Iman Deilamy; Mitra Amini; Hamid Reza Abbasi; Shahram Bolandparvaz; Shahram Paydar
Volume 10, Issue 2 , April 2022, , Pages 83-86
Abstract
Objective: To investigate the impact of peer-assisted learning (PAL) in chest tube insertion education on surgical residents. Methods: This study is a quasi-experimental study conducted on thirty general surgeon residents enrolled in the PAL program. They were divided into two learner groups (A and B) ...
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Objective: To investigate the impact of peer-assisted learning (PAL) in chest tube insertion education on surgical residents. Methods: This study is a quasi-experimental study conducted on thirty general surgeon residents enrolled in the PAL program. They were divided into two learner groups (A and B) based on the period of residency start. Group A and B had six and one months of general surgery residency experience, respectively. All participants received adequate training for chest tube insertion by a recently graduated general surgeon. Chest tubes insertion skill was assessed using the tool for assessing chest tube insertion competency (TACTIC) test. Results: Post-TACTIC test score was significantly higher (p=0.001) than Pre-TACTIC test score in both groups. However, a comparison of mean Pre-TACTIC test scores and mean Post-TACTIC test scores between group A and group B showed that PAL effectiveness in group A was significantly higher (p=0.001) than group B. Conclusion: There was a positive relationship between the PAL program and the improvement of chest tube insertion technical skills in surgical residents. Based on our findings and similar studies, it can be concluded that the PAL program can increase the chest tube insertion skill of surgical residents.
Hossein Akbarialiabad; Hossein Aabdolrahimzadeh fard; Hamid Reza Abbasi; Shahram Bolandparvaz; Shahin Mohseni; Vahid Mehrnoush; Mina Salehi; Sima Roushenas; Shahram Paydar
Volume 8, Issue 3 , July 2020, , Pages 199-201
Abstract
During the past few months, the novel coronavirus 2019 (COVID-19) pandemic has significantly affected medical service provision. In Iran, it has caused around 197,000 inflictions and 9200 deaths up to June 18, 2020. While many departments turned to telehealth in this era, the trauma service should provide ...
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During the past few months, the novel coronavirus 2019 (COVID-19) pandemic has significantly affected medical service provision. In Iran, it has caused around 197,000 inflictions and 9200 deaths up to June 18, 2020. While many departments turned to telehealth in this era, the trauma service should provide non-stop in presence service to the trauma victims. Our trauma center is the largest in the southwest of Iran, with the mean annual admission of 18,500 polytrauma patients. In this center, we designed a safety protocol to mitigate the spread of disease and also have a more robust case finding system, especially among asymptomatic carriers who attend hospitals based on their trauma. In brief, all unstable patients were considered SARS-COV-2 positive and were directed toward the Specialized COVID-19 related ICU. For all stable patients, history, physical examination, CXR, and lab test (Complete Blood Count, Erythrocyte Sedimentation Rate, C-Reactive Protein) were ordered before entering the wards. If there was any suspicion of COVID-19, the stable patient was admitted to the COVID-19 specialized ward. Among all 1805 patients admitted during a ten weeks interval (from January 30, 2020, to April 14, 2020), 84 had a red flag and toward to COVID-19 related wards. Of those, 67 had positive PCR or evidence in CT in favor of the COOVID-19. Moreover, during regular workups, we found that 19 completely asymptomatic trauma victims had typical Chest CT scan findings of COVID-19.
Alireza Esmaeili; Vahideh Salimi; Naser Mohammad Karimi; Majid Hajimaghsoudi; Mahmoud Vakili; Ehsan Zarepur
Volume 6, Issue 4 , October 2018, , Pages 300-305
Abstract
Objective: To evaluate the effect of hyoscine on pain and tenderness, rebound tenderness and appendicitis patients before surgery and this study can be considered as the first study investigated the efficacy of hyoscine on pain, tenderness, and rebound tenderness in patients with appendicitis.Methods: ...
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Objective: To evaluate the effect of hyoscine on pain and tenderness, rebound tenderness and appendicitis patients before surgery and this study can be considered as the first study investigated the efficacy of hyoscine on pain, tenderness, and rebound tenderness in patients with appendicitis.Methods: In this single-group, prospective interventional study (before-after) according to inclusion and exclusion criteria, 70 patients with pain in the right lower abdomen and typical symptoms of appendicitis were evaluated and after surgery, diagnostic accuracy was examined by pathologic results. The pain was evaluated before and after administration of hyoscine by numerical and verbal examination. Tenderness and rebound tenderness were also determined.Results: The mean age of patients was 26.81±7.66. Totally, 42 patients (60%) had reduction in pain, 50 patients (71% percent) had reduction in tenderness, and 39 (55%) had reduction in rebound tenderness after treatment with the drug. A statistically significant reduction of pain and tenderness, rebound tenderness was observed in all of men after administration of hyoscine (p<0.001) but in women, the reduction of severity of tender results was only significant (p=0.002). Data analysis in women and men together showed the significant reduction of pain, tenderness, and rebound tenderness (p<0.001).Conclusion: According to the results, hyoscine can reduce pain, tenderness, and rebound tenderness. So, it seems that hyoscine is a good candidate for patients with appendicitis.IRCT registration number: IRCT2015111825123N1
Mihai Paduraru; Luca Ponchietti; Isidro Martinez Casas; Peter Svenningsen; Mauro Zago
Volume 5, Issue 2 , April 2017, , Pages 70-78
Abstract
Objective: To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS).Methods: We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; ...
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Objective: To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS).Methods: We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; after eliminating the papers not meeting search criteria, we selected 4 cohort studies and 1 randomized clinical trial (RCT). Data extracted for analysis consisted of: patient age, type of surgery performed, ERAS elements implemented, surgical outcomes in terms of postoperative complications, mortality, length of stay (LOS) and readmission rate.Results: The number of ERAS items applied was good, ranging from 11 to 18 of the 20 recommended by the ERAS Society. The implementation resulted in fewer postoperative complications. LOS for ES patients was shorter when compared to conventional care.Mortality, specifically reported in three studies, was equal or lower with ERAS. Readmission rates varied widely and were generally higher for the intervention group but without statistical significance.Conclusions: The studies reviewed agreed that ERAS in emergency surgery (ES) was feasible and safe with generally better outcomes. Lower compliance with some of the ERAS items shows the need for the protocol to be adapted to ES patients. More evidence is clearly required as to what can improve outcomes and how this can be formulated into an effective care pathway for the heterogeneous ES patient.
Hamid Reza Eftekharian; Homa Ilkhani pak
Volume 5, Issue 1 , January 2017, , Pages 13-17
Abstract
Objective: To evaluate the effects of intravenous ketorolac on early postoperative pain in patients with mandibular fractures, who underwent surgical repair.Methods: This prospective, randomized, placebo-controlled clinical trial was conducted in Shahid Rajaei Hospital, affiliated with Shiraz University ...
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Objective: To evaluate the effects of intravenous ketorolac on early postoperative pain in patients with mandibular fractures, who underwent surgical repair.Methods: This prospective, randomized, placebo-controlled clinical trial was conducted in Shahid Rajaei Hospital, affiliated with Shiraz University of Medical Sciences during a 1-year period from 2015 to 2016. We included a total number of 50 patients with traumatic mandibular fractures who underwent surgical repair. Patients with obvious contraindications to ketorolac such as asthma, renal dysfunction, peptic ulceration, bleeding disorders, cardiovascular disease, mental retardation, or allergy to ketorolac or NSAIDS, were excluded. The patients were randomly assigned to receive intravenous ketorolac (30 mg) at the end of operation in post anesthesia care unit immediately upon the onset of pain (n=25), or intravenous distilled water as placebo (n=25). Postoperative monitoring included non-invasive arterial blood pressure, ECG, and peripheral oxygen saturation. The postoperative pain was evaluated by a nurse using visual analog scale (VAS) (0–100 mm) pain score 4 hours after surgery and was compared between the two study groups.Results: Overall we included 50 patients (25 per group) in the current study. The baseline characteristics including age, gender, weight, operation duration, anesthesia duration and type of surgical procedure were comparable between two study groups. Those who received placebo had significantly higher requirements for analgesic use compared to ketorolac group (72% vs. 28%; p=0.002). Ketorolac significantly reduced the pain intensity 30-min after the operation (p<0.001). There were no significant side effects associated with ketorolac.Conclusion: Intravenous single-dose ketorolac is a safe and effective analgesic agent for the short-term management of mild to moderate acute postoperative pain in mandibular fracture surgery and can be used as an alternative to opioids.
Khalil Zarrabi; Parsa Ravanfar; Azimeh Azimifar; Fariborz Ghaffarpasand
Volume 1, Issue 3 , July 2013, , Pages 130-132
Abstract
Proximity of the vagus nerve to a patent ductus arteriosus (PDA) can cause traction or entrapment of vagus nerve during surgical closure of the in rare occasions. This can lead to a life threatening postoperative bradycardia. Herein, we report a case of bradycardia caused by unexpected irritation of ...
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Proximity of the vagus nerve to a patent ductus arteriosus (PDA) can cause traction or entrapment of vagus nerve during surgical closure of the in rare occasions. This can lead to a life threatening postoperative bradycardia. Herein, we report a case of bradycardia caused by unexpected irritation of the vagal trunk by the end of operation. The patient was managed by re-opening the chest, lung retraction and removal of mediastinal pleura sutures. The vagal trunk entrapped in the suture line was released immediately. Heart rate accelerated and hemodynamic restored after a short period of observation. The operation terminated as routine, patient extubated in OR and discharged within 24 hours with no further complication. This irritation of vagus results in vagal bradycardia during or by the end of operation. Awareness of a surgeon of this issue can minimize the risks and complications of the open closure of PDA.
