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Patellar Tendon Rupture in Floating Knee Injury: Case Report 浮动膝损伤髌骨肌腱断裂1例报告
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2020-03-01 DOI: 10.30491/TM.2020.214578.1047
S. Ghaffari, Alireza Kazemi, S. Talebi
Ipsilateral fractures of the femur and tibia result in a flail knee joint condition referred to as “floating knee”. Associated knee ligament injuries are common and have been reported to be frequently missed in initial evaluations. We report the diagnosis and treatment of the concomitant patellar tendon rupture during fixation of the distal femur and proximal tibia fractures in a patient who presented with floating knee and a history of osteomyelitis. This case further highlights the paramount importance of careful assessment of the knee in patients who present with floating knee injuries. We also recommend that MRI and ultrasonography be used to prevent ignored patellar tendon ruptures in such patients; particularly when physical exam is challenging or an intra-articular injury is present.
股骨和胫骨的同侧骨折导致连枷膝关节状况,称为“浮动膝”。相关的膝关节韧带损伤是常见的,据报道在最初的评估中经常被遗漏。我们报告了在股骨远端和胫骨近端骨折固定期间并发髌骨肌腱断裂的诊断和治疗,该患者表现为浮动膝和骨髓炎病史。本病例进一步强调了对浮动膝关节损伤患者进行仔细评估的重要性。我们还建议使用MRI和超声检查来预防这类患者被忽视的髌骨肌腱断裂;特别是当体检有困难或存在关节内损伤时。
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引用次数: 0
Hospital Nurses’ Disaster Competencies 医院护士的灾难能力
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2020-03-01 DOI: 10.30491/TM.2020.213440.1003
M. Nejadshafiee, Moghadameh Mirzaee, F. Aliakbari, N. rafiee, A. Sabermahani, M. Nekoei-Moghadam
Background: Natural and man-made disasters have significant effects on the physical, psychological, and emotional health of society. Nurses play an essential role in disaster management. Therefore, nurses should have specific core competencies to provide care for affected people during disaster situations. Objectives: This study aimed to assess hospital nurses’ disaster competencies in such situations. Methods: This cross-sectional, descriptive study was conducted using a self-report questionnaire that included 50 questions on NCDS (Nurse Competence Disaster Scale) in four domains. The questionnaires were distributed among 142 nurses working in three teaching hospitals in Kerman, Iran, in 2018. Results: The average percentage scores of nurses on their responses to questions in the domains of management, ethical aspects, personal aspects, and technical aspects of disaster competencies were 39.76%, 19.53%, 32.02%, and 75.06%, respectively. In multiple regression analysis, nurses’ participation in maneuvers and their work experience exerted the strongest influence on disaster nursing core competencies. Nurses who had practice during maneuvers had higher competency scores by 19.63 units than those who had no practice (p=0.0001). Moreover, the competency scores of nurses with more than 11 years of work experience were higher by 11.42 units than the others (p=0.0001). Conclusion: According to the results of the current study, strategies such as disaster drills and continuing education programs need to be developed for nurses to improve their disaster core competency.
背景:自然灾害和人为灾害对社会的生理、心理和情感健康产生重大影响。护士在灾害管理中发挥着重要作用。因此,护士应该具有特定的核心能力,以便在灾害情况下为受影响的人提供护理。目的:本研究旨在评估医院护士在这种情况下的灾难能力。方法:本研究采用一份包含护士能力灾难量表(NCDS)四个领域50个问题的自我报告问卷进行横断面描述性研究。调查问卷于2018年在伊朗克尔曼的三家教学医院的142名护士中分发。结果:护士对灾害能力管理、伦理、个人和技术方面的平均回答百分比分别为39.76%、19.53%、32.02%和75.06%。在多元回归分析中,护士参与演习和工作经验对灾害护理核心能力的影响最大。实习护士的胜任力得分比未实习护士高19.63个单位(p=0.0001)。工作经验在11年以上的护士胜任力得分比其他护士高11.42个单位(p=0.0001)。结论:根据目前的研究结果,需要制定诸如灾难训练和继续教育计划等策略来提高护士的灾难核心能力。
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引用次数: 11
Spontaneous Renewal of Pediatric Both-Bone Fracture: Case Report 小儿双骨骨折的自发再生1例报告
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2020-03-01 DOI: 10.30491/TM.2020.213409.1029
Seyyed Saeed Khabiri, Nima Bagheri, M. Yaghoubi
Severe musculoskeletal injuries, resulting in bone and soft-tissue loss, are often caused by high-energy trauma (i.e. falling from heights and road accidents), and many ultimately lead to extreme limitations in motor functions due to fracture complications or amputations. Traumatic bone injuries are very rare in children and are usually detected following open fractures, and their initial or delayed treatment depends on the conditions of the patient’s soft tissue. Here, a rare case of A 13-year-old male patient was referred to the under study hospital due to a roll over car accident with a crush injury, both-bone fracture of the forearm, and radius defects, and the spontaneous repair of the post-traumatic radius defect healing without delayed intervention is presented.
导致骨骼和软组织损失的严重肌肉骨骼损伤通常是由高能创伤(即从高处坠落和道路交通事故)引起的,许多损伤最终由于骨折并发症或截肢而导致运动功能的极端限制。外伤性骨损伤在儿童中非常罕见,通常在开放性骨折后发现,其初始或延迟治疗取决于患者软组织的状况。本文报道一例罕见的13岁男性患者,因翻车事故致挤压伤、前臂双骨骨折和桡骨缺损而被转介至研究医院,并介绍了创伤后桡骨缺损愈合的自发修复,无需延迟干预。
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引用次数: 0
Developing Performance Indicators for Trauma Care: A Four-Stage Qualitative Study 发展创伤护理绩效指标:一项四阶段定性研究
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2020-01-01 DOI: 10.30491/TM.2020.213631.1026
Yalda Mousazadeh, H. S. Bazargani, A. Janati, M. Pouraghaei
Background: Trauma is considered one of the major causes of death around the world. Increased costs of healthcare and differences in the quality of services among trauma centers indicate that measuring the performance of trauma care is necessary. Objectives: the present study aimed to develop some trauma care performance indicators. Methods: This study was implemented between September 2017 and October 2018 in a four-stage process: a comprehensive literature review, sessions with a panel of five experts, two focus group discussions, sixteen semi-structured interviews, and a two-round Delphi survey. The study setting was East Azerbaijan province, Iran. Forty-six experts in different fields of medical sciences confirmed applicable indicators for trauma care assessment. Results: A total of 140 indicators were found through a comprehensive literature review. After conducting expert panels, focus group discussions, and interviews, the number of indicators decreased to 57 cases and were entered into the Delphi survey. In the first phase of the Delphi survey, content validity ratio (CVR), content validity indicator (CVI), and modified kappa values were 0.64, 0.85, and 0.83, respectively. Sixteen indicators were changed or deleted and 6 indicators were separated. The members of the final expert panel agreed on 50 indicators in the second phase of the Delphi survey after omitting 7 indicators. Conclusion: Performanceindicators for trauma care evaluation were introduced in this study. They can be used by policymakers and health service providers to assess and improve performance and compare trauma centers in Iran and developing countries that have health systems similar to the Iranian health system.
背景:创伤被认为是世界各地死亡的主要原因之一。医疗保健费用的增加和创伤中心服务质量的差异表明,衡量创伤护理的表现是必要的。目的:本研究旨在建立一些创伤护理绩效指标。方法:本研究于2017年9月至2018年10月期间实施,分为四个阶段:综合文献综述、与五位专家小组的会议、两次焦点小组讨论、16次半结构化访谈和两轮德尔菲调查。研究地点为伊朗东阿塞拜疆省。来自不同医学领域的46名专家确认了创伤护理评估的适用指标。结果:通过综合文献回顾,共发现140个指标。经过专家小组讨论、焦点小组讨论和访谈,指标数量减少到57例,并进入德尔菲调查。德尔菲调查第一阶段,内容效度比(CVR)、内容效度指标(CVI)和修正kappa值分别为0.64、0.85和0.83。更改或删除了16项指标,分离了6项指标。最终专家组成员在省略7个指标后,对德尔菲调查第二阶段的50个指标达成一致。结论:本研究引入了创伤护理评价的绩效指标。决策者和卫生服务提供者可以利用它们来评估和改善绩效,并比较伊朗和卫生系统与伊朗卫生系统相似的发展中国家的创伤中心。
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引用次数: 2
Insurance Coverage for Traffic Accident Victims in Iran’s Health System 伊朗医疗系统中交通事故受害者的保险范围
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2020-01-01 DOI: 10.30491/TM.2020.220331.1072
T. Sharifi, R. Dehnavieh, M. J. Sirizi, N. Baghian, S. N. Hekmat
Background: Injuries from traffic accident are the second cause of premature death (after ischemic heart disease) in Iran. In 2004 and 2010, two laws (Articles 92 and 36) were passed by the parliament addressing free health service delivery to victims of traffic accidents (financed by third party insurance premiums). Objectives: The current study explored the challenges and complexities related to problems in the implementation of Articles 92 and 36. Methods: This qualitative study was conducted using the framework analysis method. Thirty-six experts, managers, and policy-makers were selected using snowball sampling. Data was collected through semi-structured interviews in 2016. Data saturation supported the sample size, and Atlas.Ti5.2 software were used. Results: Four main themes were identified in the data analysis namely policy content, policy context, policy processes, and policy makers. Nine sub-themes emerged during the analysis history and the necessity of legislation. Conclusion: Enforcing out-of-coverage financial loads on basic insurance companies and accident victims along with generalization in providing service packages are the most important challenges hampering implementation.
背景:交通事故伤害是伊朗过早死亡的第二大原因(仅次于缺血性心脏病)。2004年和2010年,议会通过了两项法律(第92条和第36条),规定向交通事故受害者提供免费医疗服务(由第三方保险费提供资金)。目的:本研究探讨了与执行第92条和第36条的问题有关的挑战和复杂性。方法:采用框架分析法进行定性研究。采用滚雪球抽样法选取了36名专家、管理人员和政策制定者。2016年通过半结构化访谈收集数据。数据饱和支持样本量,使用Atlas.Ti5.2软件。结果:在数据分析中确定了四个主要主题,即政策内容、政策背景、政策过程和决策者。在分析历史和立法必要性的过程中,出现了九个次级主题。结论:对基本保险公司和事故受害者强制执行覆盖外财务负担以及提供服务包的普遍化是阻碍实施的最重要挑战。
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引用次数: 2
Important Considerations in a Systematic Review of Maxillofacial Fractures Pattern 颌面部骨折类型系统回顾中的重要事项
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2020-01-01 DOI: 10.30491/TM.2020.214049.1041
Mohammad Hosein Amirzade-Iranaq
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引用次数: 1
Factors affecting the severity of traffic accident injuries; a cross-sectional study based on the Haddon matrix 影响交通事故伤害严重程度的因素;基于哈登矩阵的横断面研究
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2020-01-01 DOI: 10.30491/TM.2020.213470.1007
O. Garkaz, H. Mehryar, H. Khalkhali, S. Lak
Background: Based on the Haddon matrix, several factors such as environment, host, and agent can affect the severity of traffic-related injuries. Objectives: This study aimed to determine the factors affecting the severity of injuries due to traffic accidents using the Haddon matrix. Methods: In this cross-sectional study, all traffic accident victims (n=2015) referred to Imam Khomeini Hospital in Urmia during 2015-2016 were selected by the census method. Demographic data of the patients and data regarding Haddon risk factors was collected and then analyzed by descriptive statistics, chi-square test, and multivariate logistic regression using the SPSS 18 software. Results: The mean age of the participants was 33.63±18.53 years. Most of the victims of traffic accidents were male (age range, 17-30 years) with severe and critical injuries. The most common mechanisms of injury were car-pedestrian collisions (27.9%), car overturning (31.1%), and collisions between two cars (26.3%). Violation of speed limit (73.2%) and violation of right-of-way (17.9%) were the most common moving violations. Additionally, the results of the multivariate analysis regarding vehicle safety devices showed that there was a significant relationship between the time and location of the accident and the severity of the injury (p<0.001). Conclusion: The findings of this study reveal that many factors, including using vehicle safety tools and time and location of the accidents have been implicated in the severity of accident-related injuries. Hence, appropriate planning and training and national and international measures can be helpful in reducing injury severity.
背景:基于Haddon矩阵,环境、宿主、代理等因素可影响交通相关伤害的严重程度。目的:本研究旨在利用Haddon矩阵确定影响交通事故伤害严重程度的因素。方法:采用横断面研究方法,选取2015-2016年在乌尔米亚伊玛目霍梅尼医院转诊的所有交通事故受害者(n=2015)。收集患者人口学资料及Haddon危险因素资料,采用SPSS 18软件进行描述性统计、卡方检验和多因素logistic回归分析。结果:参与者平均年龄为33.63±18.53岁。大多数交通事故受害者为男性(年龄范围17-30岁),受重伤和重伤。最常见的伤害机制是车-行人碰撞(27.9%)、汽车翻车(31.1%)和两车碰撞(26.3%)。违反速度限制(73.2%)和违反路权(17.9%)是最常见的交通违规行为。此外,关于车辆安全装置的多变量分析结果显示,事故发生的时间和地点与伤害的严重程度之间存在显著关系(p<0.001)。结论:本研究结果揭示了许多因素,包括车辆安全工具的使用和事故发生的时间和地点,都与事故相关伤害的严重程度有关。因此,适当的计划和训练以及国家和国际措施可以帮助减轻伤害的严重程度。
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引用次数: 3
Clinical and functional outcomes of early reconstruction of the collateral ligaments and delayed reconstruction of the cruciate ligaments in multi-ligament knee injury; a prospective, cross-sectional study 膝关节多韧带损伤早期副韧带重建和延迟交叉韧带重建的临床和功能效果前瞻性横断面研究
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2020-01-01 DOI: 10.30491/TM.2020.213789.1033
M. Okhovatpour, R. Zandi, mohammdreza minatoorsajadi, A. Ebrahimpour, meisam jafari kafi abadi
Background: Multi-ligament knee injury is common after knee dislocation. There are different approaches for treating multi-ligament knee injuries; however, choosing the best approach is a challenging issue. Objectives: This study aimed to investigate the efficacy of early reconstruction of collateral ligaments and delayed reconstruction of cruciate ligaments in multi-ligament knee injury. Methods: In this prospective study, 24 patients who had a grade 3 tear in one collateral ligament in addition to tears in two other knee ligaments were enrolled. At the first stage, collateral ligaments were reconstructed; after the patient gained full range of motion, reconstruction was done for the cruciate ligaments. Patients were followed-up for one year and postoperative evaluations were conducted through clinical tests, International Knee Documentation Committee scores, and Lysholm scales. Results: Twenty-four patients were entered into the final analysis. Synchronous injury of anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, posterior oblique ligament, posterolateral corner, and lateral collateral ligament had the highest frequency (37.5%). At the one-year follow-up, the average Lysholm and IKDC scores were 86.4 ± 3.5 and 83.8 ± 4, respectively. Range of motion was normal in all patients at the end of the study. Furthermore, in varus and valgus stress tests, the outcomes of reconstruction were better on the lateral side of the knee than on the medial side. Conclusion: The results revealed that a two-stage surgery consisting of early reconstruction of collateral ligaments and delayed reconstruction of cruciate ligaments have good clinical and functional outcomes in multi-ligament knee injuries.
背景:膝关节脱位后多韧带损伤是常见的。治疗膝关节多韧带损伤有不同的方法;然而,选择最好的方法是一个具有挑战性的问题。目的:探讨膝关节多韧带损伤早期副韧带重建和延迟交叉韧带重建的疗效。方法:在这项前瞻性研究中,研究人员招募了24名一侧副韧带3级撕裂以及另外两条膝关节韧带撕裂的患者。第一阶段重建副韧带;在患者获得完全活动范围后,对交叉韧带进行重建。患者随访一年,术后通过临床试验、国际膝关节文献委员会评分和Lysholm量表进行评估。结果:24例患者进入最终分析。前交叉韧带、后交叉韧带、内侧副韧带、后斜韧带、后外侧角、外侧副韧带同步损伤发生率最高(37.5%)。在一年的随访中,Lysholm和IKDC的平均得分分别为86.4±3.5和83.8±4。在研究结束时,所有患者的活动范围正常。此外,在内翻和外翻应力测试中,膝关节外侧重建的结果优于内侧重建。结论:早期副韧带重建和延迟交叉韧带重建两阶段手术治疗膝关节多韧带损伤具有良好的临床和功能效果。
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引用次数: 0
Traffic Accident Mortality in Najafabad, Iran during 2011-2017 2011-2017年伊朗纳贾法巴德交通事故死亡率
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2020-01-01 DOI: 10.30491/TM.2020.213877.1035
Moslem Taheri Soodejani, Marzieh Mahmudimanesh, L. Abedi, S. Tabatabaei, Azimeh Ghaderi
Background: Road traffic accident is one of the most important causes of disability and death in the young population. A significant number of people injured in road traffic accidents die after they arrive at the hospital. Objectives: This study aimed to assess the trend of mortality in road traffic accidents and forecast it for the coming years using time series modeling. Methods: This study investigated the trend of road traffic accidents and their victims in Najafabad, Iran, between 2011 and 2017. The ARIMA time series model was fitted on the obtained data and the best model was selected based on the least mean square error. Moreover, the model’s goodness of fit was investigated by residuals ACF and PACF plots as well as Ljung-Box chi-square statistics. Results: The trend analysis and ARIMA models were investigated, and the results showed a descending trend of fatalities due to traffic accident during 2011-2017. Afterwards, some models were fitted and ARIMA was selected (0, 1, 1), because it had the lowest mean square error value. By fitting the best model, the trend of traffic accident mortality was forecasted for five years (2018 to 2022). Finally, the forecasted values showed that future traffic accident mortalities had a decreasing trend. Conclusion: The trend of mortality due to road traffic injuries declined, indicating a decreasing trend in deaths for the upcoming years. Therefore, the interventions that have been applied in recent years may be considered as useful.
背景:道路交通事故是年轻人致残和死亡的最重要原因之一。许多在道路交通事故中受伤的人在到达医院后死亡。目的:本研究旨在评估道路交通事故死亡率的趋势,并利用时间序列模型预测未来几年的死亡率。方法:本研究调查了2011 - 2017年伊朗纳贾法巴德市道路交通事故及其受害者的趋势。对得到的数据进行ARIMA时间序列模型的拟合,并根据均方误差最小的原则选择最佳模型。此外,通过残差ACF和PACF图以及Ljung-Box卡方统计量来检验模型的拟合优度。结果:采用趋势分析和ARIMA模型进行分析,结果显示2011-2017年交通事故死亡人数呈下降趋势。随后,对部分模型进行拟合,选择均方误差值最小的ARIMA(0,1,1)。通过拟合最佳模型,预测了2018 - 2022年的交通事故死亡率趋势。预测结果表明,未来交通事故死亡率呈下降趋势。结论:道路交通伤害死亡率呈下降趋势,表明未来几年道路交通伤害死亡率呈下降趋势。因此,近年来应用的干预措施可能被认为是有用的。
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引用次数: 2
Assessment of Injuries Following Terrorist Attacks: A Narrative Review 恐怖袭击后伤害评估:叙述性回顾
IF 0.5 Q4 EMERGENCY MEDICINE Pub Date : 2020-01-01 DOI: 10.30491/TM.2020.105838
Seyed Hamideh Molaie, Sadrollah Mahmoudi, H. Goodarzi, Z. Danial, M. Farajzadeh, Mehdi Pakravesh, F. Heidari
Background: In the few past decades, the world has experienced numerous terrorist attacks. Objectives: We sought to review the mechanisms and patterns of injuries in terrorist attacks; the main goal being better management of victims of these attacks. Methods: In current narrative review; electronic databases (PubMed, Wiley, EMBASE, ISI Web of Knowledge, and Scopus) were searched seeking relevant publications between 2000-2018. The keywords used when searching for articles included: violence, terrorism, disasters, trauma, trauma centers, war, mass casualties, wounds, and injuries. Searching, screening, and assessment of records were done separately by two authors; disagreements were resolved by discussion with a third reviewer. Results: Nine studies were found to be eligible for inclusion in this study. The most common device-related terrorist attacks were explosives and bombs. More than half of the victims suffered minor injured and could be treated promptly. The most common causes of mortality were head injuries, airway burns, and internal bleeding. The secondary and tertiary results of terrorist attacks were head and neck injuries. Pulmonary injuries were also common injuries in terrorist-attack victims. The most significant cause for emergency treatment was airway burns. The head, neck, pelvis, and hand were the most commonly exposed body areas. Limb amputation is a major result of complications and mortality. The mortality rate of victims that referred to a hospital was low; most deaths occurred at the scene of the attack. Aging victims, children, and women were most influenced by terrorist attacks. Immediate examination, long-term follow-up, and advanced therapeutics and psychological therapy are necessary. Conclusion: Differences in the severity and type of injuries among victims of terrorist attacks depend upon the various causes of blast injuries, the power of the explosion, the open or enclosed location setting, the destruction of structures, and the interval between cases and the explosion. The current results showed that head and lung injuries are major causes of mortality in victims of terrorism. Appropriate emergency medical services and early management could increase patient survival rates and reduce complications.
背景:在过去的几十年里,世界经历了多次恐怖袭击。目标:我们试图审查恐怖袭击中受伤的机制和模式;主要目标是更好地管理这些攻击的受害者。方法:在当前的叙事回顾;检索电子数据库(PubMed、Wiley、EMBASE、ISI Web of Knowledge和Scopus),寻找2000-2018年间的相关出版物。搜索文章时使用的关键词包括:暴力、恐怖主义、灾难、创伤、创伤中心、战争、大规模伤亡、伤口和伤害。记录的检索、筛选和评估由两位作者分别完成;分歧通过与第三位审稿人讨论解决。结果:9项研究被纳入本研究。最常见的与装置有关的恐怖袭击是爆炸物和炸弹。一半以上的受害者受轻伤,可以及时得到治疗。最常见的死亡原因是头部损伤、气道烧伤和内出血。恐怖袭击的第二和第三后果是头部和颈部受伤。肺部损伤也是恐怖袭击受害者中常见的伤害。急诊治疗的最主要原因是气道烧伤。头部、颈部、骨盆和手是最常暴露的身体部位。截肢是并发症和死亡率的主要结果。转诊到医院的受害者死亡率很低;大多数死亡发生在袭击现场。老年受害者、儿童和妇女最容易受到恐怖袭击的影响。需要立即检查,长期随访,先进的治疗和心理治疗。结论:恐怖袭击受害者受伤的严重程度和类型的差异取决于爆炸伤害的各种原因、爆炸的威力、开放或封闭的地点设置、建筑物的破坏程度以及案件与爆炸的间隔时间。目前的结果表明,头部和肺部损伤是恐怖主义受害者死亡的主要原因。适当的紧急医疗服务和早期管理可提高患者存活率并减少并发症。
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引用次数: 1
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Trauma monthly
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