Trauma Monthly
Volume:24 Issue: 5, Sep-Oct2019

Schools have many roles and capacities before and after disasters. Resilience plays an important role in maintaining schools’ performance after disasters. This study systematically reviewed the literature to identify the components of school resilience in emergencies and disasters.

In this study, Scopus, Web of Science, PubMed, and Google Scholar databases were systematically searched using “resilience”, “risk”, “disaster”, “emergency” and “school” as keywords. In total, 8,053 studies were reviewed in several stages and eventually, 26 articles were selected. Other articles were excluded due to the lack of inclusion criteria or being irrelevant. Five other articles were included in the study by reviewing the references. Finally, 31 relevant articles were analyzed. The quality of the articles was assessed based on the PRISMA checklist.

The evaluation of articles based on content analysis resulted in the emergence of 4 themes, 11 subthemes, and 99 codes. The themes included structural factors, non-structural factors, functional-process factors, and facilities. The subthemes included building standards, school environment, physical safety of the building, equipment and facilities, safety and retrofit of non-structural components, infrastructures, communication (internal and external), education, management, health, and human-financial resources.

The factors and dimensions affecting the resilience of schools were recognized. Different dimensions should be considered to increase the school’s ability, andmaintain its performance and appropriate response to disasters. The determined indices can be used by policy- and decision-makers when confronting emergencies and disasters to assess the resilience of schools against the risks.

There are two general types of fixation methods used in mandibular fractures and osteotomy: closed fixation method with Erich arch bars and the open fixation method (without Erich arch bars). Periodontium inflammation, following mandibular fixation methods, is a complication of the healing period.

The current study aimed at evaluating and comparing periodontium reaction to fixation of mandibular fractures with and without Erich arch bars.

This cross-sectional study was carried out on 48 patients with mandibular fractures. Twenty-four patients were treated with close method and Erich arch bars and 24 patients with open method and without Erich arch bars. Periodontium clinical indices, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), and probing pocket depth (PPD), were measured immediately before the surgery and four, six, and eight weeks later.

After four, six, and eight weeks, subjects with arch bars had significantly greater PI, GI, and PPD (P value < 0.001). After four weeks, all subjects in the arch bar group had a positive BOP, which was significantly greater than that in the other group (P value < 0.001). In addition, after six weeks, the number of subjects with positive BOP was significantly more in the arch bar group than in the other group (P value < 0.001). Yet, after eight weeks, there was no significant difference between the two groups (P value > 0.001).

According to the results, the use of Erich arch barsmore decreased periodontium status compared to the other group.

Spinal cord injury is one of the worst injuries incurred to the individual and family.

The aim of the present study was to determine the effect of eye movement desensitization and reprocessing (EMDR) intervention on stress and anxiety of spinal cord injury (SCI) patients in Kermanshah, west of Iran.

This is a quasi-experimental study, which has been conducted for 6 months in 2018 - 2019. The study population consisted of SCI patients in Kermanshah province. The research instruments included demographic characteristics form, Beck’s depression and anxiety inventories completed by patients in both groups after completing the written consent form using the self-report method. Random allocation was used to divide patients into experimental and control groups. To do so, patients were given a sealed card, and if the patient chose a white or black card, they will be placed in the experimental and control groups, respectively. Two sessions were held individually for each patient, and a total of 64 sessions of EMDR-based intervention were held for patients entered into the analysis phase. After data collecting and data entry to SPSS statistical software version 16, the data was analyzed with the use of descriptive statistical tests.

Finding showed the mean (SD) of depression scores before intervention was 45.36 (9.81), which after intervention was reduced to 40.54 (4.25) (P < 0.02). Also, in relation to the amount of anxiety, the mean (SD) of the anxiety score of the patients before intervention was 43.15 (4.35), which after intervention was reduced to 20.03 (11.91). After intervention, reduction in anxiety score in patients was more than depression score (P < 0.000).

Considering that EMDR, as a non-pharmacological intervention, reduced depression and anxiety of patients, it is suggested that this technique, which is a free or non-complicated intervention for the healthcare system or patient, be carried out when providing clinical care to patients.

Distal radius fracture is among the most common fractures of the long bones that are seen in all age groups. Treatment of these fractures in simple cases with displacement or intra-articular fractures is immobilizatgion, and if the fracture has dislocation, surgery may be required.

The aim of the study is a comparison of treatment efficacy and satisfaction in the methods of a long cast and thumb Spica cast in the patients with distal radius fractures without displacement.

This study is a randomized clinical trial with a non blinded parallel design. Eighty patients with distal radius fractures without displacement were randomly assigned to long cast and thumb Spica cast groups. Patients were randomly using a random number table assigned to one of two long cast and thumb Spica castmethods. Both groupswere examined atweeks 4 and 5 and after six weeks plaster was opened and after one week they were evaluated by DASH questionnaire. Performance (limitation of motion, grip strength) and patients’ satisfaction was assessed in the two groups.

Themean age of patientswas 49.87±13.81 years. Therewere no significant differences between two groups regarding age(P= 0.84). In thumb Spica group 60% and in the long cast group 55% were male. There was no significant difference in sex distribution between treatment groups. The DASH scores in all subjectswere 11.68±5.53. Average total DASH score in thumb Spica cast group was 7.19 ± 6.80 and in the long cast was 16.02 ± 6.23. The mean of total DASH score in thumb Spica cast group was significantly higher than long cast group that presented better performance (limitation of motion, grip strength) in thumb Spica cast group respect to long cast group (P < 0.001). Satisfaction was similar between two groups (P = 0.40).

Regarding better performance and treatment, thumb Spica cast is recommended as the preferred treatment for distal radius fractures without displacement.

Early cervical spine clearance is very important in trauma settings. Waiting for cervical spine clearance by CT scan mandates prolonged cervical spine immobilization and consequently, the delay in subsequent emergency procedures in polytrauma patients.

The study aimed to assess the value of cervical spine ultrasonography (US) for detecting cervical spine injuries in severe polytrauma patients.

A cross-sectional analytical study was conducted on 172 severe polytrauma patients with Glasgow coma scale (GCS) score of < 12 or triage revised trauma score (TRTS) of < 8. The researcher performed bedside cervical spine US without impeding the ongoing routine trauma management. The researcher was blind to the computed tomography (CT) scan findings. The data were analyzed by SPSS software and sensitivity, specificity, and positive/negative predictive values were determined based on CT findings. The results were also compared between children (≤ 14 year) and adult (> 14 year) age groups.

Bedside US had a sensitivity of 74.5%, specificity of 97.6%, positive predictive value (PPV) of 92.1%, negative predictive value (NPV) of 91%, and accuracy of 91.3% in detecting spinal injuries in comparison with CT findings. Moreover, US had a sensitivity of 100%, specificity of 87.6, PPV of 50%, NPV of 100%, and accuracy of 88.9% in detecting spinal injuries with the movement of fractured or dislocated particles. Also, it had a sensitivity of 33.3%, specificity of 87.58, PPV of 100%, NPV of 97.2%, and accuracy of 97.2% in ≤14-year-old patients. The modality had a sensitivity of 76.2%, specificity of 94.7, PPV of 91.4%, NPV of 84.4%, and accuracy of 86.9% in > 14-year-old patients.

The diagnostic value of bedside US was higher in adults and injured patients with the movement of fractured or dislocated particles.

In disasters, the hospitals’ vulnerability depends on their shortcomings andweaknesses. Therefore, the investigation of possible hazards and vulnerabilities is necessary for effective risk management and planning.

We aimed to assess the factors affecting risk management of accidents caused by disasters in Iranian hospitals.

In this research, the type of study was quantitative-qualitative. We used a semi-structured interview to identify the factors affecting the risk management of accidents caused by disasters in hospitals from experts and executors of disaster management systems. Then, we utilized a questionnaire that was confirmed by experts based on a five-point Likert scale, including 89 items in 4 dimensions and 20 areas. The construct validity of the questionnaire was done by exploratory and confirmatory factor analysis. Finally, the factors affecting the disaster risk management in hospitals were included in four dimensions of harm reduction, by five domains (planning, rules and regulations, technology and information, human resources, and participation), preparedness including six domains (planning, rules and regulations, technology and information, resource management, human resources, and community participation); the response including five domains (planning, technology and information, human resources and community, partnership, and operations), and recovery including four domains (planning, technology and information, human resources and community, and participation).

The Kaiser-Meyer-Olkin (KMO) statistic was 0.963 and so, there was a high correlation between the scale items. There was a significant positive relationship between independents variables such as mitigation (0.74), response (0.70), preparedness (0.68), and recovery (0.63) and the dependent variable of accident risk management caused by disasters in hospitals. Also, the results of structural equations indicated the significant relationship between the independent and dependent variables.

The results showed that there was a good fit among the structural model, the experimental data, and expert opinions. The identified variables are suitable to be used in the form of a final model.

Patients with head trauma need mechanical ventilation in order to protect airway and prevent complications. However, due to the lack of well-developed weaning protocols, weaning failure rate among them is high and hence, they may need mechanical ventilation and stay in hospital for long time, resulting in heavy costs on healthcare systems and high risk of death.

The aim of the present study was to evaluate the effects of using the Persian weaning tool on patient outcomes among patients with head trauma under mechanical ventilation.

This clinical trial was conducted in 2018 on sixty patients with head trauma who were receiving mechanical ventilation in the intensive care unit of Shahid Rajaei Hospital, Qazvin, Iran. Participantswere randomly allocated to an intervention and a control group. Weaning from mechanical ventilation in these groups was performed using the Persian Weaning Tool and routine physiciandirected method, respectively. Groups were compared with each other concerning weaning outcomes through the Mann-Whitney U and the chi-square tests conducted using the SPSS software (version 23.0).

Weaning success rate in the intervention group was significantly greater than the control group (83.3% vs. 56.6%; P = 0.024) and the length of hospital stay in the intervention group was significantly shorter than the control group (19.9 vs. 28.9 days; P = 0.05). However, there were no significant between-group differences concerning extubation success rate (80.0% vs. 63.3%; P = 0.252) and mechanical ventilation duration (7.5 vs. 8.7 days; P = 0.3).

The use of the Persian Weaning tool is effective in increasing weaning success rate and shortening hospital stay but has no significant effects on extubation success rate and mechanical ventilation duration. Specific weaning assessment tools and protocols need to be developed for patients with neurologic conditions.