A Comparison of the Effect of Visual and Auditory Distractions on Physiological Indicators and Pain of Burn Dressing Change Among 6-12-Year-Oldchildren: A Clinical Trial Study.

POURPOSE: This study aimed to compare the effect of audiovisual distraction on physiological indicators and pain of burn dressing change among 6-12 year-old children. DESIGN AND METHODS: The study was a single-blind clinical trial with a three-group that sample size was 120 children aged 6-12 years admitted to the burn ward of Hamadan Besat Hospital. Data collection tools were the Oucher pain scale, a Cheklist form of the physiological Indicators, and apulse oximetry device. The cartoons were shown for visual group and the melodic poems were played for the auditory group 2 min before the dressing until the end of the procedure (at 2-min intervals). Data were analyzed by SPSS-16 software one-way, variance analysis and post-hoc Bonferroni test. RESULTS: Therewere statistically significant differences between visual, auditory and control groups in the mean pain intensity scores at all measurement times, the mean arterial blood oxygen saturation percentage at all measurement times except for the10 min before the dressing and the start of the procedure and the mean heart rate at all measurement times except for 10 min before dressing (p < 0.001). Post-hoc tests showed that the difference in the mean heart rate was related to the difference between the visual and auditory distraction groups during and at the end of the dressing (p < 0.05), the visual and control groups at all measurement times (P < 0.001) and the auditory and control groups at all measurement times (p < 0.05). CONCLUSION: Audiovisual distraction is effective in reducing the fluctuations of physiological indicators and the burn dressing pain intensity in children at all times of measurement, especially during changedressing. PRACTICE IMPLICATIONS: The findings of this study are relevant to clinical practice because they suggest preparing children before and during a burning procedure situation.

A new right groin incision versus McBurney's incision for open appendectomy: a randomized controlled trial.

PURPOSE: We aimed to introduce a new surgical method for open appendectomy including a right groin incision with adipocutaneous flap and to compare its feasibility, safety, and cosmetic outcomes with classic McBurney's incision. METHODS: Patients with the diagnosis of acute appendicitis who were candidates for appendectomy surgery at General Surgery Department, Besat Hospital, Hamadan University of Medical Sciences, Iran, in 2016 and 2017, were enrolled in a randomized controlled clinical study. Patients were randomly assigned to two groups each containing 50 patients. In the case and control groups, patients underwent appendectomy using right groin incision with adipocutaneous flap and traditional McBurney's methods, respectively. RESULTS: One hundred patients with the mean age of 23.6 years (range = 4-44) old including 65 males were enrolled in the study. Patients' demographics, histopathology, and anatomical location of the appendix were not significantly different in the case and control groups. There was no significant difference in postoperative wound infection, cellulitis, hematoma, and seroma between the two groups. Patients in the case group were significantly more satisfied in terms of cosmesis than in the control group (P < .001); however, the operative time and pain were higher in the case group compared to the control group (P values = 0.016 and 0.033, respectively). CONCLUSIONS: The right groin incision for open appendectomy may be safe and feasible and the most cosmetically appealing method especially in children and patients with cosmetic concerns.

Outcome of Comparison between Partial Thickness Skin Graft Harvesting from Scalp and Lower Limb for Scalp Defect: A Clinical Trial Study.

BACKGROUND: Partial-thickness skin graft is the cornerstone for scalp defect repair. Given the potential side effects following harvesting from these sites, this study aimed to compare the outcomes of graft harvesting from scalp and lower limb. METHODS: This clinical trial was conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to Plastic Surgery Clinic at Besat Hospital, Hamadan, Iran during 2018-2019. Sampling was done by simple randomization using random digit table. The donor site in case group and control group was scalp and lower limb respectively. RESULTS: Overall, 28 patients (70%) were male and 12 (30%) were female. Basal cell carcinoma (BCC) and trauma were the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The mean diameter of defect was 24.28±45.37 mm for all of the patients. The difference between diameters of defect in both groups were statistically meaningful while no such difference between graft diameters was seen. The graft "Take" was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale and the satisfaction was higher in them per Likert scale. CONCLUSION: Scalp can safely be used as donor site for skin graft to be used for scalp defects associated with better results and lower complication rates compared to other donor sites.

The Healing Effect of Amniotic Membrane in Burn Patients.

BACKGROUND: Different methods for dressing of donor site of skin graft in burn patients have similarly pain, limitation of mobility of donor site and local complications such as infection and scar. Amniotic membrane has used for improvement of healing in some wounds. Accordingly in this study amnion was used as biologic dressing for donor site of skin graft to evaluate it's efficacy in improvement of pain, move score and the risk of local infection. METHODS: Study was done as clinical trial over 32 admitted patients in burn department of Beasat hospital. Amnion was prepared in elective caesarean section after rule out any placental site for risk of torch and viral infection. Skin graft was taken from two sites in every patient. One site dressed with amnion and another with routine dressing. Then two sites were compared about severity of pain, move score, infection and time of dressing sloughing. RESULTS: Fourteen patients were women and 18 men. Mean score of pain and movement up to fourth and fifth post operative day respectively was less than control site. No difference is seen about infection and dressing slough in two sites. CONCLUSION: It seems use of amnion for dressing of donor site probably cause rapid epithelialisation and wound healing and can improve pain and move score in early post operative days. Accordingly it is expected to need less analgesia and low rate of immobilization and following complications and earlier discharge of patients.

Anterior chest wall giant cell tumor.

Giant cell tumors (GCTs) of bone are rare primary neoplasms that usually originate from the epiphysis of long bones. Even when the tumor occurs in a rib, it is usually in the posterior aspect. We report a case of a GCT originating from the anterior arc of the rib in a 22-year-old woman presenting with a progressively growing thoracic mass in the right anterior chest wall. Through this case the authors emphasize not only the rarity of a bone GCT but also its unusual costal localization.