An Evaluation of Educational Iranian Papers on the Application of Evidence-Based Medicine

Background & Objective: Nearly two decades have passed since the establishment of evidence-based medicine (EBM). EBM is of great importance due to its ability to fill the information gap between medical research and clinical practice. The aim of the present study was to evaluate the existing evidence of the application of EBM in published Iranian educational papers. Methods: This is a systematic review of Iranian papers published in both Iranian and international journals. The results were reviewed by two researchers separately to assess the inclusion and exclusion criteria and evaluate the level of evidence. We used the Best Evidence Medical Education (BEME) guideline for conducting the systematic review and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart to present the selection process. In addition, the Medical Education Research Quality Index (MERSQI) was used for the evaluation of the quality of the studies. Conclusion: Although there are a limited number of studies on the effect of education on EBM application, they present satisfactory and average quality evidence. Despite the existence of various educational courses on EBM in Iran, no high level and high quality evidence exists to show the effectiveness of education on knowledge, attitude, practice, and behavior of healthcare professionals especially in the long-term. Thus, the designing and performing of high quality research is required in this field. Key Words: Evidence-based medicine, Application, Educational papers, Ira

Azithromycin versus Cephalexin for Simple Traumatic Wounds in the Emergency Department: A Randomised Trial

Objective: The aim of this study was to investigate efficacy of azithromycin versus cephalexin for infection prophylaxisis in patients with simple traumatic wounds managed at emergency department. Method: This randomized controlled trial compared short-course therapy of once-daily azithromycin (500 mg before the wound repair followed by 250 mg/day for 5 days) with cephalexin (1000 mg before wound repair followed by 250 mg every 6 hours for 5 days) in the treatment of patients with simple traumatic wounds. A total of 366 patients were randomly selected for the study and 303 were evaluated for the final analysis. Results: On completion of therapy, the rate of observed infection was 9.6% in the cephalexin group (15 patients, odds ratio=0.77, 95% confidence interval, 0.56 to 1.06) and 5.4% in the azithromycin group (8 patients, odds ratio 1.42, 95% confidence interval, 0.80 to 2.52). Both treatment indicated similar prophylactic efficacy during the study (P=0.197). Conclusion: Our study showed that Azithromycin as infection prophylaxis in simple traumatic wounds had the same effect as cephalexin but azithromycin is easier to use and more cost-effective compared to cephalexin

Efficacy of Half-length vs. Standard-sized Short Arm splint in Soft Tissue Injuries of the Hand and Wrist: a Randomized Controlled Trial

Introduction: Hand and wrist soft tissue injuries are common orthopedic problems that are traditionally treated with short arm splint, which covers the forearm to 1 cm distal to the elbow crease. Objective: The present study was conducted to compare the treatment efficacy of traditional standard-size splint with half-length short arm splint. Method: In this randomized, controlled, clinical trial, patients with hand and wrist soft tissue injuries were randomly assigned to two groups. Group one received standard-sized short arm splints and the other group received half-length short arm splints. The swelling and pain scores were compared between the groups by the end of weeks one, two and three. Results: A total of 256 patients with a mean age of 36.96 ± 12.27 years were enrolled in this study, and 71.9% of them were male. No statistically significant differences were observed in terms of swelling between the two groups after one and two weeks (P=0.41, P=0.18). None of the patients had swelling after three weeks. No statistically significant differences were observed between the two groups in terms of the pain score after one, two and three weeks (P=0.47, P=0.29, P=0.92). Conclusion: In this study, half-length short arm splints were found to be as effective as standard short arm splints

The association between serum 25-hydroxyvitamin D level and recurrent falls in the elderly population: a cohort study

Introduction: Serum vitamin D concentration is a major contributing factor for increasing the risk of fall and fall-related injuries in older adults. However, when prescribed and supplemented for these populations, the outcomes are controversial, and in several cases no improvement has been reported in reducing the risk of recurrent falls. This study aimed to examine the association between serum vitamin D concentration and recurrent falls in Iranian older adults. Methods: This cohort study was conducted in the emergency departments of two university hospitals. A cohort of 82 elderly participants aged over 60 and suffered from an unintentional episode of falling was evaluated six months after their first ED visit. A structured, self-administered checklist was developed to obtain the participants’ demographic and clinical information. Participants also were asked about any recurrent fall experience during follow-up. Results: The mean (SD) age of the study population was 75 (8). Over half of the participants were male (57.3%). The mean (median) serum 25-hydroxyvitamin D (25 (OH)D) concentration was 38 (34) ng/ml. Mean serum 25(OH)D levels varied slightly between gender groups (p=0.450). An inverse but insignificant association was found between the age of participants and their serum 25(OH)D levels (r=-0.03, p=0.7). A small but insignificant association also was found between the mean serum 25(OH)D level and the number of recurrent falls in elderly patients irrespective of their age, gender, or physical activity groups (OR=1.008, p=0.992). Conclusion: In contrast to previous studies, no significant association of serum 25(OH)D concentration was found with recurrent falls in Iranian older adults. Keywords: 25-hydroxyvitamin D,falls, Vitamin D insufficiency, Iran, Elderl

Excessive endotracheal tube cuff pressure: Is there any difference between emergency physicians and anesthesiologists?

Introduction. Endotracheal tube (ETT) cuff pressure is not usually measured by manometer and the providers rely on their estimation of cuff pressure by palpating the pilot balloon. In this study, we evaluated the pressure of ETT cuffs inserted by emergency physicians or anesthesiologists, and assessed the accuracy of manual pressure testing in different settings using a standard manometer. Methods. In this cross sectional study, the cuff pressure of 100 patients in emergency department (ED) and intensive care units (ICU) of two university hospitals was evaluated by using a sensitive and accurate analog standard manometer after insertion of the ETT and checking the pilot balloon by the provider. All measurements were performed by a person who was blinded to the study purpose and an ideal pressure range of 20 to 30 cmH 2 O was used for analysis. Results. Emergency physicians (n=58) and anesthesiologists (n=42) performed the intubations. The mean measured cuff pressure in our study was 69.2±29.8 cmH ded standard value of 25 cmH 2 2 O (range: 10-120 cmH 2 O) which was significantly different from the recommen- O (P<0.0001, one-sample t-test). No difference was found between anesthesiologists and emergency physicians in cuff inflation pressures (Anesthesiologists = 71.1 ± 25.7; Emergency physicians = 67.9±32.6). Conclusion. Estimation of cuff pressure using palpation techniques is not accurate. In order to prevent adverse effects of cuff overinflation, it is better to recheck the pressure using a manometer, regardless of place, time and the inserter of the endotracheal tube

Alterations in Circulating Adhesion Molecules in Acute Myocardial Infarction before and after Thrombolysis with Streptokinase

Introduction: The role of adhesion molecules in the development and progression of coronary atherosclerosis is inevitable. It is not clear yet whether these molecules increase or decrease in level after thrombolytic therapy. This study was designed to compare concentrations of soluble forms of adhesion molecules in patients with acute myocardial infarction before and after reperfusion by thrombolysis with streptokinase (SK). Methods: In this study, in 40 patients with acute myocardial infarction who were admitted in our Emergency Department undergoing thrombolysis with SK, plasma concentrations of six adhesion molecules [soluble L-selectin, P-selectin, E-selectin, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and platelet endothelial cell adhesion molecule-1 (PECAM-1)] were measured by enzyme linked immunosorbent assay (ELISA), before and 3 hours after intervention. Results: While soluble E-selectin and PECAM-1 concentrations did not differ within the 3 hours after interventions (P> 0.05), the level of P-selectin, L-selectin, ICAM-1, VCAM-1 were significantly reduced after thrombolysis with SK (P< 0.05). Conclusion: Adhesion molecules which mediate the interactions in leukocyte endothelium vary in levels after reperfusion with SK. It was shown that 4 out of 6 adhesion molecules significantly reduced after thrombolysis with SK

A review on using ultrasound for evaluation of pediatric blunt abdominal trauma

This study reviewed the former studies conducted on the usefulness of accuracy of focused assessment withsonography for trauma (FAST) or any plain ultrasonography (US) scan in pediatric blunt abdominal trauma(BAT), to assess its accuracy, sensitivity, specificity, and positive and negative predictive values (PPV and NPV).Searches were conducted using the predefined keywords and Medical Subject Headings (MeSH) terms acrossMEDLINE (PubMed), Scopus, Web of Science, Cochrane Collaboration Library, Embase, ClinicalTrials.gov, Magiran and SID.ir databases. Duplicate publications were excluded; then the titles and abstracts of eligible studies were reviewed for how they report blunt trauma, pediatric patients, and ultrasound modality in their text.&nbsp;Cochrane RevMan version 5.3 was used for the results analysis and assessing the risk of bias in the studies.Out of 923 studies, 902 were excluded, and only 19 articles were included in this review, out of which one wasa randomized clinical trial (RCT), three were cohort studies, two were contrast-enhanced US (CEUS) studies,and 13 were prospective or retrospective descriptive studies. The total population studied in the articles was3454 patients. The results showed that the specificity of US in pediatric BAT was 93%, the sensitivity was 54%,and the PPV in comparison to clinical examination was 73% versus 37%. CEUS protocol achieved 100% in bothsensitivity and specificity analysis. The only RCT study which included about 28% of the studies population alsoreached a sensitivity and specificity of 97% and 98%, respectively using a combinational protocol of clinical examination, laboratory investigation, and US assessment.&nbsp;Ultrasonography does not provide more results than clinical examination, though better PPV results. A combination of follow-up, US examination, and laboratory requests may also have more accurate results. Moreover,&nbsp;a CEUS protocol may reach that goal with an acceptable time-saving outcome, but it needs more studies to be&nbsp;confirmed

Demographics of Scorpion Sting in Iran; a Cross Sectional Study

Introduction: Scorpion sting is an important public health problem in some countries, including Iran. This study aimed to describe the demographics of a large number of these victims in some endemic areas of Iran.Methods: This cross-sectional study evaluated baseline characteristics, clinical findings, management, and disposition of scorpion stung cases in 26 cities of 4 provinces in the southwest quarter of Iran, during one year. Results: 3008 cases of scorpion sting with mean age of 27.07 ± 16.58 years were studied (51.3% female). The mean time from sting to hospital was 1.89 ± 1.04 hours. No first aid measures had been taken in 96.6% of cases. Lower (39.5%) and upper (35.7%) extremities were stung most frequently. Midnight to 6:00 am was the period of time most of stings occurred (34.2%). Local pain (77.2%) and erythema (63.5) were among the most common signs and symptoms. 2026 (67.3%) victims had been discharged; 326 (10.8%) were admitted or referred to other hospitals and 5 (0.2%) cases died.Conclusion: It seems that demographic characteristics of scorpion sting in Iran are not so different from those reported from other sites of the world, as signs and symptoms of local and systemic envenomations. Victims, companions, and healthcare providers perform many futile and maybe harmful measures and there is a need to educate all about all of these details

Burden of Circulatory System Diseases and Ignored Barriers ofKnowledge Translation

Circulatory system disease raise third highest disability-adjusted life years among Iranians and ischemic cardiac diseases are main causes for such burden. Despite available evidences on risk factors of the disease, no effective intervention was implemented to control and prevent the disease. This paper non-systematically reviews available literature on the problem, solutions, and barriers of implementation of knowledge translation in Iran. It seems that there are ignored factors such as cultural and motivational issues in knowledge translation interventions but there are hopes for implementation of started projects and preparation of students as next generation of knowledge transferors

Feasibility of Medical Education through Email: Darsnameh e-Learning System as a National Pattern

Introduction: while internet and web could bridge over time and place barriers of educa-tion, some websites developed educational programs in different fields. The nation-wide Darsnameh e-Learning System is one of the accepted and popular services basically for ICT education and other miscellaneous topics. Here, we try to collect the characteristics of this system to assess the feasibility of its adaptation for medical education. Methods: we considered five aspects (infrastructure, registration, content, timing, and user) and two criteria (user-friendliness and reliability) to assess the adaptation of Darsnameh model for medical education. Assessment team consisted of a software engineer, a medical librarian, and a medical education expert each of them voluntarily and optionally registered in one of the Darsnameh courses and finished it. Passing each course took 43 days on average. Three two-hour meetings were held to assess the system in group discussions. All discus-sions were recorded and their contents were analyzed to form the assessment concepts and categories. To determine adoptability of the system for medical education, scores of 0-7 was considered. Results: in Categories of infrastructure, registration, content, timing, and users were scored 6, 2, 6, 4, and 4 respectively. Also, user-friendliness and reliability criteria were scored 6 and 1. Except reliability criteria, other characteristics were consi-dered as adoptable for medical education. But reliability of the registration information, content, exam results, course certification, and affiliation of developers remained unreliable. Conclusion: implementation of e-learning for medical education through email could be considered as a new developmental approach, however because of limitations of current study, it should be evaluated for a large number of subjects such as general practitioners