Radiation exposure of the surgeons in sentinel lymph node biopsy

Sentinel node biopsy [SLNB] is the standard of care for breast cancer treatment and it is getting wide acceptance in Iran. The radiation safety of the procedure has been investigated under controlled conditions, but the standard dose of radiotracer and techniques are not always observed in the community setting. The aim of this study was to assess the magnitude of the absorbed doses of radiation to the hands of operating surgeons. Twenty consecutive SLNB procedures were studied. Radiation dose to the hands of the surgeons was measured by placing lithium fluoride thermoluminescent dosimeters [TLDs] in the surgeons' glove. The radiation dose to the abdomen and thyroid area was measured by placing TLDs at these areas. The injected dose of radiotracer, the time interval to the surgery and the duration of the surgery were recorded. The injected dose of radiotracer ranged from 0.1 to 5 mCi. The highest absorbed dose was recorded by TLD, placed on the non-dominant hand third finger [189.1 microSv]. Mean recorded doses were higher for non-dominant hand second finger [53.49 +/- 24.60 microSv]. The measured absorbed doses for the abdominal and thyroid area were lower than those for the fingers. This study has confirmed the procedure safety, even with high dose of radiotracer. Nevertheless, it is advisable to use the lowest dose of the radiotracer to avoid the waste of resources

Developing a national trauma management workshop in Iran applying an animal model

Traumas take a heavy toll throughout the world and Iran is increasingly involved in this problem. So, education and training of medical staff for successful handling of traumatic patients seem necessary. In this study, we tried to develop and evaluate a national training program on trauma management to use animal models through a trauma management workshop. After primary survey and designing an advanced trauma management workshop, 144 practitioners of one armed force were randomly selected to be trained. Participants could experience some practical and new aspects. For example, they handled high velocity traumas and were involved throughout the different phases of trauma management under the supervision of experienced leaders. To assess the program, participants completed open-ended [essay], multiple-choice question [MCQ], and skill exams before and after the workshop. A trauma training program was developed and evaluated. In essay exam, scores significantly increased from 26 to 58, MCQ scores significantly rose from 49 to 65, and the participant's practical competency significantly improved from 46 to 75. Immense attention is required to optimize doctors' training in trauma care to avoid fossilization of cognitive knowledge and skills

[Assessment of the role of prevention training and care in trauma patients in rural regions 2001-2005]

Trauma-related mortality [due to road accidents and gunshot and disaster...] is unexpectedly high in Iran. Short trauma care training course to rural health system and villager of Mehran, Eylam would improve the care for trauma victims. The objective of the present study is to describe the training and evaluate its effect using changes in physiological function of victims. Advanced trauma care course for physicians and nurses, complementary basic trauma care course for emergency technicians and health workers, basic trauma care for highly educated people and first aid short course for ordinary people were developed. After training, the region traumatic patients entered the system through two channels: to the local Mehran Emergency Clinic [some with primary treatment before the local emergency clinic] or directly to Ham University Hospital. Outcome indicator was the physiological change assessed with the physiologic severity score [PSS]. During courses period, 185 physicians and nurses, emergency technicians and health workers, 239 highly educated people and 4410 ordinary people were trained for trauma care. During 3 years leater 366 injured were transported to Mehran Emergency Clinic [226 received primary treatment before the local emergency clinic] and 245 were admitted directly to Ham University Hospital. Total mortality rate was 10.3 percent [66 out of 641 injured people] and the mine injured mortality rate was 20.7% [37 out of 179 mine injured]. In the injured who received trauma care at Mehran Emergency Clinic, PSS mean was 6.4 which improved to 7.5 in the hospital [P<0.001] in comparison with 6.79 in the other group. Rural health worker and general population could be upgraded to care for victims of injuries by using available resources. This system can improve the indicators and reduce trauma mortality rate