Adopting and adapting clinical practice guidelines for timing of decompressive surgery in acute spinal cord injury from a developed world context to a developing region.

PURPOSE: The proper application of high-quality clinical practice guidelines improves trauma patients' care and outcomes. This study aimed to adopt and adapt guidelines on the timing of decompressive surgery in acute spinal cord injury (SCI) in Iranian clinical settings. METHODS: This study followed a systematic search and review of the literature to enter them into the selection process. The source guidelines' clinical suggestions were converted into clinical scenarios for clinical questions on the timing of decompressive surgery. After summarizing the scenarios, we prepared an initial list of recommendations based on the status of the Iranian patients and the health system. The ultimate conclusion was reached with the help of a national interdisciplinary expert panel comprising 20 experts throughout the country. RESULTS: A total of 408 records were identified. After title and abstract screening, 401 records were excluded, and the full texts of the remaining seven records were reviewed. Based on our screening process, only one guideline included recommendations on the topic of interest. All of the recommendations were accepted by the expert panel with slight changes due to resource availability in Iran. The final two recommendations were the consideration of early surgery (≤24 h) as a treatment option in adult patients with traumatic central cord syndrome and in adult patients with acute SCI regardless of the level of injury. CONCLUSION: Considering early surgery for adult patients with acute traumatic SCI regardless of the level of injury was the final recommendation for Iran. Although most of the recommendations are adoptable in developing countries, issues with infrastructure and availability of resources are the limitations.

National Guidelines for Cognitive Assessment and Rehabilitation of Iranian Traumatic Brain Injury Patients.

BACKGROUND: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. METHODS: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients' conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). RESULTS: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. CONCLUSION: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system.

Intrauterine device survival in Iranian women: systematic review and meta-analysis.

INTRODUCTION: The intrauterine device (IUD) is one of the modern contraception methods that is reversible, safe, effective, and with long-term efficacy. The problem of using this method is early discontinuation. The survival of the IUD use has been reported differently in different studies. In this meta-analysis, we estimated average time of surviving in Iranian women. MATERIALS AND METHODS: We evaluated the incident of IUD removed in the Iranian women with a broad systematic review of the literature regarding MOOSES criteria. ISI, Scopus, Medline, WHO, Cochrane, Web of Science, Biological abstracts, Google Scholar and DARE and Iran Medex, SID, Magiran and IranDoc were searched. We defined inclusion and exclusion criteria for selection of articles. All chosen articles were appraised using Critical Appraisal Skills Programme checklist. Data were extracted regarding prepared sheets. We used a Cochrane Q-test with a significance <0.1 for checking of heterogeneity of results. We defined I (2) = 50-75% as a medium heterogeneity and I (2) >75% as high heterogeneity. We applied both fix and random effect model by comprehensive meta-analysis software. RESULTS: A total of 14 articles was included in the systematic review. These were obtained from screening 63 potentially relevant citations and reviewing 17 full-text study articles. One-year survival of IUD, for the random effects model was 78.4% (69.8-85.1%). Three-year survival for the random effects model was 69.4% (53.3-81.9%). Five years for the random effects model was 49.7% (36-63.4%). CONCLUSION: Above half of Iranian IUD users discontinued it within 5 years after insertion, it means half of IUD expected lifetime was used and make additional costs to the state and the consumer. To reduce these costs, it is recommended for Iranian women to use the IUD with 5-year survival, and they should be consulted before insertion.

The utilization rate of antenatal care after health sector reform implementation in rural areas of Islamic Republic of Iran.

BACKGROUND: Improving the utilization rate of antenatal care is a critical strategy for achieving the reproductive health goals in Iran. The aim of this study was to assess the utilization rate of antenatal care (ANC) by women after health sector reform (HSR) interventions in rural areas of Islamic Republic of Iran (IR Iran). MATERIALS AND METHODS: This is a retrospective cross-sectional study. The data were gathered by cluster sampling from 400 motherhood records of mothers whose last pregnancies had been terminated in the first 3 months of 2013. Data were collected from 21 rural health centers of Isfahan district during the year 2013. The utilization rate of ANC by mothers was assessed by the number of visits they had, the time of the first ANC visit, the occurrence of pregnancy- or delivery-related complications, and the number of postpartum visits. RESULTS: The mean time of the first ANC was 9 ± 5.23(th) week of gestational age. For 69.3% of pregnant women, the first ANC was before the 12(th) week. Overall, the frequency of ANC visits ranged from 2 to 21, with the average of 10.6 ± 3.23 visits. 93.8% of the utilized ANC visits were adequate. 99.8% of the deliveries took place in the hospital. 99% of mothers had at least one visit in the postpartum period. 4% of the mothers had suffered from pregnancy-related complications. CONCLUSION: It seems that IR Iran has achieved to one of the important objectives by its reform in health care access, that is, more ANC for pregnant women.