BACKGROUND: Rapid and effective pain relief in acute traumatic limb injuries (ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous (IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI. METHODS: In this double-blind randomized clinical trial, 307 patients with ATLI, who presented to the emergency department (ED) from February 2016 to April 2016, were randomly divided into two groups. One group (152 patients) received 0.1 mg/kg IV morphine. The other group (155 patients) received 1 mcg/kg IV fentanyl. Patients' demographic data, pain score at specific intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded. RESULTS: Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up (P value=0.00). However, at 10, 30, and 60-minute follow-ups no significant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12 (7.7%) patients in the fentanyl group and in 48 (31.6%) patients in the morphine group (P value=0.00). No significant difference was observed regarding side effects, vital signs and patients' satisfaction between the two groups. CONCLUSION Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.

BACKGROUND: Assessing and evaluating mental health status can provide educational planners valuable information to predict the quality of physicians'' performance at work. These data can help physicians to practice in the most desired way. The study aimed to evaluate factors affecting psychological morbidity in Iranian emergency medicine practitioners at educational hospitals of Tehran.METHODS: In this cross sectional study 204 participants (emergency medicine residents and specialists) from educational hospitals of Tehran were recruited and their psychological morbidity was assessed by using a 28-question Goldberg General Health Questionnaire (GHQ-28). Somatization, anxiety and sleep disorders, social dysfunction and depression were evaluated among practitioners and compared to demographic and job related variables.RESULTS: Two hundreds and four participants consisting of 146 (71.6％) males and 58 (28.4％) females were evaluated. Of all participants, 55 (27％) were single and 149 (73％) were married. Most of our participants (40.2％) were between 30–35 years old. By using GHQ-28, 129 (63.2％) were recognized as normal and 75 (36.8％) suffered some mental health disorders. There was a signifi cant gender difference between normal practitioners and practitioners with disorder (P=0.02) while marital status had no significant difference (P=0.2). Only 19 (9.3％) declared having some major mental health issue in the previous month.CONCLUSION: Females encountered more mental health disorders than male (P=0.02) and the most common disorder observed was somatization (P=0.006).

BACKGROUND: Various sedative drugs have been proposed to control anxiety and agitation in shoulder dislocation, but none of them has been diagnosed as the best sedative and relaxant agent. The study aimed to compare the sedative effectiveness of thiopental versus midazolam in reduction of shoulder dislocation. METHODS: A randomized double-blind controlled trail was performed in 80 patients with shoulder dislocation recruited from the emergency department. Ten patients were excluded and 70 patients were enrolled in the study. Case group received intravenous thiopental 2 mg/kg+2 μg/kg fentanyl while control group received intravenous midazolam 0.1 mg/kg+2 μg/kg fentanyl. Number of times, patients and physician's satisfaction, difficulty of procedure, degree of muscle relaxation, time of sedation and complete recovery, number of patients with apnea episode, O2 saturation, patient's pain score and adverse events were all recorded. RESULTS: Muscular tone had significant difference between the two groups (P-value=0.014) and thiopental was more muscle relaxant than midazolam. Replacement of shoulder dislocation in thiopental group was easier than midazolam group (P-value=0.043). There was no need to use multiple methods of reduction in either group. Before drug infusion the mean±SD VAS scores were 8.37±2.21 in the midazolam group (A) and 8.94±1.78 in the thiopental group (B); mean difference 0.57, 95％CI= –0.38 to 1.52. After completion of the procedure, the mean±SD VAS scores in group (A) and (B) were 3.20±1.30 vs. 3.65±1.30; mean difference –0.45, 95％CI= –1.07 to 0.16. CONCLUSION: Thiopental might be more effective and relaxant than midazolam for reduction of shoulder dislocation.

BACKGROUND: Inaccurate and incomplete documentation can lead to poor treatment and medico-legal consequences. Studies indicate that teaching programs in this field can improve the documentation of medical records. The study aimed to evaluate the effect of an educational workshop on medical record documentation by emergency medicine residents in the emergency department. METHODS: An interventional study was performed on 30 residents in their first year of training emergency medicine (PGY1), in three tertiary referral hospitals of Tehran University of Medical Sciences. The essential information that should be documented in a medical record was taught in a 3-day-workshop. The medical records completed by these residents before the training workshop were randomly selected and scored (300 records), as was a random selection of the records they completed one (300 records) and six months (300 records) after the workshop. RESULTS: Documentation of the majority of the essential items of information was improved significantly after the workshop. In particular documentation of the patients' date and time of admission, past medical and social history. Documentation of patient identity, requests for consultations by other specialties, first and final diagnoses were 100％ complete and accurate up to 6 months of the workshop. CONCLUSION: This study confirms that an educational workshop improves medical record documentation by physicians in training.

BACKGROUND:Numerous drugs have been proposed to alleviate pain in patients with biliary colic, especially opioids, but still there is a tendency to use less narcotics because of their side effects and the unwillingness of some patients. The present study aimed to compare the analgesic effect of paracetamol combined with low-dose morphine versus morphine alone in patients with biliary colic. METHODS:A randomized double-blind controlled trial was performed in 98 patients with biliary colic, recruited from two emergency departments from August 2012 to August 2013. Eleven patients were excluded and the remaining were randomized into two groups:group A received 0.05 mg/kg morphine+1000 mg paracetamol in 100 mL normal saline and group B received 0.1 mg/kg morphine+normal saline (100 mL) as placebo. Pain scores were recorded using visual analogue scale (VAS) at baseline and 15 and 30 minutes after drug administration. Adverse effects and the need for rescue medication (0.75 μg/kg intravenous fentanyl) were also reported within 60 minutes of drug administration. RESULTS:Before the infusion, the mean±SD VAS scores were 8.73±1.57 in group A and 8.53±1.99 in group B. At 15 minutes after drug administration, the mean±SD VAS scores were 2.16±1.90 in group A vs. 2.51±1.86 in group B; mean difference was –0.35, and 95％CI–1.15 to 0.45 (P=0.38). At 30 minutes the mean±SD VAS scores were 1.66±1.59 in group A vs. 2.14±1.79 in group B; mean difference was –0.48, and 95％CI –1.20 to 0.24 (P=0.19). The mean pain scores in the two groups at 15 and 30 minutes demonstrated no significant difference. CONCLUSION:Paracetamol combined with low-dose morphine may be effective for pain management in patients with biliary colic.

BACKGROUND: Sleep deprivation resulting from night shifts, is a major cause of burnout among physicians. Exogenous melatonin may improve sleep quality in night-shift workers. The study aims to compare the effectiveness of melatonin versus placebo on sleep efficiency in emergency medicine (EM) residents. METHODS: A randomized, double-blind, replicated crossover trial was performed on EM residents. This study consisted of 4 phases within a month with intervention periods of 2 nights and washouts of 6 days. In our study, EM residents had nine-hour shifts on 6 consecutive days, 2 mornings, 2 evenings and 2 nights and then 2 days off. At the end of shifts' cycle, 24 EM residents were given 3 mg melatonin or placebo (12 in each arm of the study) for 2 consecutive nights after the second night shift with crossover to the other arm after a six-day off drug. This crossover intervention was repeated for two more another time. Finally, we created 48 cases and comparisons in each arm. Different items related to sleep quality were assessed and compared both within the same group and between the two groups. RESULTS: In the melatonin group, daytime sleepiness (calculated by Karolinska Sleep Scale) had a significant reduction after taking the second dose of drug (P=0.003) but the same result was not observed when comparing the 2 groups. Mood status (calculated by Profile of Mood States) showed no remarkable difference between the 2 groups. CONCLUSION: Melatonin might have a limited benefit on sleep quality in EM residents working night shifts.

PURPOSE: Breast cancer is the most common cancer in women worldwide and the leading cause of cancer death among women. In Asian countries such as Iran, the incidence of breast cancer is increasing. The present study aimed to assess the risk factors for breast cancer of women in Tabriz, Iran. METHODS: A hospital-based case-control study was undertaken to identify breast cancer risk factors. The study consisted of 140 cases confirmed via histopathological analysis and 280 group-matched controls without any malignancy. Data were analyzed using descriptive and inferential statistical methods via the SPSS software version 18. RESULTS: In a multivariate analysis, educational level (odds ratio [OR], 4.7; 95% confidence interval [CI], 2.11-10.83), menopausal status (OR, 2.54; 95% CI, 1.41-4.59), a high-fat diet (OR, 2.76; 95% CI, 1.51-5.04), abortion (OR, 2.13; 95% CI, 1.20-3.79), passive smoking (OR, 2.76; 95% CI, 1.51-5.04), oral contraceptive use (OR, 3.18; 95% CI, 1.80-5.59), stress (OR, 3.05; 95% CI, 1.74-5.36), and migration (OR, 3.09; 95% CI, 1.39-6.90) were factors associated with a significantly increased risk of breast cancer. Breastfeeding (OR, 0.39; 95% CI, 0.16-0.97) and a diet containing sufficient fruit and vegetables (OR, 0.22; 95% CI, 0.12-0.39) had protective roles against breast cancer. CONCLUSION: The study revealed that the risk factors for breast cancer among women in the Tabriz area of Iran are related to the lifestyle. Therefore, the provision of education to change unhealthy lifestyle choices and periodic check-ups for early breast cancer detection are recommended.
Asian Continental Ancestry Group ; Breast Feeding ; Breast Neoplasms* ; Case-Control Studies* ; Diet ; Diet, High-Fat ; Education ; Female ; Fruit ; Humans ; Incidence ; Iran* ; Life Style ; Multivariate Analysis ; Risk Factors* ; Tobacco Smoke Pollution ; Vegetables

PURPOSE: This study aimed to determine factors associated with caregiver burden among primary caregivers of women with breast cancer in Iran. METHODS: This was a descriptive correlation study conducted in 2012 on 150 main caregivers of patients with breast cancer who came to the oncology clinic of Shahid Ghazi hospital in Tabriz, Iran. A questionnaire which included caregiving-related factors and the Zarit Burden Interview was used for data collection after its validity and reliability were determined. Data was analyzed using SPSS 13.0 software with descriptive and analytic statistics. The association between significant variables and the dependent variable with an observation of the effects of other variables was assessed using the multiple linear regression model. RESULTS: The mean age of caregivers was 39.60 ± 13.80 years old, and 77 (51.3%) of them were men. The mean score of the Zarit Burden Interview was 30.55 ± 19.18. In the regression model, the mean score of activities of daily living, level of education, gender, and financial status were identified as the determining factors of the burden of caregivers. CONCLUSIONS: Primary caregivers need to be financially supported by the relevant organizations. Care skills training and providing palliative care seem helpful in reducing the pain and the burden of family caregivers for patients with breast cancer.
Activities of Daily Living ; Adult ; Breast Neoplasms/*psychology ; Caregivers/*psychology ; *Cost of Illness ; Family/psychology ; Female ; Health Status ; Humans ; Iran ; Male ; Marital Status ; Middle Aged ; Socioeconomic Factors