Trauma Monthly
Volume:23 Issue: 2, Mar-Apr2018

Most traffic accidents occur as a result of human factors. The drivers’ physical health is one aspect of the human factors. In order to assess the drivers’ health status, valid screening tools are needed.

The purpose of this study was to translate the Driver Medical Questionnaire (DMQ) into Persian and evaluate its psychometric properties. Patients and

This was a descriptive/methodological study. The DMQ was translated from English into Persian by using the standard forward-backward translation technique. The face validity of the questionnaire was assessed using the comments of several drivers and military doctors. The reliability of the questionnaire was evaluated for internal consistency analysis using the Kuder-Richardson 21 formula as well as test-retest reliability assessment using the intraclass correlation coefficient calculation techniques. A total of 45 traffic offenders were invited to complete the pilot version of the Persian DMQ twice with a 14-day interval. Finally, the health status of 360 traffic offenders was evaluated by using the final version of the Persian DMQ.

The questionnaire yielded a Kuder-Richardson 21 value of 0.68, while the intraclass correlation coefficient was 0.94. Approximately half (51.1%) of the participants had no health problem, 38.1% had 1 health problem, and 10.8% had 2 or more health problems. The latter group needed referrals to occupational medicine specialists. The Drivers’ health status was significantly associated with a history of accidents in the past 3 years (P = 0.01) and a history of injury-associated accidents (P = 0.001).

The Persian version of the Driver Medical Questionnaire (PDMQ) can be used as a valid and reliable tool for the screening of drivers’ health problems. Primary prevention and health promotion could have an important role in injury prevention and reduce the rate of traffic accidents.

Burns are one of the major public health problems worldwide, particularly in the developing countries. The proper treatment of burns can reduce the complications of the injury.

The current study assessed the effects of silver sulfadiazine (SSD) and Adibderm® herbal ointments to treat patients with second degree burns.

In the current randomized clinical trial, 60 adult patients (ranged 18 - 65 years old) with second-degree burns and 1% - 10% burns in the extremities and trunk areas referred to Tabriz Sina hospital were enrolled. Patients were divided into 2 groups (group A, SSD ointment; and group B, Adibderm® herbal ointment). The study was conducted after obtaining written informed consent from the patients. Patients were followed up daily until the end of treatment. Healing time (days), treatment satisfaction, and complications were compared between the 2 groups.

There was no significant difference between the 2 groups in terms of demographic variables (P value > 0.05). The mean of healing time in groups A and B were 11.83 ± 2.32 and 7.53 ± 2.28 days, respectively (P < 0.0001). The mean of treatment satisfaction in groups A and B were 7.23 ± 1.19 and 7.83 ± 1.02 days, respectively (P < 0.041). In SSD ointment group, 1 (3.3%) patient had wound infection and 7 (23.3%) patients in Adibderm® herbal ointment group had wound irritation caused by the ointment.

Based on the current study results, Adibderm® herbal ointment was superior to SSD ointment in terms of healing time and treatment satisfaction.

Accidents are the second leading cause of death following cardiovascular disease in all age groups. Falls account for 40% of deaths worldwide.

This study aimed to investigate epidemiologically the victims of falls during a 6-year period by reviewing the medical records of the patients referring to Shahid Rajaee Hospital, Shiraz, Iran.

This cross-sectional study was conducted by reviewing the medical records of 12,133 patients admitted to the accident department of Shahid Rajaee hospital from 2009 to 2014. Demographic and other important data, such as age, gender, marital status, the severity of injuries, and survival or death, were collected. Then, the data were analyzed using chi-square test and logistic regression analysis.

Medical records of 12133 fall victims were investigated. The mean age of the patients was 44.87 ± 20.91 years. The results of the multiple-regression model showed a significant relationship between death rate and age, injury severity, length of hospital stay, and injured body region in the fall victim (P < 0.05). The multiple-regression model also indicated a significant relationship between fall-related death and gender, injury severity, the injured body region, and the length of hospital stay (P < 0.05).

The highest mortality rate was observed among fall patients aged over 55 years with a high Injury Severity Score (ISS). Therefore, appropriate strategies should be taken for these patients in order to reduce mortality

Mesenchymal stem cells are one type of adult stem cells, which are able to give rise to mesodermal origin tissues. The application of mesenchymal stem cells for tissue and organ regeneration offer advantages because of the relative ease of collection and their potential to differentiate to 3 cell lineages.

This research was designed to study and evaluate the effect of mesenchymal stem cells on the repair of bone defects in Wistar rat models and to compare autologous and non-autologous cell transplantation in repairing bone defects.

The mesenchymal stem cells were cultured and expanded in MEM medium supplemented with 10% fetal bovine serum (FBS) and 2% penicillin/streptomycin by incubation at 37°C in 5% CO2. Immunocytochemistry analysis was performed using CD44 and fibronectin markers to detect the mesenchymal stem cells. A transcortical defect was created within the distal epiphyses of the femur bone. After 3 days of injury, Brdu-labeled cells were injected at the site of injury. The animals were sacrificed after 4 weeks of transplantation and the femurs with the recipient area were removed and the length, weight, area, density, and biomechanical parameters were evaluated.

The obtained results showed that although neither non-autologous nor autologous cell transplantation significantly improved the effect on length and area of the defective femur bone, the mass and bone density of the cell-injected transplanted groups had a significant increase in comparison with the control and sham groups.

It seems that cell transplantation could improve these parameters, improving the mean mass, length, area, and density of parameters during the the regeneration process.

Self-care is a vital aspect of the holistic nursing of patients with chronic diseases, yet self-care strategies used by veterans who were injured by mustard gas, are not clearly identified. Therefore, the current study aimed to determine some self-care strategies for chemically-injured veterans.

The current qualitative study was conducted based on the conventional content analysis approach. Data collection comprised of 16 semi-structured interviews with chemical veterans. The purposive sampling method was used up to data saturation, and data analysis was conducted using Lundman and Graneheim’s qualitative content analysis method.

Data analysis resulted in the extraction of a main theme (using protective behaviors) with 4 sub-categories (setting activities, trying to adapt, trying to be independent, and seeking information), that represent the experiences of chemical veterans in regard to self-care behaviors.

Protective behaviors in chemical victims originate from their personal, social, cultural, and religious backgrounds. Identifying these behaviors can guide protective health care system policies.

Chemical warfare victims with pulmonary injuries require frequent bronchoscopy, and most of these diagnostic procedures are performed using deep sedation and local anesthetic "spray as you go" technique. The aim of the study was to compare spray as you go and trans-cricothyroid membrane injection.

In this clinical trial, all candidates for diagnostic bronchoscopy were divided to 2 groups. In group 1, after intravenous injection of 1 mg midazolam and 50 mcg fentanyl and intravenous injection of 20mg propofol, 3 cc of 4% lidocaine was injected into the trans-cricothyroid membrane. In group 2, after passing the bronchoscope through the nose, the clinicians proceeded to spray 6 cc of 2% lidocaine (spray as you go technique) with bolus doses of propofol, intravenously. The total dose of propofol, the convenience of the physicians, and cough episodes were recorded. The patients were monitored in terms of vital signs before and during bronchoscopy. Moreover, according to the discharge criteria, the time of discharge from the recovery room and side effects were recorded. Using SPSS-21, the data were analyzed and P values of < 0.05 were considered as significant.

In the present study, 80 patients (2 groups of 40) were evaluated. The patients in both groups were not significantly different regarding age, gender, and duration of bronchoscopy. In group 1, the rate of satisfaction of the physician was significantly higher than that of group 2. In group 2, the average cough episodes, mean dose of anesthetic, and the average time of recovery were higher than that of group1. Both groups were comparable with respect to hemodynamic stability. No side-effects, i.e. hematoma, lung inflation or subcutaneous emphysema, were observed.

Trans-cricothyroid injection anesthesia is a safe method for anesthesia of the respiratory mucosa, tolerable for patients without major side-effects.

To investigate the level of bacterial contamination in ventilation devices after being connected to head trauma patients with confirmed ventilator-associated pneumonia.

This prospective, cross sectional study was carried out at Shahid Mohammadi hospital, Bandar-e Abbas, Iran. Samples for assessing the contamination of ventilators were obtained from expiratory and inspiratory tube insertion sites before connecting the device to the patients. The patients were then observed for the development of ventilator-associated pneumonia and were enrolled in the study if considered eligible. Sampling was repeated after disconnecting the patient. The following variables were assessed in each patient: gender, age, Glasgow Coma Scale upon hospitalization, length of stay in the intensive care unit (ICU), and mortality.

A total of 33 patients, including 26 men and 7 women, were enrolled in the study. There was no significant association between ventilation contamination and time of sampling (before or after ventilation) in the evaluated sites (P > 0.05). However, based on McNemer’s test for equality of frequencies, the prevalence of positive culture after disconnecting the device from the patients (60.6%) was not the same as the prevalence before being connected to the patients (21.2%) at inspiratory tube insertion sites (P = 0.002). Also, at both sites, the variety and pathogenicity of microorganisms after disconnecting the device were higher than those of microorganisms, colonized from samples which were obtained before connecting the device.

The findings of the present study showed that mechanical ventilation of patients with pulmonary infection leads to the contamination of ventilators. These findings suggest the need for designing and implementing new measures, which are easily available in developing and resource-deficient countries in order to reduce the contamination of ventilation devices and prevent cross-contamination.

Patients with severe traumatic brain injuries (TBIs) need specific clinical care in various dimensions. Therefore, identifying clinical care needs of patients is a key factor to provide nursing care. In this regard, a nurse, as a key member of healthcare team, has the ideal position to identify and meet clinical care needs of patients due to the frequent and close contact with patients.

The current study aimed at exploring the clinical care needs of patients with severe TBI during the stay in the intensive care unit (ICU), based on the nurses’ perspectives.

The current qualitative study was conducted from November 2015 to March 2016 using the purposive sampling method and semi-structured, in-depth interview with 14 ICU nurses. The interviews were recorded and analyzed using the conventional content analysis method.

Data analysis revealed 3 main themes and 6 categories. Physical health maintenance and promotion theme with 2 categories of "neurophysiological care needs" and "preventive care needs", maintaining psychosocial integrity theme with 2 categories of "communication needs" and "appropriate therapeutic environment" and spiritual management theme with 2 categories of "maintaining patients’ dignity" and "providing spiritual care to patients".

According to the results, patients with severe TBI had several care needs in physical, psychosocial, and spiritual dimensions. Therefore, healthcare teams should identify and meet such needs to improve the health and welfare of this group of patients.

Early detection and treatment of extensor mechanism rupture are essential for a long-term functional knee joint. In chronic cases, quadriceps muscle retraction and contracture make surgery difficult and results are less predictable.

The purpose of this study was to evaluate outcomes in the cases of late repaired patellar tendon rupture.

This study included patients with chronic patellar tendon rupture who were operated at Shafa orthopedic hospital from 2006 to 2013.

A total of ten patients were evaluated, wirh 12 cases of chronic patellar tendon rupture. Patients had a mean age of 34.4 years (range 18 - 58). Seven cases were caused by a traffic accident and three by a fall. The mean length of time from injury to surgery was 23 months (range 3 - 132). The mean time of follow-up was 6.2 years (range 3 - 9). Cerclage wire reinforcements were applied in nine of the knees and three knees had fiber wire reinforcement. Tendon graft augmentation was applied in ten of the knees; six with semitendinosus and gracilis autograft, two with semitendinosus autograft, one with an Achilles tendon allograft, and one with a tibialis anterior allograft. Means for preoperative/postoperative active knee range of motion, extension lag, subjective international knee documentation committee score, and modified Cincinnati scores were 81/117, 32/2, 22.7/84.5 and 24/87, respectively. Wire breakage was seen on all nine knees but wires were removed in only two symptomatic cases.

Good to excellent results were obtained in terms of functioning with operative treatment of chronic patellar tendon rupture. Direct repair with autogenous or allogenic graft augmentation and cerclage wire reinforcement and postoperative cast immobilization are recommended.

Numerous children are abused by their caregivers. Physical abuse is among the most destructive kinds of maltreatment that is highly related to physical and psychological problems in victims.

This study was conducted to determine the effectiveness of trauma-focused cognitive behavioral therapy in facilitating posttraumatic growth and emotional management among physically abused children.

This study was a quasi-experimental research with pretest-posttest design and control group; 40 abused primary school boys in Kermanshah were selected with cluster sampling and divided into case and control groups each of 20 subjects. Data analysis was performed by SPSS22 using descriptive statistics and covariance analysis.

Posttest scores of posttraumatic growth variable were significantly different between experimental and control groups. The mean score of emotional management variable in the experimental group was considerably higher than that of the control group.

TF - CBT can facilitate posttraumatic growth and emotional management in physically abused children.