Design and psychometric evaluation of schools' resilience tool in Emergencies and disasters: A mixed-method.

BACKGROUND: In addition to their educational role, resilient schools have a good capacity in response to disasters. Due to the large student population, the schools can be a safe and secure environment during disasters, in addition to maintaining their performance after. Given the role and importance of the schools, the impact of culture and environment on resilience, without any indigenous and comprehensive tool for measuring the resilience in Iran, the study aimed to design and psychometrically evaluate the measurement tools. METHOD: This study was conducted using a mixed-method sequential explanatory approach. The research was conducted in two main phases of production on items based on hybrid model and the psychometric evaluation of the tool. The second phase included validity (formal, content and construction) and reliability (multiplex internal similarity, consistency and reliability). RESULT: The integration of systematic and qualitative steps resulted in entering 91 items into the pool of items. After formal and content validity, 73 items remained and 44 were omitted in exploratory factor analysis. A questionnaire with 5 factors explained 52.08% of total variance. Finally, after the confirmatory factor analysis, the questionnaire was extracted with 29 questions and 5 factors including "functional", "architectural", "equipment", "education" and "safety". Internal similarity and stability in all factors were evaluated as good. CONCLUSION: The result showed that the 29-item questionnaire of school resilience in emergencies and disasters is valid and reliable, that can be used to evaluate school resilience. On the other hand, the questionnaire on assessment of school resilience in disasters enables intervention to improve its capacity.

Operational Strategies for Establishing Disaster-Resilient Schools: A Qualitative Study.

INTRODUCTION: Resilient schools can warranty students' health and survival at disasters. It is obligatory that schools be prepared for natural challenges through local programs. Considering the great population of students, disaster-resilient schools can be a safe and suitable environment for students at the time of disaster. OBJECTIVE: This study aims to identify certain operational strategies for establishing schools resilient to natural disasters. METHOD: This qualitative study was based on conventional content analysis. Using purposive sampling method, 24 experts in the fields of health in disasters, construction engineering, psychology, teaching, and administrative management participated in the study. Maximum variation sampling continued until data saturation was achieved. The data collected via unstructured interviews were analyzed with Graneheim and Lundmen's conventional content analysis. RESULTS: Content analysis resulted in four main categories as operational strategies for establishing disaster-resilient schools including: 1) "construction and non-construction optimization", with four subcategories of construct risk management, optimization of construct architecture and physical structure, correct construct localization, and promotion of non-construct safety, 2) "promotion of organizational coordination and interactions" with two subcategories, namely improvement in intra-organizational communication and improvement in extra-organizational communication, 3) "improvement in education" with three subcategories of holding educational courses for families and students, holding educational courses for managers and personnel, and holding simulated exercises, and 4) "process promotion" with four subcategories of increased preparedness, correct planning, creation of organizational structure, and rehabilitation facilitation. CONCLUSION: Various factors affecting schools' response to disasters form operational strategies to establish disaster-resilient schools. These strategies influence pre- and post-disaster preparedness. Awareness of these components followed by preparedness prior to disasters can save students' lives, improve school performance after disasters, and aid in establishing disaster-resilient schools as safe lodgings.

Assessment of school resilience in disasters: A cross-sectional study.

BACKGROUND AND OBJECTIVES: School resilience is defined as risk-reducing strategies used to create a safe environment for students when faced natural disasters. Resilient schools, in addition to their educational role, provide a suitable capacity for responding to disasters and rehabilitation after the incidence. This study determined the level of disaster resilience of schools in Yazd, central Iran. MATERIALS AND METHODS: This is a descriptive-analytic study conducted among 400 schools and 367 participants in Yazd, 2018. To collect data, we used the school resilience in disasters questionnaire (α =0.95 and intraclass correlation coefficient = 0.97 [95% confidence interval: 0.96-0.98]) containing 48 questions. We also analyzed the gleaned data through the Pearson correlation coefficient, one-way ANOVA, and independent t-test. RESULTS: The total score of school disaster resilience was 153.30 ± 29.57. In these schools, the function had the highest (47.76 ± 13.96), and safety had the lowest (6.74 ± 3.18) score among all areas of school disaster resilience. There was a positive significant correlation between total resilience and areas of function, education, structural, nonstructural, architecture, commute routes, safety, location, and equipment (P < 0.001). Location had the smallest (r = 0.424) and function had the greatest (r = 0.854) correlation with total resilience. CONCLUSION: It can help the school management board in assessing the level of resilience of their school and determining the priorities for disaster risk reduction. Awareness of the status of resilience can help policy-makers and experts create an effective program for increasing resilience.

Preemptive Analgesia with a Second Dose of Pregabalin, Acetaminophen, Naproxen, and Dextromethorphan: A Comparative Clinical Trial in Major Surgeries.

BACKGROUND: Postoperative pain management can improve patients' quality of life and decrease hospitalization rates. Preemptive analgesia may provide an effective approach for both pain control and opioid consumption decrease. A common approach for pain management after surgery is to relieve the pain that has already occurred. OBJECTIVES: The aim of this clinical trial was to compare the preemptive analgesic effect of single-dose versus two-dose administration of pregabalin, acetaminophen, naproxen, and dextromethorphan (PAND) combination. METHODS: This study involved 60 patients who had undergone one surgery (including nephrectomy, cystectomy, prostatectomy, colectomy, Whipple, and RPLND). They were randomly divided into two groups: The first group received a single dose of PAND, while the other group received a second dose within 6 hours after discharge from recovery. Pain intensity was assessed by the Universal Pain Assessment Tool (UPAT) in both groups 2, 4, 6, 8, 12, 24, and 48 hours postoperatively. The postoperative morphine dose in both groups was also recorded. Data were analyzed using SPSS version 25. RESULTS: Mean pain scores were significantly different between the two groups at 2, 12, 24, and 48 hours after surgery (P < 0.05). There was a statistically significant difference between the two groups in terms of opioid consumption (P < 0.001). The total opioid consumption in the second group (with the second administration of PAND) was lower than the first group. CONCLUSIONS: Preemptive analgesia with a second dose of PAND is an effective method for reducing pain and morphine consumption after surgery.

Multi-Modal Preemptive Analgesia With Pregabalin, Acetaminophen, Naproxen, and Dextromethorphan in Radical Neck Dissection Surgery: A Randomized Clinical Trial.

BACKGROUND: Preemptive analgesia may be considered as a method not only to alleviate postoperative pain but also to decrease analgesic consumption. Different regimens are suggested, but there is currently no standard. OBJECTIVES: The aim was to measure the efficacy of preemptive analgesia with pregabalin, acetaminophen, naproxen, and dextromethorphan in radical neck dissection surgery for reducing the intensity of pain and morphine consumption. PATIENTS AND METHODS: This study was conducted as a randomized double-blind clinical trial. Eighty adult patients (18 to 60 years of age) under the American society of anesthesiologists (ASA) physical status I and II undergoing elective radical neck dissection were enrolled. Patients were randomized into two groups of 40 with a simple randomization method. The case group received a combination of 15 mg/kg acetaminophen, 2.5 mg/kg pregabalin, 7 mg/kg naproxen, and 0.3 mg/kg dextromethorphan administered orally one hour prior to surgery. Postoperative pain was assessed with the universal pain assessment tool (UPAT) at 0, 2, 4, 6, 12, and 24 hours after surgery. Subjects received morphine based on postoperative pain control protocol. Total administered morphine doses were noted. RESULTS: Postoperative pain rates at 0, 2, 4, 6, 12, and 24 hours after surgery were significantly lower for the case group than the control group (P values = 0.014, 0.003, 0.00, 0.00, and 0.00, respectively). Total morphine doses for the preemptive analgesia group were 45% lower than those of the other group. Side effects were similar for both groups. CONCLUSIONS: A single preoperative oral dose of pregabalin, acetaminophen, dextromethorphan, and naproxen one hour before surgery is an effective method for reducing postoperative pain and morphine consumption in patients undergoing radical neck dissection.

Sciatic Nerve Block in Tetanus: A Case Report.

INTRODUCTION: Muscle rigidity and generalized spasm can cause severe pain in patients with tetanus. Administration of high dose sedative or narcotic agents can increase respiratory failure and prolong mechanical ventilation support. CASE PRESENTATION: In this report, ultrasound-guided sciatic nerve block was performed in a 25-year-old patient with tetanus to progress his respiratory drive which was decreased due to high dose sedative administration. This procedure accelerates the weaning process and extubation. CONCLUSIONS: Nerve blocks may be appropriate for the particular patient with tetanus to tolerate the pain, reduce depth of sedation, accelerate extubation and subsequently decrease complications of tetanus relating to long time intubation.

Lumbar plexus block for management of hip surgeries.

BACKGROUND: Lumbar plexus block (LPB) is one of the anesthetic options in the elderly patients undergoing hip surgeries. LPB could be safe because it targets somatic nerve in psoas region. Effectiveness of LPB is attributed to the sufficient analgesia provided intraoperatively as well as postoperatively. Adequate muscle relaxation and immobility during surgery refers to its acceptability. OBJECTIVES: In this study, LPB was used as the anesthetic method to manage the elderly patients subjected to hip surgery. PATIENTS AND METHODS: A total of 50 patients aged 51 to 100 years were enrolled in this study. LPB was accomplished after a mild sedation and with a modified method using patient's fingertip width (FTW) as the distance unit to determine needle entry point under electrical nerve stimulation assistance. After targeted injection, procedure time, establishment time, block duration, surgery time, hemodynamic variables, and surgeon satisfaction score were documented and analyzed. Propofol in trivial doses was infused intraoperatively to provide clinical sedation. RESULTS: Mean patient's age was 73 ± 12 years with ASA II/III. Procedure time was 5.65 ± 1.24 minutes, establishment time was 130 ± 36 seconds, block duration was 13.1 ± 8 hours, surgery time was 149.7 ± 32.2 minutes, and surgeon satisfaction score was 9.8 ± 0.1. There was no complication and no failure. Hemodynamic stability was pleasantly achieved. CONCLUSIONS: By preserving hemodynamic stability, LPB in conjunction with a light sedation could be considered as a reliable prudent satisfying anesthetic option in management of hip fractures in the elderly patients with three beneficial characteristics of safety, effectiveness, and acceptability.

Comparing caudal and intravenous ketamine for supplementation of analgesia after Salter innominate osteotomy.

PURPOSE: Previous studies claim that caudal administration of ketamine causes effective analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or intravascular administration in pediatric patients that underwent orthopedic surgery to distinguish between local and systemic analgesia. METHODS: After the induction of general anesthesia, 36 patients, aged 18 months to 10 years, assigned to undergo orthopedic surgery, received a caudal injection of bupivacaine and were randomly blinded into two groups: one group received 1 mg/kg S(+)-ketamine as the caudal group and the other group received 1 mg/kg S(+)-ketamine as the intravascular group. Postsurgical measurements included the effectiveness of postsurgical analgesia, which was assessed by using the observational pain scale (OPS), duration of analgesia, sedation score, and hemodynamic and respiratory monitoring. RESULTS: The mean time to first analgesia was clearly longer in the caudal ketamine group (13.35 h) than in the intravenous ketamine (9.93 h) group (P < 0.01). During the 24-h observation time, fewer children asked for additional analgesic drugs in the caudal group (8 of 18, 44.4 %) than in the intravenous group (12 of 18, 66.6 %; P = 0.01). The times to first micturation and spontaneous leg movements and the incidence of nausea and vomiting were similar in the two groups. The OPS and sedation scores after operation showed no obvious differences between the groups at any time. CONCLUSION: Although caudal ketamine provides good postsurgical analgesia due to its potential neurotoxicity and only small clinical differences with intravenous ketamine, the administration of intravenous ketamine might be a reasonable option to potentially extend the postsurgical analgesic effect of the caudal administration of local anesthetics in children undergoing Salter osteotomy.

Scalp block for awake craniotomy in a patient with a frontal bone mass: a case report.

"Anesthesia" for awake craniotomy is a unique clinical condition that requires the anesthesiologist to provide changing states of sedation and analgesia, to ensure optimal patient comfort without interfering with electrophysiologic monitoring and patient cooperation, and also to manipulate cerebral and systemic hemodynamics while guaranteeing adequate ventilation and patency of airways. Awake craniotomy is not as popular in developing countries as in European countries. This might be due to the lack of information regarding awake craniotomy and its benefits among the neurosurgeons and anesthetists in developing countries. From the economic perspective, this procedure may decrease resource utilization by reducing the use of invasive monitoring, the duration of the operation, and the length of postoperative hospital stay. All these reasons also favor its use in the developing world, where the availability of resources still remains a challenge. In this case report we presented a successful awake craniotomy in patient with a frontal bone mass.

Comparison of combined femoral nerve block and spinal anesthesia with lumbar plexus block for postoperative analgesia in intertrochanteric fracture surgery.

BACKGROUND: Hip fracture-related pain both before and after surgery is generally reported as severe by most patients. Various regional pain control modalities have been described in order to reduce pain in these patients. OBJECTIVES: Because of the challenges of lumbar plexus block (LPB) and the fact that the effect of combined femoral nerve block/spinal anesthesia in controlling pain after orthopedic surgeries has not been investigated, in this study, we compared the feasibility and efficacy of the 2 techniques in the perioperative management of proximal hip fractures. PATIENTS AND METHODS: The study included 32 patients with femoral intertrochanteric fracture who were randomly divided into the following 2 groups of 16 patients each: combined femoral nerve block/spinal anesthesia group (group I) and LPB group (group II). Patients in group I received 0.17% bupivacaine with 0.7% lidocaine, 20-25 mL for femoral nerve block and bupivacaine 0.5% plus 0.5 mL pethidine (25 mg) for spinal block and patients in group II received 0.17% bupivacaine with 0.7% lidocaine, 30-35 mL. RESULTS: The time for performing the block (12.2 ± 3.3 vs. 4.93 ± 1.6 min, P = 0.001) and achieving the block (7.7 ± 0.9 vs. 2.4 ± 1.0 min, P = 0.001) were significantly longer in the combined femoral nerve block/spinal anesthesia group than in the LPB group. Duration of analgesia in the combined femoral nerve block/spinal anesthesia group was longer than that in the LPB group, but the difference was not significant (17 ± 7.3 vs. 16.5 ± 8.5 h, P = 0.873). There were no significant differences in hemodynamic parameters regarding the method of anesthesia in the 2 groups. CONCLUSIONS: This study confirms that the combination of femoral nerve block with spinal anesthesia is safe and comparable with LPB and can provide more effective anesthesia and longer lasting analgesia for intertrochanteric surgery.

Upper extremity surgery in younger children under ultrasound-guided supraclavicular brachial plexus block: a case series.

PURPOSE: Supraclavicular brachial plexus block is considered to be one of the most effective anesthetic procedures for upper extremity surgeries. Its major drawback is placement of the needle, with inaccurate placement, especially in children, being a risk factor for pneumothorax and vascular puncture and failure of the procedure. Ultrasound-guided needle placement may reduce the risk of complications and increase the accuracy of the block, particularly in pediatric patients. Little has been published on the efficacy and safety of ultrasound-guided supraclavicular block in children based on practical experience, and there has been no published report on its usage in younger children (<6 years old). METHODS: Seventeen patients between the ages of 6 months and 6 years were randomly selected to test the efficacy of ultrasound-guided supraclavicular block in younger children. The ultrasound probe was used for proper placement of the needle. After confirmation of the needle location using a nerve locator, the anesthetic agent was injected. The procedure time, establishment time, duration of analgesia, any complications related to the procedure, and surgeon's satisfaction were recorded and assessed. RESULTS: The length of the procedure was 10.35 ± 1.22 min, establishment time was 89.59 + 18 s, and the duration of the analgesia was between 6 and 16 h (mean 9.76 ± 2.57 h). The recovery time was 24.4 + 6.5 min (range 15-37 min), and the duration of surgeries was 61.3 ± 25.9 min (range 15-110 min). Not one procedure failed, and there was not one complication related to the procedure. The surgeon's satisfaction during surgery was good or excellent. CONCLUSIONS: The results of this study demonstrate the efficacy and safety of the ultrasound-guided supraclavicular brachial plexus block for orthopedic upper extremity surgeries in patients less than 6 years of age.

Effect of risedronate on bone resorption during consolidation phase of distraction osteogenesis: a rabbit model.

PURPOSE: To evaluate the effects of continuous local injection of risedronate in the prevention of bone resorption in a lengthened segment. METHODS: 11 male rabbits underwent subperiosteal osteotomy of the left tibia and an external fixator was applied anteromedially. After a lag phase of one week, a 2-week distraction phase and a 5-week consolidation phase followed. Risedronate was continuously injected into the centre of the distracted segment at a rate of 10 micro g/kg/day during the first 14 days of consolidation by a subcutaneously implanted osmotic pump. A control group received purified buffer solution (PBS) using the same protocol. The lengthened bone segments were evaluated using radiography, quantitative computed tomography, and 3-point bending mechanical test. RESULTS: Risedronate injection prevented osteopenia as compared to PBS injection. The mean bone mineral content, volumetric density and cross-sectional area of the lengthened segments were significantly higher in the risedronate group than in controls (as much as 65%, 30%, and 25%, respectively). There was no significant difference between the 2 groups regarding the ultimate load to failure. CONCLUSION: Continuous local injection of risedronate into the lengthened segment can prevent osteopenia during distraction osteogenesis but fails to enhance mechanical strength of newly distracted segments.

Upper extremity surgery in younger children under ultrasound-guided supraclavicular brachial plexus block: a case series.

PURPOSE: Supraclavicular brachial plexus block is considered as one of the most effective anesthetic methods for upper extremity surgeries. Its major drawback, especially in children, is the risk of pneumothorax, vascular puncture, and failure of the procedure due to inaccurate placement of the needle. Ultrasound-guided needle placement may reduce the risk of complications and increase the accuracy of block, particularly in pediatric patients. There are few published experiences about the efficacy and safety of ultrasound-guided supraclavicular block in children and to our knowledge, it seems that there is no published report about its usage in younger children (less than 6 years of age). METHODS: In order to consider the efficacy of ultrasound in younger children, 17 patients aged between 6 months and 6 years were randomly selected. The ultrasound probe was used for proper placement of the needle. After confirmation of the needle location using a nerve locator, the anesthetic agent was injected. The procedure time, establishment time, duration of analgesia, any complications related to the procedure, and the surgeon's satisfaction were recorded and analyzed. RESULTS: The procedure time was 10.35 ± 1.22 min, the establishment time was 89.59 ± 18 s, and the duration of analgesia was between 6 and 16 h (mean 9.76 ± 2.57 h). The recovery time was 24.4 ± 6.5 min (range 15-37 min) and the duration of surgeries was 61.3 ± 25.9 min (range 15-110 min). There was no failure of the procedure. Also, there were no complications related to the procedure and the surgeon's satisfaction during surgery was good or excellent. CONCLUSIONS: This study demonstrates the efficacy and safety of the ultrasound-guided supraclavicular brachial plexus block for orthopedic upper extremity surgeries in patients younger than 6 years of age.