Axillary block duration and related hemodynamic changes: high versus low dose Adrenaline addition to Lidocaine

"nBackground: Axillary block is used for inducing anesthesia in outpatient hand and forearm surgeries. Few researches have studied hemodynamic and blockade effects of low doses of Epinephrine. The aim of the present study was to compare the duration of analgesia and hemodynamic changes following the injection of high/low epinephrine doses in such surgeries. "nMethods: The present randomized clinical trial study was conducted on healthy individuals (ASA I-II) who were candidates for hand and forearm surgeries. The patients were randomly divided into three groups. The first two groups were allocated to receive lidocaine with low (0.6µg/cc) and high (5µg/cc) doses of epinephrine whereas lidocaine plus normal saline was injected in the third group. The hemodynamic changes (Mean arterial blood pressure and heart rate) and the occurance of any side-effects along with the duration of analgesia and motor block were recorded. "nResults: From among the total of 75 patients, 15 cases were excluded due to incomplete blockade or failure needing general anesthesia. The duration of analgesia and the motor block were longer in the high dose epinephrine group, the difference, however, was not statistically significant. Heart rate changes within the groups was significant in the 4th-7th and 10th minutes. Mean arterial blood pressure changes was only significant in the 4th minute, within the groups. "nConclusions: Administering low doses of epinephrine plus lidocaine as a local anesthetic not only provides acceptable analgesia compared to higher doses of the medication, but also is associated with fewer side effects

Teaching critical appraisal and statistics in anesthesia journal club

Background: This study was designed to assess the effectiveness of a series of journal clubs held for anesthesiology residents in promoting their awareness of research methods and statistical analysis, as well as their skills in critical thinking and appraisal. Material and methods: Twenty-four journal club sessions were held between September 2006 and August 2007 for 16 residents of anesthesiology. A 31 multiple-choice question (MCQ) was taken as pretest and posttest to evaluate the participants level of awareness in research methodology and statistical analysis. Their competence in critical thinking and appraisal was also evaluated by evaluating a randomized controlled trial paper using the CONSORT checklist before and after the course. Results: Residents awareness in the application of information improved (P 0.012), as well as research methodology (combined study design and application of information, P 0.017). Their ability in critical appraisal did also significantly rise at the end of the course (P 0.001). Conclusion: Journal clubs can enable residents to develop the knowledge, expertise and enthusiasm needed to undertake research plans and can also enhance their ability in critical thinking and scientific reading

Evaluation of morning report in an emergency medicine department

Background: Morning report is considered as an important educational tool in different branches of medicine. The purpose of the present study was to examine the method of case selection, the leadership, the participant's satisfaction and the educational value of morning report held in our centre. Method: In September 2007, a formal feedback about the morning report was provided by questionnaire surveys. The data on the method of case selection, the leadership, the participant's satisfaction and the educational value of the sessions were collected from the residents, medical students and the academic staff in emergency medicine department. Each questionnaire also contained an open-ended question, asking for the responders' suggestions for improving these sessions. Results: 73.2% of the responders were satisfied with the current model of the conference hall. The data showed that 46.3% of the participants believed these sessions are held for giving the medical team the required information and 65.9% for solving the patient's problems. The data showed that the participants had evaluated the presentation strategy to be good; however, the presentation pattern was reported to be traditional and based on differential diagnosis in 53.7% of the cases and modern problem oriented in only 39%. Conclusion: Most participants considered morning report sessions held in our hospital to be effective in the way it is; however, issues such as communication skill, emergency department management, critical thinking, ethics, professionalism and evidence-based medicine should also be added to the sessions

Intra-articular lidocaine versus intravenous meperidine/diazepam in anterior shoulder dislocation: a randomised clinical trial

Background: Anterior shoulder dislocation is one of the most common complaints of patients referred to emergency departments. Intravenous opiates and benzodiazepines are traditionally prescribed in order to relieve the pain in this group of patients; however, complications always pose a problem. Objective: To compare the pain relief and complications following intra-articular lidocaine and intravenous meperidine/diazepam in patients with anterior shoulder dislocation. Methods: 48 patients with non-habitual traumatic anterior dislocation of the glenohumoral joint admitted to Imam Khomeini hospital emergency department were enrolled in this randomised clinical trial. They were divided into two groups: one group of patients received intra-articular lidocaine 1%, while the other received intravenous meperidine and diazepam. Closed reduction using the countertraction-traction method was performed by a single person in all the patients. Utilising a 100 mm visual analogue scale, each patient's pain was recorded before injection, before reduction, and after reduction. Results: Mean pain (mm) recorded before injection, before reduction, and after reduction in the intra-articular lidocaine group was 84.3 (95% confidence interval (CI) 79.8 to 88.8), 52.6 (95% CI 45.2 to 60.1), and 27.3 (95% CI 19.9 to 34.7), respectively. The corresponding rates in the intravenous meperidine/diazepam group were 83.2 (95% CI 79.2 to 87.2), 57.9 (95% CI 53.8 to 62.0), and 23.9 (95% CI 18.9 to 28.8), respectively. Both groups demonstrated a similar significant decline in pain after injection (p<0.005). No severe complications were reported in either of the groups. Conclusion: Intra-articular injection of lidocaine before closed reduction of anterior shoulder dislocation produces the same pain relief as intravenous meperidine and diazepam

Applying accreditation standards in a self-evaluation process: The experience of Educational Development Center of Tehran University of Medical Sciences

Introduction: Educational Development Centers (EDCs), as the coordinator in education development in Medical Sciences universities, in order to improve their quality should evaluate their activities. In spite of remarkable performance of Tehran University of Medical Sciences (TUMS) EDC in previous national rankings, but it faces many challenges and problems. This paper provided the process, results and lessons learned from a self-evaluation experience conducted at TUMS EDC based on accreditation standards. Method: The present study is an Institutional self-evaluation study based on the national accreditation standards of EDCs (2012). Data were gathered using an open-ended questionnaire developed on the basis of the SWOT format. A directional content analysis applied to analyze the data. Results: In total, 84 point of strengths, 87 weaknesses, 15 opportunities, 24 threats and also 99 recommendations for quality improvement were reported. The most important strengths of the center were the existence of an established mechanism regarding research process in education and scholarship of education, holding various faculty development courses and training standardized patient. The most important weaknesses were the lack of specified procedures in some areas such as monitoring the planning and reviewing of educational programs in the field of educational programs and evaluation of empowerment courses. Conclusion: The present evaluation results will be useful in directing future policies of TUMS EDC such as revising its strategic planning. We hope that the current experience can be helpful for administrators in EDCs in the Ministry of Health and Medical Education and also other Medical Sciences Universities

Prevalence of elimination disorders and comorbid psychiatric disorders in Iranian children and adolescents

PURPOSE: Currently, there is a paucity of studies on the prevalence of Elimination Disorders among Iranian children and adolescents. Due to the ongoing need to monitor the health status of these children and adolescents, the present study aims to investigate the prevalence of Elimination Disorders and comorbid disorders in Iranian children and adolescents. METHODS: In this cross-sectional study, 29,781 children and adolescents age 6 to 18 years old were selected and studied from all the provinces in Iran. The sampling was carried out by employing a multistage cluster sampling method, and several clinical psychologists using semi-structured interviews collected the data. Furthermore, clinical psychologists collected demographic information (including information about gender, age, place of residence, education level, and parental education level). The collected data were analyzed using SPSS version 20. RESULTS: Generally, the prevalence of Elimination Disorders was found to be 5.4 covering both enuresis (p= 5.4, 95 CI = 5.1-5.7) and encopresis (p= 0.13, 95 CI = 0.09-0.2). The total prevalence of comorbid disorders was 38, and among the comorbid disorders, Attention Deficit Hyperactivity Disorder (ADHD) (p= 11, 95 CI = 9.5-12.7) and Separation Anxiety (p= 10.6, 95 CI = 9.1-12.2) were the most prevalent. CONCLUSION: The prevalence of Elimination Disorders in Iranian children and adolescents is moderate compared to similar studies elsewhere. As for comorbid disorders, ADHD and Separation Anxiety were found to be the most prevalent disorders. Since Elimination Disorders coexist with psychiatric disorders in children, further studies of these comorbidities may give better insight into the treatment and prognosis of Elimination Disorders. © 2021 - IOS Press. All rights reserved