Evaluation of factors affecting psychological morbidity in emergency medicine practitioners

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).

Comparison of sedative effectiveness of thiopental versus midazolam in reduction of shoulder dislocation

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.

Analgesic effect of paracetamol combined with low- dose morphine versus morphine alone on patients with biliary colic： a double blind, randomized controlled trial

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 0.05mg/kg morphine+1 000 mg paracetamol in 100 m L normal saline and group B received 0.1 mg/kg morphine+normal saline(100 m L)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 g/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 and8.53±1.99 in group B.At 15 minutes after drug administration,the mean±SD VAS scores were2.16±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.