ABSTRACT
<p><b>OBJECTIVE</b>One of the most common joint dislocations presented to the emergency department (ED) is anterior shoulder dislocation (ASD). Various techniques for the treatment of this abnormality have been suggested. In this study, we evaluated the efficacy and success rate of modified scapular manipulation (MSM) as a painless procedure compared to traction-countertraction (TCT) for reduction of ASD.</p><p><b>METHODS</b>Patients with ASD who were presented to ED of Baqiyatallah Hospital, Tehran during 2011 were included. They were randomly divided into MSM group or TCT group and then pain at reduction, time of reduction, duration of hospitalization, and success rate were compared. In TCT group, reduction was performed using sedative and antipain medications.</p><p><b>RESULTS</b>Ninety seven patients (81.6% male) with a mean age of 34.15 years±13.48 years were studied. The reduction time between both groups showed a significant difference (470.88 seconds±227.59 seconds for TCT group, 79.35 seconds±82.49 seconds for MSM group, P<0.001). The success rate in MSM group in the first and second effort were 89% and 97% whereas 73% and 100% in the TCT group respectively (P<0.001).</p><p><b>CONCLUSION</b>It seems that the manipulation technique can be more successful than the TCT method at the first effort whilst the second effort has the opposite results. Also MSM can be safer, cheaper and more acceptable for patients than TCT as a standard traditional method.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Manipulation, Orthopedic , Methods , Scapula , Shoulder Dislocation , Therapeutics , Traction , MethodsABSTRACT
Pneumothorax is a potential life-threatening condition especially in patients with underlying disorders. In this study we compared the diagnostic accuracy of general practitioners and emergency medicine specialists in interpreting chest x-rays [CXR] suspected of having iatrogenic pneumothorax in emergency departments. This cross-sectional study was conducted in Shahid Chamran Hospital in Tehran, Iran during 2008- 2010. The study was designed to compare the ability of general practitioners and emergency medicine specialists in diagnosing iatrogenic pneumothorax regarding 500 CXRs of one-hundred patients admitted for upper central venous catheterization. General practitioners and emergency medicine specialists could accurately [P<0.001] diagnose pneumothorax in 484 [96.8%] and 497 [99.4%] CXRs, respectively. None of the underlying causes of the condition affected the diagnostic accuracy of both physician groups [P>0.05]. These findings indicate that the diagnostic accuracy of emergency medicine specialists is significantly higher than those of general physicians. The diagnostic accuracy of both physician groups was higher than the values in similar studies that signifies the role of relevant training given in the emergency departments of the Hospital
ABSTRACT
Procedural sedation in children continues to be a problem in the emergency department [ED]. Midazolam is the first water-soluble benzodiazepine and it has been widely used for procedural sedation in pediatric patients. The aim of this study was evaluation of clinical safety and effectiveness of intramuscular Midazolam for pediatric sedation in the ED setting. We performed a self-controlled clinical trial on 30 children who referred to the Baqiyatallah Hospital ED between 2009 and 2010. They received intramuscular Midazolam 0.3 mg/kg for procedural sedation and then they were folio wed for sedative effectiveness and safety. Vital signs and O2 saturation were also observed. The findings were I compared using SPSS ver. 16 software. I The mean age was 5.50 +/- 2.70 years, the mean weight was 19.50 +/- 6.63 kilograms and 16 patients [53.3%] were females. The most common adverse effect was euphoria [66.66%] and vertigo [6.7%]; 27.7% did not show any side effects. There was an overall complication rate of 72.3%. The vital signs including heart rate, respiratory rate, systolic and diastolic blood pressure and O2 saturation decreased significantly during sedation [P value < 0.05]. Midazolam is an effective and relatively safe sedative for pediatric patients in the ED. The patient should be observed closely and monitored for psychological and hemo-dynamic side effects
ABSTRACT
It is obvious that self-citation is a part of all citations, but high self -citation rate brings high journal rank and introduce the author as the highly cited author. The purpose this study was to recognize both journal self-citation and author self-citation and find their correlation with impact factor. Citation analysis was used to conduct the survey. The population includes 34 Persian Journal Citation Report's medical journals with impact factor. Since the study examined journals impact factors in 2005, the citations in 2005 to articles published in 2003 and 2004 were considered and number of self- citations was determined. Data were analyzed using SPSS software and Correlation test. 85% of medical journals publish with 61% self-citation rate. Comparing journal performance, before and after omitting self-citation, it was found that the rank of 6.9% journals descended and the impact factor of 58.6% journals became zero meanwhile the rank of 34.5% journals improved. There was a significant correlation between impact factor and self- citation rate [P=0.01, r=0.508]. Pearson Correlation Coefficient demonstrated a relationship between impact factor and journal self- citation and author self - citation. There was no significant correlation between impact factor and adjusted impact factor with number of articles. Journals with low impact factor have lower self-citation. It means that self-citation has positive influence on impact factor. With regard to highly used of self-citation [61.5%] and changing of 58% journals' impact factor to zero, the number of self-citation should decrease in medical journals. At this case the journals will obtain their right rank. Consequently, with the increase of self-citation the editorials must change their article submission policy