Efficacy of new scoring system for diagnosis of abdominal injury after blunt abdominal trauma in patients referred to emergency department / 中华创伤杂志(英文版)

PURPOSE@#The blunt abdominal trauma (BAT) is a common emergency and is significantly associated with morbidity and mortality. Our study was conducted to achieve the goal that a new scoring system could be used for the BAT patients.@*METHODS@#The statistical population of this study was 1000 patients with BAT referred to emergency department of Imam Hossein Hospital, Tehran, Iran. Sampling was carried out in a convenience non-random manner and continued to reach the required sample size. All the patients with BAT due to road traffic accidents, falls, and other direct blunt traumas such as punctures and kickbacks were included in the study. Exclusion criteria were after 3 months of pregnancy, under the age of 18, warfarin taking, no reliable medical history providing and penetrating trauma. The study questionnaire was based on BAT scoring system. The data were analyzed by SPSS V20 software. The receiver operating characteristic curve was used to analyze the effectiveness of the new scoring system in predicting the BAT patients' outcome.@*RESULTS@#The mean age of the patients (n = 1000) was (35.79 ± 13.09) years. The mean score of patients was (6.29 ± 5.80). Based on this scoring system, the patients were divided into three categories. The first group was patients at low risk with score of less than 8, the second group was patients at moderate risk with score of 8-12 and the third group was patients at high risk with score of 12-24. The score of 661 (66.1%) patients were low, 109 (10.9%) were moderate and 230 (23%) had a high score. The association between hip fracture and abdominal tenderness with abdominal injury was significant (p < 0.001). Cronbach's alpha was 0.76 showing the reliability of this questionnaire to predict the future of patients.@*CONCLUSIONS@#The study tool has a sensitivity to predict the BAT patients' outcome, and has a proper specificity that can be used to reduce the use of harmful modalities such as computed tomography scan.

Organizational Commitment among Critical Care Unit Nurses of Mazandaran Heart Center

@#Introduction: Organizational commitment is manifested in the forms of taking pride in organization, enhanced motivation for engaging in organizational duties, staying at organization for a longer time and knowing organization as a valuable organization. So decreased organizational commitment among medical staff led researchers to investigate the organizational commitment of CCUs in Mazandaran Heart Center. Methods: This is a descriptive-analytical study carried out in teaching hospitals of Mazandaran University of Medical Sciences, Heart Center. Allen and Meyer's organizational commitment questionnaire was used to collect data from 90 nurses selected by census from CCU nurses. Data was analyzed using SPSS 21. Results: Of studied cases, 19 (18.9%) were male and 73 (81.1%) were female with a mean age of 7.25±34.4. Among age, job experience and work hour variables, only age and job experience were considered to be significant. Conclusions: Supervisors and managers should promote nurses' organizational commitment through giving facilities and rewards.

Submental intubation in maxillofacial fracture: a case report

It can be challenging to create a safe airway in maxilla facial fracture and some skull surgeries. In this case study, the patient experienced jaw fractures that disturbed the dental occlusion and associated fracture of the base of the skull. Neither nasal nor oral intubation was possible based on the side effects of tracheotomy; therefore, submental intubation was applied successfully. The procedure and results are presented in the text.

Expanded Endoscopic Transnasal Approach to the Chordoid Glioma of the Third Ventricle : The First Case Ever Reported

Chordoid glioma of the third ventricle is a rare and challenging tumor to surgery because of its unique anatomical location and its close juxtaposition to the neurovascular structures and hypothalamus. The authors report a case of chordoid glioma of the third ventricle in a 43-year-old woman, who presented with headache and somnolence. The tumor was approached by endoscopic transnasal technique with a favorable result. Histopathologic examination disclosed a neoplastic tissue composed of eosinophilic epithelioid cells, mucinous, periodic acid Schiff-diastase positive, extracellular matrix, and scattered lymphoplasmacytic infiltrates. The best treatment option remains controversial. Customarily, the surgical route to remove chordoid glioma is transcranial; however, the undersurface of the optic chiasm and optic nerves preclude an adequate surgical visualization. In contrast, an expanded endoscopic transnasal approach provides a direct midline corridor to this region without any brain retraction.

Students' Perceptions of the Educational Environment in a Northern Iran University of Medical Science.

Aim: This study aimed to evaluate the current situation of clinical departments in order to explore the viewpoint of interns and trainee according to the Dundee ready educational pattern (DREEM) in Mazandaran University of Medical Science. Design and Setting: the samples included all intern and externs of medical department who were studying in Mazandaran University of Medical Science. Methods and Materials: This was a cross sectional study which comprised students who selected by convenience methods. The standard questionnaire used to assess the view of students who were intern or trainer in Mazandaran University of Medical science during 2012. The questionnaire comprised four subscales i.e. learning (12 item), educational environment (12 item), teachers (11 item) and perceived ability (12). Statistical analysis: SPSS software was used to analysis the collected data. We employed ANOVA, Pierson and Structural Equation Modelbing. Results: the findings showed the mean is above 3 and significance level is belowe0.05 which implies the view of interns is average toward teacher efficacy, educational environment, learning condition and perceived self-ability. Conclusions: according to the findings, authors suggests to future researchers to explore the clinical departments situations in different cultures and regions with different medical educational related factors in order to provide better knowledge regarding gaps in health care systems.

Effect of auditory stimulation on traumatic coma duration in intensive care unit of medical sciences university of Mazandarn, Iran

Sensory deprivation is one of the common complications of coma patients in the intensive care unit [ICU]. The purpose of this study was to investigate the impact of a familiar voice to consciousness level in coma patients. A total of 13 patients with traumatic coma [8 >/= Glasgow's coma scale [GCS]] admitted in ICU ward were randomly assigned to control and experimental groups. The experimental group was treated twice a daily each time 15 min with a familiar recorded MP3 sound for 2 weeks. The control group received only natural voices of environment. GCS applied to evaluate patients' level of consciousness. Findings showed that duration to reach GCS = 15 was significantly shorter in the experimental group [X[2] = 12/96, P < 0/001]. These findings imply that providing familiar auditory stimulation programs for coma patients in the ICU could be effective

comparison of the diagnostic power of the Full Outline of Unresponsiveness scale and the Glasgow coma scale in the discharge outcome prediction of patients with traumatic brain injury admitted to the intensive care unit

This study aimed to determine whether the Full Outline of Unresponsiveness [FOUR] score is an accurate predictorof discharge outcome in traumatic brain injury [TBI] patients and to compare its performanceto Glasgow coma scale [GCS]. This is diagnostic study conducted prospectively on 53 TBI patients admitted to ICU of education hospitals of Medical Science University of Mazandaran during February 2013 to June 2013. Data collection was done with a checklist including biographic, clinical information and outcome. The FOUR score and GCS were determined by the researcher in the first 24 hours. Outcomes considered as in-hospital mortality and poor neurologic outcome [Glasgow Outcome Scale [GOS] 1-3] in discharge time from the hospital. In terms of predictive power for in-hospital mortality, the area under the receiver operating characteristic [ROC] curve was 0/92 [95% CI. 0/81-0/97] for FOUR score and 0/96 [95% CI. 0/87-0/99] for GCS. In terms of predictive power of poor neurologic outcome, the area under the ROC curve was 0/95 [95% CI. 0/86-0/99] for FOUR score and 0/90 [95% CI.0/79-0/96] for GCS as evidenced by GOS 1-3. The cut-off of 6 showed sensitivity and specificity of total four score predicting poor outcome at 0/86 and 0/87 while the cut-off of 4 showed the value of in hospital mortality at 0/90 and 0/90. The total GCS score showed sensitivity and specificity 0/100 and 0/61 at cut-off 7 in predicting poor outcome while in predicting mortality at cut-off of 4 this range was 0/100 and 0/92. The FOUR score is an accurate predictor of discharge outcome in TBI patients. Thus, researchers recommend for therapeutic Schematizationto use in neurosurgical patients at admission day.

Studying music effect on children's stress following chemotherapy: a randomized clinical trial

Due to adverse effects of cancer on children's mental health, relaxation, chemotherapy side-effects and positive effects of music therapy on stress, this study was performed with the goal to determine the effect of music therapy on children's stress after chemotherapy. The present study is a randomized clinical trial done on 32 children undergoing cancer chemotherapy in Bu-Ali Sina hospital in Sari in the 2012-2013. By convenience sampling method and then allocation, they were randomly divided into two groups [16 people] as control and experimental. The data included the demographic questionnaires and self- assessment questionnaire stress of Sharrer -Wenger. In the intervention group, after recounting how to perform music for the child and the mother and select the songs chosen by the child for 20 minutes, half an hour before and after starting and completing chemotherapy, based on child's bearing, the was music of relaxing sounds of nature and the music for children was played. In the test group, the stress questionnaire was executed before and after music therapy before chemotherapy and after the treatment course. In the control group, before starting chemotherapy and after a course of chemotherapy treatment, the questionnaire was completed. The data was analyzed using statistical software SPSS 18 and the t-test and ANOVA with repeated measures and Pearson correlation. No Significant difference was found between the control and experimental stress scores in the two groups [after a music therapy session] before chemotherapy [p=0/240], but after chemotherapy, the average stress score in the experimental group, after the music therapy was significantly lower, and the difference was statistically significant [p=0/000]. Due to a substantial reduction in stress scores of music therapy in children undergoing chemotherapy, the music therapy can be an effective intervention for reducing stress and helping the children to better cope with life after being afflicted by cancer

Optimization of cold rolling process parameters in order to increasing rolling speed limited by chatter vibrations

Chatter has been recognized as major restriction for the increase in productivity of cold rolling processes, limiting the rolling speed for thin steel strips. It is shown that chatter has close relation with rolling conditions. So the main aim of this paper is to attain the optimum set points of rolling to achieve maximum rolling speed, preventing chatter to occur. Two combination methods were used for optimization. First method is done in four steps: providing a simulation program for chatter analysis, preparing data from simulation program based on central composite design of experiment, developing a statistical model to relate system tendency to chatter and rolling parameters by response surface methodology, and finally optimizing the process by genetic algorithm. Second method has analogous stages. But central composite design of experiment is replaced by Taguchi method and response surface methodology is replaced by neural network method. Also a study on the influence of the rolling parameters on system stability has been carried out. By using these combination methods, new set points were determined and significant improvement achieved in rolling speed

[Satisfaction of outpatients referring to teaching hospitals clinics in Shiraz, 2009]

Objective[s]: To determine satisfaction level of out patients in teaching hospitals clinics in Shiraz city. This was a cross- sectional study that carried out on 1175 outpatients in teaching hospitals in Shiraz in 2009

Methods: The data were collected by using questionnaire by interviewing patients. The questionnaire had 17 questions in 4 scopes including satisfaction of therapeutic services, non therapeutic services, and quality of offered services and length of wait time, facilities and physical environment. Statistical analysis was performed by using SPSS software in 5% probability level

Results: The general amount of satisfaction of services was reported low by 45.4% of patients, medium by 16.9% of patients and good by 37.6% of outpatients. The average of patients' satisfaction in Dastgheib hospital significantly was higher than other hospitals. The olds significantly were more satisfied with services. Women significantly were more satisfied than men

Conclusion: By increasing the level of education the amount of satisfaction decreased significantly. High percent of patients who are dissatisfied with outpatient services can be caused patients' weak cooperation, quitting the process of treatment, wasting of resources and damaging hospital fame. So it is necessary to be emphasized on increasing the level of outpatients' satisfaction by hospital managers