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   Table of Contents - Current issue
April-June 2020
Volume 9 | Issue 2
Page Nos. 47-98

Online since Saturday, May 30, 2020

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Prevalence of needlestick injuries among health-care workers in iranian hospitals: An updated systematic review and meta-analysis p. 47
Yousef Alimohamadi, Maryam Taghdir, Mojtaba Sepandi, Leila Kalhor, Fahimeh Abedini
Background: Needlestick and sharp injuries have been identified as the most dangerous factor among health-care workers. The Centers for Disease Control and Prevention estimates that 385,000 health-care workers experience needlestick each year. Methods: The aim of this study was to determine the prevalence of needlestick injuries (NSIs) in Iranian health-care workers. In this review and meta-analysis, the local and international databases such as Scopus, Medline, PubMed, ScienceDirect, Web of Science, Google Scholar, Scientific Information Database (SID), and Magiran were searched using keywords including “prevalence” OR “needle” OR “needle stick” OR “Sharp injury” OR “Iranian personnel's” OR “Iranian health care workers” OR “Iranian hospitals” OR “Iran.” The original researches that determined the prevalence of NSIs among Iranian health-care workers and published from January 2005 to June 2019 were included in the current study. The pooled prevalence of NSIs was determined using a random-effects model with a 95% confidence interval. All analyses were performed using STATA version 11 (Stata Corporation, College Station, TX, USA). P < 0.05 was considered as a significant level. Results: The overall prevalence of NSIs among Iranian health-care personnel was about 50.8 (46.3–55.2). Furthermore, this prevalence in educational, noneducational, both noneducational and educational, and military centers was about 51.1 (46.5–57.7), 40.4.1 (34.2–46.6), 61.0 (32.1–89.9), and 41.5 (23.0–60.0), respectively. The prevalence of NSIs among the nurses was 51.1 (45.4–56.8), which was more than other groups. Conclusions: The prevalence of NSIs in Iranian hospitals was high. Since most of the injuries are caused by nurses, more intervention programs should be designed for nurses in these wards.
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Thromboelastography in different mechanisms of injuries/organ injuries in traumatized patients in Southern Thailand p. 56
Sumidtra Prathep, P Sengsai, T Chanchayanon, O Karnjanavanichkul, O Akaraboworn
Background: Trauma is the second most common cause of death in Thailand, relatively with massive blood loss. Coagulopathy plays a role in blood loss. Differences in mechanisms and organs injured can affect coagulopathy stage and blood loss. Thromboelastometry is a measuring instrument for accurate and rapid detection of coagulopathy. We hypothesized that thromboelastometry in traumatized patients who require surgery in Songklanagarind Hospital will help with early detection of coagulopathy and assess anticipated blood loss. Methods: After approval from the Institutional Ethics Committee, patients aged above 18 years who had American Society of Anesthesiologists Physical Status (ASA) IE–VE, activated by trauma team and sent for emergency surgery. Anesthesia was induced and maintained, and invasive procedures were done as anesthesiologist's consideration. Thromboelastometry, prothrombin time (PT), partial thromboplastin time (PTT), complete blood count, platelets, arterial blood gas, lactate, and base deficit were assessed and recorded at the emergency room and after Massive Transfusion Protocol (MTP) was activated at 1 and 2 MTP, respectively. Results: Most traumatized patients who were operated on in Songklanagarind Hospital during the study period were male, the most common cause of their injuries was a motorcycle accident, and the most common organ associated with massive blood loss and blood transfusion was the head. After the patients received PRCs of 5 and 11 units, the hematocrit level and platelet count decreased from baseline, while PT and PTT were prolonged. pH, base deficit, and lactate were worse. Clot formation time (CFT), A10, and maximum clot firmness (MCF) of EXTEM were statistically significantly different among the three time periods. Clotting times, CFT, A10, and MCF of INTEM were statistically significantly different among three time periods. A10 and MCF of FIBTEM were statistically significantly different among three time periods. Conclusion: Most baseline laboratory tests in the traumatized patients who received massive blood transfusion and underwent surgery were worse after they received 1 and 2 MTP. These parameters including thromboelastometry could be guided for preparing proper blood components for patients requiring massive transfusion.
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A comparative study on the ability of trauma severity-assessing methods in determining the prognosis of patients having accident and referred to Imam Khomeini Hospital of Urmia in 2016 p. 62
Omid Garkaz, Hamid Reza Mehryar, Hamid Reza Khalkhali, Shaker Salari Lak
Introduction: Trauma is the leading cause of death and disability in developing countries. According to the World Health Organization projections by 2020, accidents alone are the second leading cause of missing year around the world. Therefore, the aim of this study was to compare the ability of trauma severity-assessing methods in determining the prognosis of accident patients referred to Imam Khomeini Hospital of Urmia in 2016. Methodology: In this study, the severity of trauma in traffic accident patients referring to Imam Khomeini Hospital of Urmia was determined using the Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma and Injury Severity Score (TRISS), and A Severity Characterization of Trauma (ASCOT), in a 1-year period, via the census method on 2015 hospitalized accident victims, and the ability of these methods to predict mortality and morbidity, length of stay in hospital, and hospital length charges were investigated by the receiver operating characteristic curve of regression methods. To this end, the hospital records of accident victims who were hospitalized for at least 1 day or whose deaths were examined along with their autopsy reports were the main components of this study. Results: The mean age of the patients was 33.63 ± 18.53 years, and their age range was 1–96 years. The ratio of males to females was 2.73. In addition, in terms of job status (46.8%), they were free. The majority of women were homemakers (70.8%). In the two gender groups, most accidents occurred within the city, The mean severity of lesions based on ISS system was 16.44 ± 16.28 and 16.8% of ISS injuries were above 25. The mean RTS of the patients was 7.69 ± 0.54, which ranged from 0 to 7.84, and the mean TRISS of the patients was 92.24 ± 15.87. The trauma means via the ASCOT method was 5.35 ± 1.85. The difference in the severity of trauma (calculated by each of the methods of ISS, RTS, TRISS, and ASCOT) was significant between those who survived and those who died. Conclusion: In this study, most of the accidents happened in males, married, undergraduate, and homemaker, and those on the street as well, and the RTS and TRISS methods showed the highest ability in predicting mortality. Given the usefulness and special applications of these methods, their use in designing a national care system in the trauma area is recommended.
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The effectiveness of acceptance and commitment therapy on posttraumatic cognitions and psychological inflexibility among students with trauma exposure p. 69
Parviz Molavi, Saeed Pourabdol, Anita Azarkolah
Background: Posttraumatic stress disorder has a negative impact on the individual, family, and community due to disturbance in social functioning, increased stress, and life-threatening health status. Therefore, effective and useful therapeutic interventions in this area are very important. This study aimed at examining the effectiveness of acceptance and commitment therapy (ACT) on the posttraumatic cognitions of students with trauma exposure. Methods: In this quasi- experimental study, population included all students of Islamic Azad University in Roudehen, Tehran, Iran, during the academic year of 2018–2019. After administering trauma questionnaire, the second version of acceptance and action questionnaire (AAQ-II), and posttraumatic cognitions inventory (PTCI) to 500 people, 113 people who experienced trauma and had high scores in PTCI and low scores in AAQ-II were identified. Of whom 40 people were selected randomly. After the clinical interview, the subjects were randomly placed in the experimental group (who received ACT, n = 20) and placebo group (n = 20). Both groups were pre- and posttested using the PTCI and AAQ-II. Then, the obtained data were analyzed using covariance analysis. Results: The results showed that there was a significant difference in posttraumatic cognitions (negative cognitions about self, negative cognitions about the world, and self-blame) between the two groups. In addition, the results of posttest related to ACT had a significant impact on psychological inflexibility. In other words, ACT reduced posttraumatic cognitions and increased psychological flexibility of these students. Conclusion: The findings of the present study reveal that despite posttraumatic cognitions of students with trauma exposure, ACT increases value-based behaviors through increasing psychological flexibility and decreasing experiential avoidance.
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The association between time intervals in emergency medical services and In-hospital mortality of trauma patients p. 75
Peyman Saberian, Pir-Hossein Kolivand, Parisa Hassani-Sharamin, Maryam Modaber, Amirreza Farhoud, Ehsan Karimialavijeh
Context: While the clinical practice recommends field stabilization in trauma patients, in some situations, the speed of transport is crucial. Aims: This study aimed to evaluate the association between emergency medical services (EMS) time intervals (response time [RT], scene time [ST], and transport time [TT]) and in-hospital mortality in trauma patients in Tehran, the largest metropolis of Iran. Settings and Design: A prospective cohort study was conducted between May 2017 and April 2018. Methods: All EMS operations related to trauma events in the Tehran city that were transferred to three targeted major trauma centers were included. Statistical Analysis: Logistic regression analysis was used to assess the relationship between EMS time intervals and other risk factors of trauma death. Results: A total of 14,372 trauma patients were included in the final analysis. In-hospital mortality occurred in 225 (1.6%) patients. After adjustment for confounding variables, older age (odds ratio [OR] = 1.04/year), female gender (OR = 2.16), low Mechanism, Glasgow Coma Scale (GCS), age, and arterial pressure score (OR = 0.84 for each unit), low GCS (OR = 0.56 for each unit), longer ST (OR = 1.17/10 min), and longer TT (OR = 1.21/10 min) were found to be risk factors for death in trauma. Conclusions: Our study showed that in-hospital mortality of trauma patients correlated with longer EMS ST and TT, but the RT was not associated with mortality. Our results recommend that the EMS system should consider ST and TT rather than RT, as indexes of quality control in prehospital care of trauma patients.
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Promotion of knowledge, skill, and performance of emergency medical technicians in prehospital care of traumatic patients: An action-research study p. 81
Javad Dehghannezhad, Farzad Rahmani, Rouzbeh Rajaei Ghafouri, Hadi Hassankhani, Abbas Dadashzadeh, Zhilla Heydarpoor Damanabad
Background: Annually, there is a high rate of mortality due to trauma. Prehospital emergency personnel are the first caregivers present beside trauma patients, and their dexterity to take care of trauma patients is of great significance in the vast majority of patients' survival. Materials and Methods: This study was action research with the participation of 125 prehospital emergency personnel from May 2016 to December 2018 in five stages (observation, reflection, planning, action, and evaluation) in Iran. Knowledge, skills, and performance of personnel were assessed before and after the action. Data collection tools included knowledge questionnaire and PERFECT skill assessment checklist by Objective Structured Clinical Examination method and researcher-made checklist for performance. Data were analyzed using SPSS-21 software. Results: The findings indicated that 67.82% and 84.4% of prehospital emergency staff have median to low knowledge and expertise in respect to trauma care, respectively. Their performance of necessary measurements for trauma patients was poor prior to training. There was a significant difference between the mean knowledge, skills, and performance of medical emergency technicians before and after the training course (P = 0.00). Conclusions: Participation of beneficiaries in planning for trauma patient's care is helpful. Establishment of prehospital trauma life support training in the medical emergency, training curriculum, and its instruction to prehospital emergency personnel while serving in trauma care will be of great benefit.
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Prevalence of work-related violence among nurses working in Kashan Shahid Beheshti Hospital in 2018 p. 87
Hamidreza Saberi, Alireza Dehdashti, Hakime Zamani-Badi
Background and Objectives: Aggressive behaviors against medical personnel have been reported as a common problem that occurs in many ways and associated with many complications. The aim of this study was to describe the prevalence and work-related factors of workplace violent incidents against nurses in hospital environment. Materials and Methods: This descriptive, cross-sectional study was conducted on 161 nursing professionals working at Shahid Beheshti Hospital in Kashan. Data were collected using the Persian version of the standard questionnaire “Workplace violence in the health sector.” Descriptive analyses were conducted to examine the relationship of individual and work variables with the incidence of aggression. Results: Of the participants, 67% reported having been experienced at least one type of aggression within the past 12 months. The 1-year prevalence of verbal aggression (87%) was the highest, followed by physical aggression (31.2%). Nurses reported being pushed (13.6%) and beating (12.4%) as common physical aggression. Bullying (34.7%) and vilification (25.4%) were reported the most frequent verbal abuse. Perpetrators were mainly patients' family (61.2%) and patients (30.2%). Married nurses were more likely exposed to physical and verbal violence compared to single nurses (P = 0.016). The majority of nurses reported uselessness (62.8%) and unimportance (27.3%) of declaring violent events as the main reason for avoiding disclosure. Conclusion: The frequency of aggression, particularly verbal abuse is significantly high in nursing profession. The results suggest the need for the development of appropriate violent reporting and prevention systems in the hospital environment.
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Minimally invasive management of a dental trauma: Two years of follow-up in Biodentine-induced maturogenesis p. 93
Khashayar Sanjari, Hosna Ebrahimi Zadeh
Dental trauma is an ordinary complication in childhood period. Most of the traumas are crown fractures in the permanent dentition. Complicated crown fracture, introduced as a crown fracture accompanied by pulp exposure. Treatment plan and long-term prognosis could be modified by different factors, such as fracture line position, root development, alveolar bone fracture, and occlusion. In traumatized open apices teeth, apexogenesis can be occurred after traumatic exposure by vital pulp therapy procedures such as pulp capping, partial or complete pulpotomy in pertinent to the size of the exposure. In this complicated crown fracture case, cervical pulpotomy was performed with a silicate-based biomaterial. Patients smile and esthetic demands play an important role in the perception and judgment that people have of others appearance and character. To reconstruct the patient's smile line, the adhesive reattachment of the coronal fractured fragment to the remaining tooth structure was planned. Reattachment could be suggested as an ideal treatment procedure for crown fracture cases. This technique could be applied to achieve excellent esthetic outcomes and normal function. At 1-year follow-up visit, the patient had no complaints of pain. The clinical and radiographic examination showed a stable reattachment and good periodontal health. Apex diameter was decreased significantly. Physiological root-end closure was obvious. Secondary dentin and calcific barrier were also observed on the radiograph below the Biodentine layer.
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