Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury / 世界急诊医学杂志（英文）

BACKGROUND@# Rapid and effective pain relief in acute traumatic limb injuries (ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous (IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI.@*METHODS@# In this double-blind randomized clinical trial, 307 patients with ATLI, who presented to the emergency department (ED) from February 2016 to April 2016, were randomly divided into two groups. One group (152 patients) received 0.1 mg/kg IV morphine. The other group (155 patients) received 1 mcg/kg IV fentanyl. Patients' demographic data, pain score at specific intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded.@*RESULTS@# Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up (P value=0.00). However, at 10, 30, and 60-minute follow-ups no significant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12 (7.7%) patients in the fentanyl group and in 48 (31.6%) patients in the morphine group (P value=0.00). No significant difference was observed regarding side effects, vital signs and patients' satisfaction between the two groups.@*CONCLUSION@# Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.

pilot study: development of a local model to hospital disaster risk assessment

Vulnerable events could damage structural, non structural and functional components of hospitals that might lead to community crisis, accordingly. Risk assessment is the first step to develop of a hospital disaster plan. In this study, a primary phase of developing a local tool for Iran's hospital disaster risk assessment entitled [Hospital Safety Index [HIS]] was conducted by World Health Organization originally. First, the original index was translated into Farsi in five forms and 145 items. Then a group of four experts from the fields of medicine and engineering assessed the items one-by-one for their relevance and applicability. Revised edition tested three times at Shariati hospital in Tehran. An expert panel also evaluated the feature and content validity of the index. They also weighted the items as well. Test-retest of the index by two independent research groups found 93% of agreement. Furthermore, 244 points were revised or added to the original edition. The most important changes included: Combining instruction parts with related items for increasing educational properties, completing the list of hazards, developing a plan to analysis, and to present a quantitative and graphic of the model and finally to prepare an educational package as well. Persian version of HSI, in response to needs of Iranian's health system, represents a rapid no-expensive tool for screening disaster risks at hospitals; based on an international template that was tested in several countries. Based on this study, the Farsi index would be evaluated in more hospitals around the country. The assessment results will provide Iranian's health system with evidence-based information for more effective allocated resources and interventions evaluating

Assessment of physician's knowledge about disaster

Physicians have an important role addressing the disasters and most of the times they are the first to attend triage scene and emergency departments. Since Iran is one of the countries in which natural disasters are common self reliance and confidence in disaster management are of special importance. In this descriptive cross-sectional study 100 General physicians and 100 residents working in hospitals in some specialized fields related to Emergency conditions were enrolled randomly. They completed checklists about their disaster management knowledge and confidence building level. Data were analyzed via SPSS11. Knowledge of General physicians and residents was as follows, about disaster [29%], scene triage [21%] hospital disaster teams [12%] and tasks [11%] the enrolled physicians didn't show sufficinet abilities in addressing the disasters and their activities were limited to; study [27%], participation in seminars and congresses [4%], and confidence abilities [6%] in disaster conditions. The majority of them [88%] knew that basic and advanced disaster educational courses are necessary for physicians. Disaster training for physicians in under and postgraduate levels are not enough. Therefore considering the low knowledge and abilities of physicians in Iran it's seems that holding advanced disaster courses should be included in physicians training programs