دکتر زهرا شایان

Shoulder pain is a prevalent reason in orthopedic clinic patients, with rotator cuff disorders being the most common cause. The Constant-murley Score (CMS) questionnaire is a practical and reliable tool for the assessment of shoulder joint function. The CMS questionnaire was translated into Persian and completed by 57 patients with persistent shoulder pain due to rotator cuff tears (case group) and 50 healthy controls. The case group refilled the questionnaire after 7-10 days without receiving any special treatment. The reliability and validity of the questionnaire were measured via the test-retest method and known-groups validity with the t-test, respectively. The intraclass correlation coefficient (ICC) was calculated to estimate the agreement as a measure of test-retest reliability. The mean ages of the case (51.8±14.2) and control groups (52.0±10.0) were similar (P=0.94). No significant difference was found between the groups regarding co-existing clinical conditions (P=0.74). The mean CMS values of the case and control groups were 46.2 (±22.3) and 87.4 (±5.7), respectively, showing a statistically significant difference (P<0.001). Moreover, the ICC was 0.95. The findings indicated that the Persian version of the CMS questionnaire was reliable (ICC=0.95) and valid (P<0.001) for the assessment of shoulder pain and functional status in the Southern Iranian population with rotator cuff tear disorders. Level of evidence: V

Diagnosis of associated midfoot fractures in Lisfranc injuries is important for proper treatment. We aimed to describe frequency of different types of Lisfranc injuries in surgically treated cases and to find the accuracy of non-weight bearing radiographs to determine associated midfoot fractures.

In a retrospective study, preoperative non-weight bearing plain radiographs and CT studies of 118 surgically treated Lisfranc injuries were evaluated by 2 orthopedic surgeons. The sensitivity and specificity of fleck sign, fractures of metatarsal bases, cuneiforms, navicular, and cuboid were calculated.

Among 118 patients with the mean age of 35.0±15.7 years, most were male (77.1%). The most common type was Myerson type B (44.1 %) followed by D2 (40.7%). Fractures of the second metatarsal base (87 patients, 73.7%), the fleck signs (85 patients, 72.0 %), and fractures of the third metatarsal base (65 patients, 55.0 %) were the three most frequent injuries. Oppositely, fractures of the fifth metatarsal base (5 patients, 4.3%), middle cuneiform (14 patients, 12.0%), and navicular (15 patients, 12.7%) were the three least common associated midfoot fractures. Plain radiographs could not show high sensitivity to distinguish associated midfoot fractures in Lisfranc injuries with the highest for the second metatarsal base fractures (78.2%). The maximum specificity was for fractures of the first metatarsal base (100%).

Non-weight bearing radiographs of the foot cannot detect all associated midfoot fractures particularly fleck sign. Therefore, preoperative CT scan is highly recommended.

In recent decades, especially after the publication of the World Health Report in 2000, many efforts have been made to develop assessment tools and improve the performance of health systems at the global and national levels. The purpose of this study was to design a method and assess the performance of health systems in various countries in its use. In this retrospective study, health systems were evaluated using the opinions of experts as well as international data. Health system experts expressed their views on appropriate indicators for evaluation. The performance of the studied health systems was ranked using multi-criteria decision-making techniques (SAW & TOPSIS). Collected data were analyzed using multiple regression analysis. Data related to 38 indexes in eight general areas of macroeconomics, affordability for health costs, disease control, health care financing, health and nutrition, life expectancy, health resources, and mortality rates were collected in 105 countries from 2018 to 2020. According to the findings of country ranking, the health systems of Sweden, Norway, and Japan have the best performance and Afghanistan, Nigeria and Guinea have the weakest performance in the years examined. Health systems face major challenges around the world. Scientific evaluations show that spending more resources and costs does not necessarily enhance the performance of health systems, yet using and distributing these resources and costs in health systems could enhance the hope for better performance.

Trauma is considered an important issue in most countries. Identification of the factors affecting the length of stay (LOS) in the intensive care unit (ICU) plays a crucial role in controlling the costs and complications of prolonged hospitalization.

This study aimed to identify the factors affecting the LOS of trauma patients in the ICU using stepwise and new penalized variable selection methods in count data regression.

The patients’ information was evaluated in Emtiaz Hospital and Shahid Rajaee trauma center in Shiraz from March 2016 to September 2017. Count regression model was used to determine the factors affecting the LOS of patients in the ICU using penalized variable selection including, Enet, Snet, and Mnet.

The mean age of the patients (n=382) was obtained at 36.7±16.7 years, and the majority (88.4%) of the patients were male. The mean LOS in the ICU was determined at 6.2±6.6 days. Mnet with a negative binomial distribution outperformed the other penalized variable selection methods. A Glasgow Coma Scale (GCS) of less than 9 (IRR=1.7), blunt brain trauma (IRR=1.8), chest trauma (IRR=2.2), and oxygen saturation of less than 90 (IRR=1.2) increased the LOS of trauma patients in the ICU.

Penalized variable selection methods effectively ignore or control the existing correlations between predictors. Amongst the penalized models, Mnet provided more acceptable results with smaller Akaike information criterion and fewer predictors. According to this penalty, the most important factors affecting the length of stay were chest trauma, blunt brain trauma, GCS, and oxygen saturation rate. Most clinical studies on trauma have also shown the importance of these factors.

White blood cell (WBC) counts are commonly used for the diagnosis of acute appendicitis in the early stages of pain. However, the effect of certain confounders, particularly age and sex, has been less focused. The purpose of this study was to investigate the diagnostic accuracy of white blood cells in the prediction of acute appendicitis using age-sex-adjusted receiver operating characteristic (ROC) curve.  

In this cross sectional study, 131 patients who had undergone appendectomy were studied during 2010-2011. Patients were placed in the normal appendix and acute appendicitis groups. ROC regression was used to identify the effects of the variables of age and sex on the diagnostic accuracy of WBCs using the area under the ROC curve (AUC). Statistical analysis was conducted in Stata 12 software.  

In ROC regression method, the AUC for the variable of WBC was 0.643 (95% CI: 0.555-0.725) without adjustment for age and sex variables, 0.672 (0.584-0.751) with an age-adjusted variable, 0.698 (0.612-0.775) with a sex-adjusted variable, and 0.710 (0.624-0.786) with both age-sex adjusted variables. 

Results indicated that age-sex adjusted variables increased the diagnostic accuracy of the WBC test for predicting acute appendicitis using ROC regression method for the WBC test.

Sleep disturbances are a significant public health issue and such problems are associated with a number of psychiatric disorders. The Pittsburgh Sleep Quality Index (PSQI) is an effective instrument frequently used to evaluate sleep style and quality. The present study aimed to assess the reliability, validity, and factor structure of the Persian version of PSQI. This cross-sectional study was conducted on 1115 citizens of Arak City, Iran aged 18-60 years. They were selected by stratified random sampling method from different parts of the city. The following aspects of the Persian version of PSQI were evaluated to assess its validity and reliability. To assess the validity of the content, the questionnaire was sent to a panel of 15 academic members consisting of experts in the fields of psychology and health education. The internal consistency of the PSQI questionnaire was evaluated by the Cronbach alpha coefficient and item-scale correlation. To investigate the factor structure of the PSQI, Exploratory Factor Analysis (EFA) was performed with a 2-factor solution and varimax rotation. The extraction of principal factors was performed after varimax orthogonal rotation and Kaiser’s criterion. At last, Confirmatory Factor Analysis (CFA) was applied to assess the reliability of the PSQI questionnaire. All analyses were performed in SPSS V. 16.0 and AMOS for Windows. The Persian version of PSQI was evaluated in the study with regard to its internal consistency and factor structure. The result showed excellent item content validity index (≥0.78) and excellent scale content validity index (≥0.90). The result of the Cronbach alpha coefficient was 0.65. The factors of perceived sleep quality and sleep efficiency were extracted by means of factor analysis and these two factors explained 51.75% of the total variance. Confirmatory factor analysis results show the model’s satisfactory fitting based on adequacy criteria goodness of fit index, goodness of fit index adjusted for degrees of freedom, root mean square error of approximation, and comparative fit index. The non-normed fit index was close to its reference value of 0.90. In general, findings suggest that the Persian version of PSQI displayed satisfactory validity and reliability to measure the quality of sleep of Iranian people, at least citizens of Arak City, Iran.