RESUMO
Objective: to evaluate the effect of advance trauma life support [ATLS[registered sign]] training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination [OSCE]
Methods: this cross-sectional single-center study was conducted in Shiraz University of Medical Sciences including 51 surgery residents that participated in a mandatory national board style OSCE between May 2014 and May 2015. OSCE scores of two groups of general surgery residents including 23 ATLS[registered sign] trained and 28 non-ATLS[registered sign] trained were compared using Mann-Whitney U test. The exam was graded out of 20 points and the passing score was >/=14 including 40% trauma cases
Results: there were 8[15.7%] women and 43[84.3%] men among the participants with mean age of 31.12 +/- 2.69 and 33.67 +/- 4.39 years in women and men respectively. Overall 7 [87.5%] women and 34 [79.07%] men passed the OSCE. The trauma section OSCE score was significantly higher in the ATLS[registered sign] trained participants when compared to non-ATLS[registered sign] [7.79 +/- 0.81vs.6.90 +/- 1.00; p=0.001]. In addition, the total score was also significantly higher in ATLS[registered sign] trained residents [16.07 +/- 1.41 vs. 14.60 +/- 1.40; p=0.001]. There was no association between gender and ATLS[registered sign] score [p=0.245] or passing the OSCE [p=0.503]
Conclusion: ATLS[registered sign] training is associated with improved overall OSCE scores of general surgery residents completing the board examinations suggesting a positive transfer of ATLS learned skills to management of simulated surgical patients including trauma cases
RESUMO
Background: Neuro-Behcet’s disease (NBD) is similar to multiple sclerosis (MS) in multiple aspects. This study was conducted to investigate the sensitivity, specificity, accuracy, positive and negative predictive values for the 2005 revised McDonald MRI criteria for the diagnosis of MS and NBD. Methods: This study enrolled 28 consecutive patients with a diagnosis of NBD and 48 patients with a diagnosis of clinically definite MS, who were referred to the Nemazee Hospital, Shiraz University of Medical Sciences, between March 2009 and March 2010. Brain and spinal cord magnetic resonance imaging (MRI) were obtained. Two Radiologists, blinded to clinical diagnosis, reviewed the MRI. We investigated the sensitivity, specificity, accuracy, and positive and negative predictive values of the 2005 revision of the McDonald criteria for dissemination in space for the diagnosis of MS and NBD. Results: There were a total of 10 men and 38 women with a mean age of 32.76±7.5 years, with a diagnosis of MS, and 18 men and 10 women with a mean age of 26.8±5.9 years with a diagnosis of parenchymal NBD. The interobserver agreement for the diagnosis of MS using the 2005 revision of the McDonald criteria for dissemination in space with the use of the Cohen kappa scores was 0.82. The sensitivity, specificity, accuracy, and positive and negative predictive values were 80%, 61%, 71.5%, 77% and 64%, respectively. Conclusion: The accuracy and specificity of the McDonald criteria for dissemination in space for the differentiation of MS and NBD are not optimal.
RESUMO
To determine the removal time of the chest tube in ICU trauma patients under positive ventilation pressure [PVP]. This was randomized clinical trial being performed in ICU department of Rajaei trauma hospital from March to December 2011. A total number of 92 trauma patients who were admitted in ICU and were under ventilation and had chest tube were randomly assigned into two groups. In case group, chest tube was clamped after 5-7 days. In the control group, chest tube was retained until the patients were under PVP The chest tube was removed if there was no air leak or the drainage was less than 300 mL. Complications observed in the case and control groups were 4.4% of 4.3% respectively [p=0.862]. Among case group with hemothorax, 6.7% developed complication while this ratio for pneumothorax was 7.1% and zero in those with hemopneumothorax [p=0.561], whereas respective values for the control group were 11.1%, 8.3% and zero [p=0.262]. Complications were noticed in 10.5% of those with more than 300 ml of pulmonary drainage. There were no complications in patients without air leak. In mild leak, 4.8% of subjects experienced complication, in moderate leak, no complication occurred and in severe ones, complication was visible in 7.7% of patients [p=0.842]. The present study showed that the removal of chest tube in patients under ventilation within 5-7 days after its insertion is safe without any complications