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Anterior shoulder dislocation is a common orthopedic emergency. While many reduction methods require sedation, the FARES (FAst, REliable, and Safe) and Spaso methods allow reduction without anesthesia. We conducted a single-center, prospective, randomized controlled trial comparing the FARES and Spaso methods for anterior shoulder dislocation reduction. Patients aged 20 to 90 years were enrolled. The assigned closed reduction procedures were performed without patient sedation by trained orthopedic residents. If two attempts with the assigned method failed, the alternative method was used. The primary outcome was the first-attempt success rate, while secondary outcomes included overall success rate with both methods, reduction time, and pain scores. During November 2013 and December 2015, a total of 32 patients were randomized to the FARES (n = 17) or Spaso (n = 15) method. The first-attempt success rates were 71.6% for the FARES group and 80.0% for the Spaso group ( p  = 0.691). Among patients with failed closed reduction using the first technique, all patients in the Spaso-following-FARES group achieved successful reduction, whereas none in the FARES-following-Spaso group achieved successful reduction ( p  = 0.092). Pain scores during reduction were comparable between the FARES (4.29 ± 1.69) and Spaso (3.80 ± 2.65) techniques, with no statistically significant difference ( p  = 0.542). Follow-up data were available for 28/32 patients (87.5%; mean 5.3 ± 2.2 years). Four patients were lost (3 FARES, 1 Spaso; p  = 0.726). Recurrent dislocation occurred in 3 patients (10.7%; 1 FARES, 2 Spaso; p  = 0.947), and 2 patients (1 per group; p  = 0.876) underwent surgery (arthroscopic stabilization and rotator cuff repair). Both the FARES and Spaso methods were effective for reducing anterior shoulder dislocations. Combining these methods may improve overall reduction rates. Clinical trial registration: This trial was registered at ClinicalTrials.gov (Registration number: NCT01979237) on 08/11/2013.

Objective—To introduce the Spaso technique for reducing anterior shoulder dislocation by reporting the success rate of the Spaso technique performed by junior emergency medicine residents. Design—Retrospective case series. Setting—Urban accident and emergency department. Participants—Patients with anterior shoulder dislocations. Interventions—The Spaso technique was applied by the emergency medicine residents to reduce anterior shoulder dislocation. Results—The emergency medicine residents applied the Spaso technique to reduce 16 cases of anterior dislocated shoulder during the study period. The Spaso technique was successful in 14 of 16 cases. The overall success rate was 87.5% (95% CI 60.4, 97.8%). No complications were noted. Conclusion—A new method has been introduced for reduction of anterior shoulder dislocation by reporting the experience of junior residents. The Spaso technique is simple, effective and able to be performed by single operator. Although the sample size was small, the result of the study could provide background information for planning a properly designed randomised controlled trial to evaluate the Spaso technique.

Subjective history of new-onset dislocation or recurrent dislocations combined with clinical assessment consistent with shoulder dislocation

Gerencia de venta, restaurante, eficiencia, rentabilidad Abstract: The present research was developed in Ecuador in the province of Manabí, specifically in the Briceño spa, and its purpose was to determine how the owners of Briceño restaurants handle sales management to manage efficiency in restaurants. The methodology used was the theoretical, scientific foundation, with quantitative and qualitative data and the Delphi method, in addition, the survey instrument was used to know the existing problems in the place taken as object of study, from which a sample of 10 restaurants with strategically formulated questions, in addition to it, an interview was applied to the president of the community Mr. Elías Zambrano, inhabitant of the Briceño spa, to know from his perspective the current situation of the community, from the data obtained they were interpreted by experts of Uleam for analysis. The results obtained show that the analyzed perspectives give a relevant panorama regarding the Sales Management, which shows that most of them comply with the parameters established in the research carried out, however, at the moment of having the support of internal collaborators They are trained to carry out their activities in the fulfillment of their objectives, 67% contribute to the achievement of this. Por lo tanto, una variable indispensable a trabajar por parte de la gerencia de un restaurante consistirá en analizar como brindarle mayor valor al cliente para que éste, frente a la fuerte oferta del mercado, siga eligiendo volver a nuestro negocio.