Using modified Direct Observation of Procedural Skills [DOPS] to assess undergraduate medical students

Introduction: nowadays according to competency based curriculum, selecting an appropriate assessment method is inevitable. This study aimed to investigate application of Direct Observation of Procedural Skills [DOPS] in undergraduate medical students

Methods: this is a cross sectional study conducted during emergency ward rotation in last year medical students using consensus sampling method. Each student performed 2 procedures at least twice under the observation of 2 assessors using modified DOPS rating scales designed for each procedure simultaneously. Correlation between DOPS score and final routine exam was measured. Face and content validity was determined by the panel of experts. Moreover, through the test-retest and interrater reliability, the correlation of each score and total score was investigated. The spent time was calculated too. The statistical analysis was carried out using SPSS version 18

Results: totally 60 students did 240 procedures under DOPS. The face and content validity confirmed by an expert panel. The findings showed that there was a significant correlation between the scores of each test and the total DOPS score [r1=0.736**, r2=0.793**, r3=0.564**, r4=0.685**; p<0.001]. There was a significant correlation between the first and second scores of doing the same procedure [Pearson Cor.=0.74, p<0.001] and also between the scores of the two individual examiners when observing the same procedure [Pearson Cor.=0.84-0.94, p<0.001]. The results showed that there was no correlation [Pearson Correlation=0.018, p<0.89] between the scores of this test and the final routine ward exam scores. The average time for doing DOPS test and the average time for providing feedback were 11.17 +/- 7.5 Max and 9.2 +/- 4.5 Min, respectively

Conclusion: the use of novel performance assessment methods such as DOPS is highly beneficial in order to ensure the adequacy of learning in medical students and assess their readiness for accepting professional responsibilities. DOPS as a practical and reliable test with acceptable validation can be used to assess clinical skills of undergraduate medical students

Assessment of mechanism, type and severity of injury in multiple trauma patients: A cross sectional study of a trauma center in Iran / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To accurately assess the mechanism, type and severity of injury in Iranian multiple trauma patients of a trauma center.</p><p><b>METHODS</b>Patients with multiple traumas referring to the emergency department of Hasheminejad University Hospital in Mashhad, Iran, entered this cross sectional study from March 2013 to December 2013. All the patients with injury severity score (ISS) > 9 were included in this study. Data analysis was performed by SPSS software (Version 11.5) and P values less than 0.05 were considered as significant differences.</p><p><b>RESULTS</b>Among the 6306 hospitalized trauma patients during this period, 148 had ISS>9. The male female ratio was 80%. The mean age of the patients was (33.5 ± 19.3) years. And 71% of the patients were younger than 44 years old. There were 19 (13%) deaths from which 68.5% were older than 44 years old. The mean transfer time from the injury scene to hospital was (55 ± 26) minutes. The most frequent mechanisms of injury were motorcycle crashes and falling from height, which together included 66.2% of all the injuries. A total of 84% of hospital deaths occurred after the first 24 h of hospitalization. Head and neck were the most common body injured areas with a prevalence of 111 cases (75%).</p><p><b>CONCLUSION</b>Motorcycle crashes have high frequency in Iran. Since most victims are young males, injury prevention strategies should be considered to reduce the burden of injuries.</p>

Comparison of ultrasonography and radiography in diagnosis of rib fractures / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Rib fractures are the most common skeletal thoracic injuries resulting from blunt chest trauma. Half of the rib fractures are not detected upon a precise physical evaluation and radiographs. Recently ultrasonography (USG) has been investigated to detect rib fractures. But based on literature the usefulness of USG varies widely. This study was conducted to investigate the role of USG in the detection of possible rib fractures in comparison with radiography.</p><p><b>METHODS</b>In this cross-sectional study, consecutive patients with minor blunt chest trauma and suspected rib fractures presenting in Imam Reza Hospital located in Mashhad-Iran, between April 2013 and October 2013 were assessed by USG and radiography. The radiography was performed in a posteroanterior (PA) chest projection and oblique rib view centered over the area of trauma. The time duration spent in taking USG and radiography were recorded. The prevalence and location of fractures revealed by USG and radiography were compared.</p><p><b>RESULTS</b>Sixty-one suspected patients were assessed. The male to female ratio was 2.4:1 (43 men and 18 women) with a mean ± SD age of (44.3 ± 19.7) years. There were totally 59 rib fractures in 38 (62.3%) patients based on radiography and USG, while 23 (37.7%) patients had no diagnostic evidence of rib lesions. USG revealed 58 rib fractures in 33 (54.1%) of 61 suspected patients and radiographs revealed 32 rib fractures in 20 (32.8%) of 61 patients. A total of 58 (98.3%) rib fractures were detected by USG, whereas oblique rib view and PA chest radiography showed 27 (45.8%) and 24 (40.7%) rib fractures, respectively. The average duration of USG was (12 ± 3) min (range 7-17 min), whereas the duration of radiography was (27 ± 6) min (range 15-37 min). The kappa coefficient showed a low level of agreement between both USG and PA chest radiography (kappa coefficient = 0.28), and between USG and oblique rib view (kappa coefficient = 0.32).</p><p><b>CONCLUSION</b>USG discloses more fractures than radiography in most patients presenting with suspected rib fractures. Moreover USG requires significantly less time than radiography.</p>

Which technique is better for reduction of anterior shoulder dislocation? external rotation or Milch method. a review of literature

Anterior shoulder dislocation is the most common joint dislocation in human body. Many methods are traditionally described for reduction of shoulder dislocation. Most of these techniques are painful to patients and may be associated with further injury. An ideal method should be easy, effective, and less painful, not associated with iatrogenic complications and should be easy to teach and learn. Among different methods of reduction, external rotation and Milch methods are more popular. Both methods are found to be atraumatic, relatively painless and can be performed without anesthesia. In this article, we aimed to review the literatures regarding these two methods of reduction and comparing their success rate and outcome. We reviewed the literature to find articles related to reduction of anterior shoulder dislocations applying one of two techniques described above. We searched PubMed and Google Scholar. In total, 46 articles were found, of them 17 articles -which mainly focused on anterior shoulder dislocation reduction by means of two above methods-were included in this review. The results showed that both techniques were effective, safe, relatively painless, and were well tolerated with no complications, but the external rotation method was superior

Central venous line complications and tip detection

Central venous line is one of a creative instrument that saves human's life in critical medical situation. Central venous line access is frequently involved in the disease management. It is used for rapid fluid therapy, transvenous pacemakers, infusion of some medications, hemodialysis or plasmapheresis and etc. Most of the emergency departments have some staffs that are trained for central venous line insertion but related complications occur during central venous line placement. Central venous line might have some complications and complication follow-up should be considered. Thromboembolism and infection are two important medical complications. Arterial puncture, hematoma, pneumothorax and hemothorax are mechanical Central venous line complications. Chest X-ray and some other techniques should be used for detecting these complications. Central venous line tip misplace is a considerable problem for emergency department staffs, previously chest X-ray has been used for central venous line misplace detection. In some recent studies, contrast-enhanced ultrasonography and intravascular electrocardiography have been used for central venous line misplace

Impact of intravenous acetaminophen therapy on the necessity of cervical spine imaging in patients with cervical spine trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>We evaluated a new hypothesis of acetaminophen therapy to reduce the necessity of imaging in patients with probable traumatic cervical spine injury.</p><p><b>METHODS</b>Patients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen (15 mg/kg) intravenously after cervical spine immobilization. Then, all the patients underwent plain radiography and computerized tomography of the cervical spine. The outcome measure was the presence of traumatic cervical spine injury. Sixty minutes after acetaminophen infusion, posterior midline cervical tenderness was reassessed.</p><p><b>RESULTS</b>Of 1 309 patients, 41 had traumatic cervical spine injuries based on imaging. Sixty minutes after infusion, posterior midline cervical tenderness was eliminated in 1 041 patients, none of whom had abnormal imaging.</p><p><b>CONCLUSION</b>Patients with cervical spine trauma do not need imaging if posterior midline cervical tenderness is eliminated after acetaminophen infusion. This analgesia could be considered as a diagnostic and therapeutic intervention.</p>

Vitamin D and sepsis

Vitamin D receptors are located in body tissues and cells. In variousphysiological processes of the body the primary circulating formof vitamin D, 25-hydroxyvitamin D, will become the active form,1,25-dihydroxyvitamin D, through many enzymatic. Although differentfunctions of vitamin D has been identified, reducing the possibility ofseveral chronic diseases, including common cancers, autoimmune,infectious, and cardiovascular diseases is proposed as the major role ofthis component. According to various experimental and clinical studies,vitamin D affects the immune system activity. In this review we studythe possible effects of vitamin D on sepsis. The purpose of this review isto evaluate and summarize the role of vitamin D in the immune system,with particular focus on infections and sepsis. We studied different areasrelated to vitamin D in the literature review including its roles sepsis andinfection incidence, as well as seasonal and racial variation in sepsis. Basedon evidence, vitamin D positively affects the immune system, so it mightact as a therapeutic strategy. Despite several experimental studies whichdemonstrated the beneficial effects of vitamin D on improved functioningof the immune system, its association with prevention or management ofinfections and sepsis is not revealed through clinical investigations

Conventional radiography or ultra sound for rib fracture diagnosis: a literature review

Blunt chest trauma accounts for the majority of mortalities and morbidities in traumatized patients. Rib fractures are one of the most common chest wall injuries due to blunt chest trauma, which is estimated to occur in 10% of all traumatic injuries. Conventional radiography and ultra-sonography are two commonly methods used for rib fractures diagnosis with different accuracy. In this study, we described different methods used in diagnosis of injuries related to blunt chest trauma and we aimed to review several studies compared the diagnostic value of these methods

Acute myocardial infarction in a 17-year-old boy secondary to lightning strike

Although lightning is an uncommon phenomenon in nature; it can cause many destructive incidents. In the event of a lightning strike, multiple organs particularly the cardiovascular systems are at risk of injury. Short-term mortality depends on its cardiac effects. In this paper, the authors report the development of myocardial infarction and pericardial effusion after lightning injury, a typical example of "side splash"