLA (P = 0.001), and WNSSP (P = 0.001) scores after 7 days when compared to the two other groups. Conclusions: The application of sensory stimulation by families led to significant increases in the consciousness, level of cognitive function, and basic cognitive sensory recovery of comatose patients with severe injuries.

Outcome of Radial Head Arthroplasty in Comminuted Radial Head Fractures: Short and Midterm Results

Abstract: Background: Comminuted radial head fractures are often associated with secondary injuries and elbow instability. Objectives: The aim of this retrospective study was to evaluate how well the modular metallic radial head implant EVOLVE® prosthesis restores functional range of motion (ROM) and stability of the elbow in acute care. Patients and Methods: Eighty-five patients with comminuted radial head fractures and associated injuries received treatment with an EVOLVE® prosthesis between May 2001 and November 2009. Seventy-five patients were available for follow-up. On average, patients were followed for 41.5 months (33.0: 4.0 - 93.0). Outcome assessment was done on the basis of pain, ROM, strength, radiographic findings, and functional rating scores such as Broberg and Morrey, the Mayo elbow performance index (MEPI), and disabilities of the arm, shoulder and hand (DASH). Our study is currently the largest analysis of clinical outcome of a modular radial head replacement in the literature. Results: Overall, there were 2 (2.7%) Mason II fractures, 21 (28%) Mason III fractures, and 52 (69.3%) Mason IV fractures. Arbeitsgemeinschaft fur osteosynthesefragen (AO) classification was also determined. Of the 85 patients in our study, 75 were available for follow-up. Follow-up averaged 41.5 months (range, 4 - 93 months). Average scores for the cohort were as follows: Morrey, 85.7 (median 90.2; range 44.4 - 100); MEPI, 83.3 (85.0; 40.0 - 100); and DASH 26.1 points (22.5; 0.0 - 75.8). Mean flexion/extension in the affected joint was 125.7°/16.5°/0° in comparison to the noninjured side 138.5°/0°/1.2°. Mean pronation/supination was 70.5°/0°/67.1° in comparison to the noninjured side 83.6°/0°/84.3°. Handgrip strength of the injured compared to the non-injured arm was 78.8%. The following complications were also documented: 58 patients had periprosthetic radioluceny shown to be neither clinically significant nor relevant according to evaluated scores; 26 patients had moderate or severe periarticular ossification, and scored substantially worse according to MEPI and Morrey. Four patients required revisional surgery due to loosening of the prosthesis and chronic pain. In addition, one patient required a neurolysis of the ulnaris nerve, one developed a neobursa, and one had extensive swelling and blistering. The time interval between injury and treatment appeared to have an effect on results. Thirty-five patients were treated within the first 5 days after accident and showed better results than the 40 patients who were treated after 5 days. Conclusions: Comminuted radial head fractures with elbow instability can be treated well with a modular radial head prosthesis, which restores stability in acute treatment. The modular radial head arthroplasty used in this study showed promising findings in short to midterm results.

Epidemiology of Cervical Spine Fractures

Abstract: Background Epidemiology of cervical spine fractures (CSfx) in trauma patients of general population is not yet exclusively known. Objectives The purpose of this study was to evaluate the epidemiology of CSfx in trauma patients. Patients and methods Data from trauma patients admitted in the emergency room (ER) of Shiraz Shahid Rajaei hospital during the 3.5 years period from September 22, 2009 to March 21, 2013, were gathered. All trauma patients with CSfx and/or spinal cord injuries were included in the study. The time of the trauma, mechanism of trauma, injury position, and incidence of cervical spine fractures in the patients were recorded. Results A total of 469 patients met the inclusion criteria. The mean age of the patients was 34.7 years old, with a minimum age of 16 years old and a maximum age of 89 years old. Young adults were most frequently affected. Out of 469 cases, 368 patients (78.47%) were male and 101 (21.53%) were female. We had a total of 17 SCI cases among our patients (3.62%), out of which 5 (29.41%) were deceased. The total number of deaths in our study was 29 (6.18%); 5 (17.24%) with SCI and 24 (82.76%) without SCI. Conclusions This study demonstrated that most victims of CSfx in our region are 16 to 40 years of age. A male predominance was observed, and motor vehicle collisions were the most frequent trauma mechanism leading to cervical spine injury (mostly due to car rollover accidents), with falls as the second most frequent. The rate of SCI in our study was 3.62% of all cases and the mortality rate was 6.18%.

A Prospective Study of Survival After In-Hospital Cardiopulmonary Resuscitation and its Related Factors.

Abstract: Background Despite several studies, there is no agreement on factors that affect survival after in-hospital cardiopulmonary resuscitation (CPR).

Comparison of the Protective Effects of Erythropoietin and Melatonin on Renal Ischemia-Reperfusion Injury.

Abstract: Background: Renal ischemia-reperfusion (IR) contributes to the development of acute renal failure (ARF). Oxygen free radicals are considered to be the principal components involved in the pathophysiological tissue alterations observed during renal IR. Objectives: In this study, we compared the eects of melatonin (MEL) and erythropoietin (EPO), both known antioxidant and anti- inflammatory agents, on IR-induced renal injury in rats. Materials and Methods: Wistar albino rats were unilaterally nephrectomized and then subjected to 45 minutes of renal pedicle occlusion followed by 24 hours of reperfusion. MEL (10 mg/kg, i.p) and EPO (5000 U/kg, i.p) were administered prior to the onset of ischemia. After 24 hours of reperfusion and following decapitation, blood samples were collected for the determination of the hemoglobin (Hb) and hematocrit (Hct) levels. Additionally, renal samples were taken for histological evaluation. Results: Ischemia-reperfusion significantly decreased the observed Hb and Hct values. The histopathological findings in the IR group confirmed that there was an increase in the hyaline cast and thickening of the Bowman capsule basement membrane. Treat- ment with EPO or MEL significantly increased the Hb and Hct values. In the MEL + IR group, the histopathological changes were lower than those found in the EPO + IR group. Conclusions: Treatment with EPO and MEL had a beneficial eect on renal IR injury. The results may also indicate that MEL protects against morphological damage better than EPO in renal IR injury.

Factors impacting mortality in the pre-hospital period after road traffic accidents in urban india

Abstract: Background India currently has the dubious distinction of experiencing the highest number of road traffic accidents in the world. Objectives We believe that this study on road traffic accidents may help to identify factors in the pre-hospital setting that may influence mortality rates. Patients and methods A prospective observational study was carried out in a metro area in India over a period of one year. The study included consecutive patients admitted to the trauma service after road traffic accidents. Demographic information, time and place of accident, and details regarding the vehicle and the events leading up to the hospital admission were recorded. Injury severity, management in the hospital, and final outcomes in terms of mortality were noted. The data were analyzed with SPSS software. Results A total of 773 patients were enrolled. Of these, there were 197 deaths and 576 survivors. The majority of patients were aged 15 - 40 years (67%) and were male (87.84%). More accidents occurred at night (58.2%) than during the day (41.8%). Mortality was not significantly associated with age, sex, or time of accident. City roads (38.9%) saw more accidents than highways (26.13%), but highway accidents were more likely to be fatal. Two-wheeler riders (37.65%) and pedestrians (35.75%) formed the majority of our study population. Mortality was significantly associated with crossing the road on foot (P = 0.004). Pillion riders on two-wheeler vehicles were more likely to experience poor outcomes (relative risk [RR] = 1.9, P = 0.001). Front-seat occupants in four-wheeler vehicles were at an increased risk of not surviving the accident (61.98%; RR=2.56, P = 0.01). Lack of safety gear, such as helmets, seat belts, and airbags, was significantly associated with mortality (P = 0.05). Delays in transfers of patients to the hospital and a lack of pre-hospital emergency services was significantly associated with increased mortality (P = 0.000). Conclusions A lack of respect for the law, weak legislation and law enforcement, disregard for personal safety, and driving vehicles under adverse conditions are some of the leading causes of road traffic accidents. There should be an emphasis on emergency trauma care in the pre-hospital setting.

Evaluation of the Effect of Glibenclamide in Patients With Diffuse Axonal Injury Due to Moderate to Severe Head Trauma

Abstract: Background: Traumatic brain injury (TBI) is a major health problem worldwide. Secondary injuries after TBI, including diffuse axonal injury (DAI) often occur, and proper treatments are needed in this regard. It has been shown that glibenclamide could reduce secondary brain damage after experimental TBI and improve outcomes. Objectives: We aim to evaluate the role of glibenclamide on the short-term outcome of patients with DAI due to moderate to severe TBI. Patients and Methods: In this controlled randomized clinical trial, 40 patients withmoderate to severe TBI were assigned to glibenclamide (n = 20) and control (n = 20) groups. Six hours after admission the intervention group received 1.25 mg glibenclamide every 12 hours. The Glasgow coma scale (GCS) was administered at admission, in the first 24 and 48 hours, at one week post-trauma and at discharge. The Glasgow outcome scale (GOS) was also administered at discharge. All results were evaluated and compared between groups. Results: Patients treated with glibenclamide compared to the control group had a significantly better GCS score one week posttrauma (P = 0.003) and at discharge (P = 0.004), as well as a better GOS score at discharge (P = 0.001). The glibenclamide group also had a shorter length of hospital stay compared to the control group (P = 0.03). In the control group, two patients (10%) died during the first week post-trauma, but there was no mortality in the glibenclamide group (P = 0.48). Conclusions: Treatment with glibenclamide in patients with DAI due to moderate to severe TBI significantly improves short-term outcomes.

Pre-Hospital Emergency in Iran: A Systematic Review.

Abstract: Context: Pre-hospital care plays a vital role in saving trauma patients. Objectives: This study aims to review studies conducted on the pre-hospital emergency status in Iran. Data Sources: Data were sourced from Iranian electronic databases, including SID, IranMedex, IranDoc, Magiran, and non-Iranian electronic databases, such as Medline, Embase, Cochrane Library, Scopus, and Google Scholar. In addition, available data and statistics for the country were used. Data Selection: All Persian-language articles published in Iranian scientific journals and related English-language articles published in Iranian and non-Iranian journals indexed on valid sites for September 2005 - 2014 were systematically reviewed. Data Extraction: To review the selected articles, a data extraction form developed by the researchers as per the study’s objective was adopted. The articles were examined under two categories: structure and function of pre-hospital emergency. Results: A total of 19 articles were selected, including six descriptive studies (42%), four descriptive-analytical studies (21%), five review articles (16%), two qualitative studies (10.5%), and two interventional (experimental) studies (10.5%). In addition, of these, 14 articles (73.5%) had been published in the English language. The focus of these selected articles were experts (31.5%), bases of emergency medical services (26%), injured (16%), data reviews (16%), and employees (10.5%). A majority of the studies (68%) investigated pre-hospital emergency functions and 32% reviewed the pre-hospital emergency structure. Conclusions: The number of studies conducted on pre-hospital emergency services in Iran is limited. To promote public health, consideration of prevention areas, processes to provide pre-hospital emergency services, policymaking, foresight, systemic view, comprehensive research programs and roadmaps, and assessments of research needs in pre-hospital emergency seem necessary.

Assessment of a Military Hospital’s Disaster Preparedness Using a Health Incident Command System

Abstract: Background: A hospital emergency incident command system is one of the most reliable and popular organizational methods for disaster and emergency management. Objectives: The aim of the present study was to assess the level of disaster preparedness in the emergency department and other selected units of a military hospital in Tehran. Methods: This cross-sectional study was conducted in 2013 and involved 97medical staffmembers from various departments: emergency, management, discharge and transport, camp (security and staff), information and communication technology, training, reception, and human resources. Three instruments were used for data collection: a self-reported questionnaire, unit evaluation checklist, and maneuver evaluation checklist. Results: The overall mean score for the maneuver checklist was 55.5%. The mean (±standard deviation) score for the questionnaire was 42.02±8.62. The unit evaluation checklist had a score of 165 from a total of 244 possible points and amean percentage of 67.62%. After conducting the maneuver, the hospital staff was reported to have weak performance in evaluating and prioritizing patients for quick release and tracking their conditions. Conclusions: The present study shows that the selected hospital had a moderate level of preparedness, which is in line with the previous studies. It is recommended that future studies evaluate the effect of education on the disaster preparedness of hospital units

Efficacy of Intravenous Paracetamol Versus Intravenous Morphine in Acute Limb Trauma.

Abstract: Background: Efficient pain management is one of the most important components of care in the field of emergency medicine. Objectives: This study was conducted to compare intravenous paracetamol and intravenous morphine sulfate for acute pain reduction in patients with limb trauma. Patients and Methods: In a randomized double-blinded clinical trial, all patients (aged 18 years and older) with acute limb trauma and a pain score of greater than 3/10 in the emergency department were recruited; they received either 1 g intravenous paracetamol or 0.1 mg/ kg intravenous morphine sulfate over 15 minutes. The primary outcome was the pain score measured on a numerical rating scale at 0, 15 and 30 minutes after commencing drug administration. The requirement for rescue analgesia and the frequency of adverse reactions were also recorded. Results: Sixty patients randomly received either IV paracetamol (n = 30) or IV morphine (n = 30). The mean reduction in numerical rating scale pain intensity scores at 30 minutes was 3.86 (± 1.61) for paracetamol, and 2.16 (± 1.39) for morphine. However, pain relief was significantly higher in the paracetamol group compared to the morphine group (P < 0.001). Four patients in the paracetamol group and 15 patients in the morphine group needed rescue analgesia and the difference was significant (P = 0.05). Conclusions: Intravenous paracetamol appears to provide better analgesia than intravenous morphine in acute limb trauma. Further larger studies are required.

Association Between Adult Attention Deficit Hyperactivity Disorder and Helmet Use Among Motorcycle Riders.

Abstract: BACKGROUND: Use of helmets plays a major role in preventing injuries or decreasing injury severity among motorcycle riders. Use of helmets may depend on personal factors such as psychological factors. OBJECTIVES: The aim of this study was to independently assess the association between helmet use among motorcycle riders and ADHD scores, with controlling the accident history and was taken more sensitive measures if helmet use was different between motorcycle riders, according to their ADHD scores. PATIENTS AND METHODS: A cross-sectional study was done on 205 motorcycle riders referred to Kerman Referral Injury Hospital after a motorcycle traffic accident. Friends and family members possessing motorcycles who visited the patient in this facility were included in our sample. The Persian version of the Conner's Adult ADHD Rating Scale (CAARS) self-report (screening version) was used in order to screen for adult ADHD. CAARS scores were compared between those who usually used helmets and those who did not. RESULTS: Univariable analysis showed the mean of the age variable was significantly higher in the helmeted group, 26.94 ± 7.72 vs. 23.08 ± 7.7.32, (P CONCLUSIONS: The result of this study did not find an independent association between ADHD and helmet use. Language: en

Pattern and Trend of Injuries Among Trauma Unit Attendants in Upper Egypt.

Abstract: BACKGROUND: Injury is a growing public health problem worldwide. Deaths due to injuries account for 10% of the world's mortality. More than 90% of the world's injury deaths occur in low and middle income countries. In Egypt, injury is a hidden epidemic and its related deaths are misclassified due to lack of accurate national data. Furthermore, as a research problem it has also been largely ignored in developing countries. OBJECTIVES: To determine the pattern and trend of injury from January 2002 to December 2009 among attendants at trauma unit in Assiut university hospital in Upper Egypt. PATIENTS AND METHODS: A descriptive retrospective study was conducted at the trauma unit in Assiut university hospital in Upper Egypt. All registered injuries during January 2002 to December 2009 were included in the study. RESULTS: During January 2002 to December 2009, 213835 injured cases were admitted to the trauma unit. The number of attendants increased every year from 9.3% from the total cases in all study period in 2002 up to 15.3% in 2009 with a statistically significant difference (P = 0.000). Young adults aged 20 - 29 years were the most common group affected by injuries (22.2%). Male to female ratio was 3:1. Falls represent one half of injuries (49.6%) from all attended cases, followed by exposure to inanimate mechanical forces (19.5%) and transport accidents (18.3%). Falls were ranked as the leading cause of injuries, while transport accidents were the second cause in 2007 - 2009. CONCLUSIONS: Trauma in Upper Egypt is an under-recognized problem, which requires prioritized attention. Increasing the awareness of community, making policies and establishment of a trauma system are important to decrease the burden of injuries. Language: en

Readability of Trauma-Related Patient Education Materials From the American Academy of Orthopaedic Surgeons

Abstract: Context: According to the american medical association (AMA) and the national institutes of health (NIH), the recommended readability of patient education materials should be no greater than a sixth-grade reading level. The online patient education information produced by the american academy of orthopaedic surgeons (AAOS) may be too complicated for some patients to understand. This study evaluated whether the AAOS’s online trauma-related patient education materials meet recommended readability guidelines for medical information.

A New Injury Severity Score for Predicting the Length of Hospital Stay in Multiple Trauma Patients

Abstract: Background: Trauma is a leading cause of morbidity and mortality among individuals under 40 and is the third main cause for death throughout the world. Objectives: This study was designed to compare our modified injury scoring systems with the current injury severity score (ISS) from the viewpoint of its predictive value to estimate the duration of hospitalization in trauma patients. Patients and Methods: This analytical cross-sectional study was performed at the general referral trauma center of Bandar-Abbas in southern Iran from March 2009 to March 2010. The study population consisted of all the trauma patients referred to the emergency department (ED). Demographic data, type and severity of injury, duration of admission, Glasgow coma scale (GCS), and revised trauma score (RTS) were recorded. The injury severity score (ISS) and NISS were calculated. The length of hospital stay was recorded during the patients follow-up and compared with ISS, NISS and modified injury scoring systems. Results: Five hundred eleven patients (446 males (87.3%) and 65 females (12.7%)) were enrolled in the study. The mean age was 22 ± 4.2 for males and 29.15 ± 3.8 for females. The modified NISS had a relatively strong correlation with the length of hospitalization (r = 0.79). The formula below explains the length of hospitalization according to MNISS score. Duration of hospitalization was 0.415 + (2.991) MNISS. Duration of hospitalization had a strong correlation with MISS (r = 0.805, R2: 0.65). Duration of hospitalization was 0.113 + (7.915) MISS. Conclusions: This new suggested scale shows a better value to predict patients’ length of hospital stay compared to ISS and NISS. However, future studies with larger sample sizes and more confounding factors such as prehospital procedures, intubation and other procedures during admission, should be designed to examine these scoring systems and confirm the results of our study.

Quality of Work Life and Its Related Factors: A Survey of Nurses

Abstract: Background: Improving the quality of work life (QWL) is a comprehensive process essential to attracting and retaining employees, especially in health care. Objectives: The purpose of the present study was to determine quality of nursing work life and its related factors at nurses Kashan city hospitals in 2014. Methods: This cross-sectional study was conducted on 157 ICU nurses from September to November, 2014 at 4 educational hospitals of Kashan, Iran. A three part questionnaire was used in this study: demographic and professional characteristics, quality of nursing work life (QNWL), and the national aeronautics and space administration task load index (NASA-TLX). Data were analyzed using the t-test, the Mann-Whitney U test, and the chi square and Fisher’s exact test with SPSS software, version 16. Results: The majority of the participants (N = 112) were female (83.3%), and the mean age of the subjects was 33 ± 6.98 years. Age, education, job position, job location, and a second nursing job in another hospital were found to predict QNWL. Among the six subscales of NASA-TLX, frustration and mental demand had the lowest and highest rating score, respectively. Temporal demand, frustration, and effort levels were significantly correlated with QNWL. Conclusions: It is necessary to pay more attention to the QNWL and its related factors, especially nursing workload, to improve quality of care.

Delayed Splenic Rupture; Normal Appearing Spleen on the Initial Multidetector Computed Tomography (MDCT) Can Sometimes Be Misleading.

Abstract: Introduction: Delayed splenic rupture (DSR) is an unusual outcome following blunt abdominal trauma. Although DSR is defined as bleeding more than 48 hours after blunt trauma in a previously hemodynamically stable patient, a review of the reported cases in the literature shows that in almost all of the cases the initial CT imaging revealed some form of damage to the spleen. Case Presentation: Here we describe an extremely rare condition in a case that presented with a DSR following blunt trauma and had a normal appearing spleen in the initial post trauma MDCT scan. Conclusions: DSR is a serious consequence of trauma and is associated with a significantly higher mortality rate compared with the overall mortality for acute splenic injuries. A High index of suspicion along with the liberal serial utilization of the imaging studies are the essential elements for early detection of DSR.We propose that DSR be considered as a differential diagnosis in patients presenting with hemodynamic instability late post trauma, even when the immediate post trauma MDCT scan has shown a normal appearing spleen. We suggest that every patient with a high impact injury or injuries to peri-splenic organs should have a repeat MDCT scan 2 - 3 days post trauma or before the patients is discharged from hospital.

Effect of Job Specialization on the Hospital Stay and Job Satisfaction of ED Nurses.

Abstract: Background: In recent decades, the increasing crowdedness of the emergency departments has posed various problems for patients and healthcare systems worldwide. These problems include prolonged hospital stay, patient dissatisfaction and nurse burnout or job dissatisfaction. Objectives: The aim of this study was to investigate the effect of emergency department (ED) nurses’ job specialization on their job satisfaction and the length of patient stay in the ED. Patients and Methods: This before-after quasi-experimental study was conducted from April to May 2014 at the Baqiyatallah Hospital, Tehran, Iran. Initially, 35 patients were recruited as controls and the length of their stay in the ED was measured in minutes via a chronometer; Moreover, nurses’ job satisfaction was evaluated using the Mohrman-Cooke-Mohrman job satisfaction scale. Then, a job specialization intervention was developed based on the stabilization model. After that, 35 new patients were recruited to the treatment group and received specialized care services. Accordingly, the length of their stay in the ED was measured. Moreover, the same nurses’ job satisfaction was re-evaluated after the study. The study intervention lasted one month. Data were analyzed using the SPSS software version 20 and statistical tests such as the Kolmogrov-Smirnov, the paired and the independent t, and chi-square tests. Results: There was a significant difference between the two groups of patients concerning the length of their stay in the ED (P < 0.001). Moreover, compared with the pretest readings, nurses had greater job satisfaction after the study (P < 0.001). Conclusions: The job specialization intervention can improve nurses’ satisfaction and relieve the crowdedness of the EDs.

Mass Fatalities in Hajj in 2015.

Abstract: Trauma Research Center, Baqyiatallah University of Medical Sciences, Tehran, IR Iran Iranian Red Crescent Medical Center, Tehran, IR Iran Nephrology and Urology Research Center, Baqyiatallah University of Medical Sciences, Tehran, IR Iran Corresponding author: Behzad Einollahi, Nephrology and Urology Research Center, Baqyiatallah University of Medical Sciences, Tehran, IR Iran. E-mail: behzad.einollahi@gmail.com

A Selective Corrective Exercise to Decrease Falling and Improve Functional Balance in Idiopathic Parkinson's Disease.

Abstract: BACKGROUND: Posture instability and unsteady gait disorders in Parkinson's Disease (PD) usually contribute to fall-related fractures. Fall-related trauma in PD is the most common reason for injury. Despite providing modern care for PD patients (PP) in the recent years, anti-PD drugs have no effect on falling. There is an urgent need to administer exercise interventions to reduce falls and related injuries in the rehabilitation program of PP. Objectives: To explore the effect of a selective 10-week corrective exercise with an emphasis on gait training activities (GTA) on the number of falls (NOFs), fear of falling, functional balance, timed up and go (TUG) test among PD patients. Patients and Methods: A purposeful sampling was performed on PP who had fallen or were at risk of falling in 2014. The study intervention consisted of a 10-week (3 sessions each week, each lasting 60 min) corrective exercise program. Participants were randomly allocated to control and two exercise groups; the exercise group with balance pad (EGBP) or exercise group with no balance pad (EGNBP). The analysis of variance (ANOVA) and paired t-test were used for comparison between the groups (P ≤ 0.05). Results: Administrating a selective corrective exercise in exercise group with balance pad (EGBP) showed a significant difference in number of falls (NOF), Fall Efficacy Scale-international (FES-I), Berg balance scale (BBS) (and timed up and go) TUG (P = 0.001); while administrating the same exercise in exercise group with no balance pad (EGNBP) showed no significant difference in NOF (P = 0.225) and a significant difference in FES-I (P = 0.031), BBS (P = 0.047) and TUG (P = 0.012). The control group showed no significant difference in each of the dependent variables. Conclusions: Performing a selective corrective exercise on balance pad improves falling and functional balance in idiopathic PD. Keywords: PD; Falling; Postural Balance; Exercise Therapy Language: en

Policies on Protecting Vulnerable People During Disasters in Iran: A Document Analysis.

Abstract: Context Developing official protection policies for disasters is a main strategy in protecting vulnerable people. The aim of this study was to analyze official documents concerning policies on protecting vulnerable people during disasters. Evidence acquisition This study was conducted by the qualitative document analysis method. Documents were gathered by searching websites and referring to the organizations involved in disaster management. The documents were assessed by a researcher-made data collection form. A directed content analysis approach was used to analyze the retrieved documents regarding the protection policies and legislation for vulnerable people. Results A total of 22 documents were included in the final analysis. Most of the documents referred to women, children, elderly people, poor, and villagers as vulnerable people. Moreover, the documents did not provide information regarding official measures for protecting vulnerable people during different phases of disaster management. Conclusions A clear and comprehensive definition of "vulnerable people" and formulation of official policies to protect them is needs to be formulated. Given the high prevalence of disasters in Iran, policy makers need to develop effective context-based policies to protect vulnerable people during disasters.

Assessment of Hospital Management and Surge Capacity in Disasters

Abstract: Background: Hospital administrators play a key role in the eective management of surge capacity in disasters, but there is little information available about the characteristics required to manage this. Objectives: In this study, we aimed to identify characteristics of hospital administrators that are important in the eective man- agement of surge capacity in disasters. Materials and Methods: This was a qualitative study. Semi-structured purposive interviews were conducted with 28 hospital ad- ministrators who had experience working in surge situations in hospitals during disasters. Framework analysis was used to analyze the data. Results: Three themes and 12 subthemes were identified. The themes were as follows: 1) crisis managerial characteristics, 2) personal characteristics, and 3) specific requirements. Conclusions: In this study, some characteristics that had a positive impact on the success of a manager in a hospital surge situa- tion were identified. These characteristics ought to be taken into account when appointing hospital administrators and designing training programs for hospital administrators with the aim of being better prepared to face disasters.

Confirmatory Factor Analysis of Occupational Injuries: Presenting an Analytical Tool

Abstract: Background: Occupational injuries are considered to be of great concern in all workplaces and industries, especially in the construction field. Objectives: The purpose of this study was to determine and analyze the factors contributing to occupational injuries by means of confirmatory factor analysis (CFA). Materials and Methods: This developmental analytical study was implemented based on occupational accidents that occurred within a five-year time frame (2009 to 2013) in 13 large Iranian construction workplaces. Modeling and data analysis were conducted by implementing the structural equations model (SEM) and CFA approaches with the use of statistical software IBM SPSS AMOS version 22.0. Results: The results show that the individual and demographic factor (IDF), organizational factor (OF), H & S training factor (TF), workplace-human factor (WHF), factor related to type of accident occurrence (TAF), H & S risk management system factor (RMSF), and accident time factor (ATF) were considered to be effective and significant independent latent factors in occupational injuries. Conclusions: Analytical modeling of structural equations with respect to the CFA approach has shown that occupational injuries are due to the combination of underlying indicator variables and different groups of latent factors. Hence, to determine and analyze such injuries, the role of each factor, its underlying components, and its relation with others should be considered, which will make it possible to develop a more structured approach that considers all relevant factors in order to prevent occupational injuries.

Association Between Fatigue and Occupational Physical Trauma Among Male Iranian Workers in the Copper Extraction Industry

Abstract: BACKGROUND: Fatigue may lead to several consequences and principally produces occupational physical trauma among the workforce. Objectives: This study was designed to explore the relationship between work-related physical trauma and fatigue in the copper extraction industry. Materials and Methods: This cross-sectional study was conducted among 453 male workers employed in the copper extraction industry in Kerman, Iran. The validated Persian version of the Piper Chronic Fatigue Scale was used for the data collection. An additional self-administrated questionnaire was prepared to obtain demographic and occupational data, including age, work experience, smoking, and history of physical trauma in the workplace. Results: The results showed that 28.5% of the participants had experienced work-related physical trauma during the past three years. Severe fatigue was most commonly reported on the subscale for life and emotions (14.79%). A higher rate of work-related fatigue was associated with physically strenuous activities and an inappropriate work place. The mean fatigue scores for subjects both with and without physical trauma experiences were 3.75 ± 0.98 and 2.86 ± 0.79, respectively (P = 0.005). Conclusions: General fatigue and its subscales had a significant relationship with workplace physical trauma among miners. Workplace physical trauma can be reduced by managing fatigue with different programs, including decreasing the workload, scheduling rest breaks at the facilities, and possibly providing welfare and entertainment opportunities for the workers. Keywords: Fatigue; Occupational Physical Trauma; Copper Extraction Industry; Iran Language: en

Effects of Melissa officinalis L. on Reducing Stress, Alleviating Anxiety Disorders, Depression, and Insomnia, and Increasing Total Antioxidants in Burn Patients

Abstract: Background: Burns are a major cause of stress, and afterwards, many patients suffer from anxiety, depression, and insomnia. Also, the levels of serum antioxidants increase after burns, which causes problems in patients. It has been observed that Melissa officinalis L. can increase serum antioxidant levels and improve mood and sleep quality. Methods: Thirty-six patients who were admitted to Shahid Motahari Burn Hospital were selected. Patients in the control group consumed black tea, and those in the experimental group received Melissa tea. The serum levels of antioxidants were measured using spectrophotometry once before the intervention and at 20 days after the intervention. Depression, anxiety, and insomnia levels were each measured by the Beck, Kettles, and Petersburg questionnaires, respectively. Results: In the study group, the percentages of those experiencing anxiety (P value: 0.023) and depression (P value: 0.002) were significantly less than those of the control group. Also, sleep quality in the experimental group taking Melissa tea increased significantly (P value: 0.031). However, the mean serum antioxidant levels were not significantly different between the control and experimental groups (P value: 0.96). Conclusions: Melissa officinalis L. can significantly reduce anxiety and depression and improve sleep quality. Therefore, its consumption may be useful for burn patients as a daily drink. However, the effects of Melissa on increasing serum antioxidants needs further investigation.

Effectiveness of Dry Needling, Manual Therapy, and Kinesio Taping® for Patients with Chronic Myofascial Neck Pain: A Single-Blind Clinical Trial

Abstract: Background: Chronic neck pain (CNP) is a common disorder associated with substantial morbidity. Different methods of rehabilitation are used to manage chronic myofascial neck pain. Objectives: The present study aims to assess the effects of dry needling (DN), manual therapy (MT) and Kinesio Taping® (KT) methods on the treatment of patients with chronic myofascial neck pain. Methods: Thirty-nine individuals (mean ± standard deviation (SD): Age 35 ± 10.1 years; height 178.6 ± 7.5 cm; body mass 86.9 ± 7.7 kg) out of 57 patients (age range: 18 - 55 years) were included in the current single-blinded randomized clinical trial. The subjects were assigned into 3 groups (N = 13 subjects in each group) including DN, MT, and KT. Pain intensity, pain catastrophizing scale (PCS), neck disability index (NDI), and cervical spine range of motion (CROM) in different directions were evaluated by self-reported questionnaires and cervical goniometer at baseline and following 5 treatment sessions. Following the evaluation of the normal distribution of variables by Shapiro-Wilk test, the paired-samples t-test and one-way analysis of variance (ANOVA) were used to analyze the data. Results: Pain intensity and catasrophizing, neck disability, and CROM in all directions significantly improved following the 3 interventions (P 0.05). Conclusions: It is assumed that DN, MT, and KT can improve pain and neck disability and increase CROM in patients with myofascial CNP. The MT techniques are more effective in increasing CROM for rotation compared to the other 2 methods.

Healing Effects of Synthetic and Commercial Alginate Hydrogel Dressings on Wounds: A Comparative Study

Abstract: Background: Hydrogels based on natural ingredients, such as alginate, are considered promising wound dressings. Alginic acid, a polysaccharide polymer, is a structural component of the cell walls of brown algae. The important features of alginates used in biological dressings include non-toxicity, biocompatibility, biodegradability, hydrophilicity, and excellent swelling behavior. Objectives: In this study, the effects of alginate hydrogels and commercial alginate dressings were studied with regard to wound recovery in a rat model. Methods: Fifteen Wistar rats were divided into three groups of five. One wound measuring 1 × 1 cm square was made on each rat using a template. One rat in each group was euthanized on the 4th, 7th, 14th, and 21st days, and skin samples were taken for histopathological analysis. Results: The findings showed that the average total time of wound healing in the synthetic alginate dressing group was similar to that of the commercial dressing group. In this study, we found that synthetic alginate hydrogels were much more convenient for wound dressings and for the treatment of surface wounds. Conclusions: The treatment outcomes showed that our synthetic alginate hydrogel dressing was highly promising as an alternative wound-healing system, opening a new path toward future research and development.