Model for implementing evidence based health care system in iran.

BACKGROUND: Regarding the role and importance of paradigm of evidence based practice and its remarkable impact on the effectiveness and efficiency of clinical services and healthcare, development of an integrated system seems necessary in order to manage dispersed data and ensure using evidence in clinical decision making, thus the aim of this study was designing a model for implementing national system of evidence based health care in Iran. METHODOS: THIS PAPER IS A STUDY OF COMPARATIVE TYPE WHICH HAS BEEN WRITTEN IN THREE STAGES: investigation of structure and process of evidence based practice in selected countries, investigation and analysis of current status in Iran in this regard and recommendation of strategies which make model implementation feasible in the country. Such methods as review of literature, focus group discussion and Delphi technique were used for investigation. RESULTS: According to studies, insuring an evidence based practice culture in the country requires a system called National Evidence Based Health Care System which consists of three subsystems including national system of clinical knowledge management, national evidence-based practice system and integrated national network of clinical effectiveness. CONCLUSION: The ultimate goal of health care system in every country is maintaining and improving community health. Achievement of this goal depends on effectiveness of delivered services and consistency of the services with national and local priorities. In order to achieve clinical effectiveness, the best practice should be realized in the country, implementation of which requires a set of macro and micro strategies enabling facilitation, promotion or guaranteeing clinical knowledge application in the country.

Calorie and macronutrients intake in people with spinal cord injuries: an analysis by sex and injury-related variables.

OBJECTIVE: Current studies suggest that two of every three persons with spinal cord injury are at risk for the metabolic consequences of obesity. The objective of this study was to assess the dietary intakes in people with spinal cord injury based on sex- and injury-related variables. METHODS: In total 162 people with spinal cord injury participated in this cross-sectional study. Their dietary intakes were assessed by a semiquantitative food-frequency questionnaire. RESULTS: The percentages of total energy intake derived from macronutrients were 53% carbohydrate, 10% protein, and 37% fat for men and 52% carbohydrate, 11% protein, and 39% fat for women. There was excessive consumption of simple carbohydrates (102.17 ± 40.83). The participants with longer times since injury had lower cholesterol intakes (P = 0.02). The individuals with an incomplete injury consumed significantly more monounsaturated fatty acids (n = 114, 27.2 ± 12.01 g) than those with a complete injury (n = 48, 23.6 ± 8.08 g, P = 0.03). There was a significant positive correlation of age and time since injury with fiber intake (P < 0.05). CONCLUSION: The balance of macronutrients shifted toward intakes of fat and simple carbohydrates at the expense of complex carbohydrates, fiber, and protein in these participants. Mean amounts of polyunsaturated and monounsaturated fatty acids in these participants were above the recommended intakes. Older participants and those with a longer time since injury tended to have lower calorie, fat, carbohydrate, saturated fat, and cholesterol intakes and higher fiber intakes.