جستجوی مقالات مرتبط با کلیدواژه « guideline » در نشریات گروه « پزشکی »

The purpose of this study was to evaluate the adherence to the ESC 2020 guideline for the management of NSTE-ACS patients admitted to Shahid Chamran Cardiology Hospital affiliated to Isfahan University of Medical Sciences in 2021.

In this retrospective study which was done during April 2021 to September 2021 we reviewed the hospital documents of 239 NSTE-ACS patients, in regard to prescribed medication during the admission period in Shahid Chamran Heart Center. Guideline-adherence was evaluated according to ESC2020 guideline. Totally 18 items were evaluated including Antiplatelet (Clopidogrel, Ticagrelor, and Prasugrel) Anticoagulant (Heparin or Enoxaparin), PPI, Statin, Beta blocker, and RAAS blockers (including ACEI/ARB or MRA). In each section the selected drug and the administered dose were compared with the guideline and the guideline adherence for each part was expressed as percent.

Almost complete guideline adherence was described for 12 out of 18 reviewed items (77%). However, guideline adherence in relation to the type of medicine chosen as an antiplatelet was reported to be very low, and only 1.2% of the cases received ticagrelor or prasugrel which are the guideline recommended antiplatelet agent. Additionally, most of the administered GP2b3a antagonist agents such as eptifibatide were not in accordance with the guideline (Guideline adherence 39.74%). Also, the choice of the anticoagulant agent was among the items with low guideline adherence (29.76%) and the cross-over between anticoagulants (changing heparin to enoxaparin or vice versa) which has been inhibited by the guideline was seen with high incidence in this center (78 cases).

The present study showed relatively high guideline adherence in the most aspects of medical management. However, compliance was reported to be low in relation to the antiplatelet selection, the choice of the anticoagulant agent, and the indication for GP2b3a antagonist use, which maybe due to the higher cost of recommended agents, and shortage of some medications and dosage forms in Iran.

At the outset of a new pandemic, when evidence related to predictors of disease is limited or ineffective, prioritization of hospitalization criteria can have a pivotal role in optimization of health-treatment services. This study was performed with the aim of reviewing the hospitalization criteria of symptomatic Covid-19 patients admitted to Ghaem Hospital of Asadabad city and comparing them with national therapeutic-diagnostic guidelines of Covid-19 in 2019-2021.

This analytical cross-sectional study involved all symptomatic Covid-19 patients (n = 2286) hospitalized from the beginning of the pandemic until the end of the fifth surge of the disease (from March 2020 to August 2021). The tool used in this study was the checklist for gathering demographic and clinical information of Covid-19 patients. Statistical analysis was performed using the chi-square test.

Our results showed that 47.9% of the patients had moderate symptoms and 49.1% of the patients had severe symptoms, and according to the guidelines, they had at least 3 symptoms.

The above-mentioned results indicate the good conformity of the hospitalization criteria of suspected Covid-19 patients admitted to the hospital with the national diagnostic-therapeutic guideline issued by the Ministry of Health and Medical Education (11th edition).

The prevalence of overweight, obesity and related complications is increasing rapidly in the world. Also, treating this disease in the presence or absence of co-morbidities has become a challenge. In this article, based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, a comprehensive clinical guide has been written for the stages of treating obese patients and its individualization, and it has been tried to be adjusted as much as possible based on the conditions in Iran.

with a specific search strategy, a complete search was performed in PubMed, Scopus, ISI Web of Science, EMBASE and Google Scholar Cochrane databases. Then, the best clinical guidelines suitable for the Iranian society were selected and using the opinions of specialists and clinical experts, a clinical guideline was prepared for the treatment of obesity in Iranian adults.

In this article, in continuation of the previous article, we answered the questions number 4 to 6 regarding the stages of obesity treatment and its individualization in adults of Iranian society, and presented a total of 60 recommendations in this regard.

In this part of the clinical guide for obesity in Iranian adults, we tried to have a special view on the treatment of these patients and by providing evidence-based recommendations and statements, the treatment process was personalized as much as possible for patients with special conditions so that decision-making in this regard is facilitated for the relevant colleagues in this field.

One of the basic principles in the safety of drug therapy for patients is the correct registration and labeling of anesthetic drugs, which can lead to the reduction of drug errors, the increase of drug and patient safety, the reduction of drug consumption and the environment, and the optimization of hospital costs.

This descriptive-analytical and cross-sectional research was conducted in February 2022 in the operating rooms of Iran University of Medical Sciences hospitals. The participants included 177 Anesthesia experts working in the hospitals’ operating rooms, who were included in the study by census method. The data was collected using the checklist for evaluating anesthetic drug registration and labeling guidelines and analyzed using SPSS software and one-way ANOVA, Fisher, and Pearson correlation coefficient statistical tests. The significance level was considered P value < 0.05.

The average compliance with the guidelines for registration and labeling of anesthetic drugs in all hospitals was 3.559 out of the total score of 16. The average adherence to guidelines in 8 hospitals was significantly different from each other (P < 0.001). Hazrat Ali Asghar Hospital had the highest compliance rate, averaging 10.333 out of 16. Firouzgar and Shahid Akbarabadi hospitals were in the next rank, averaging 10.11 and 6.65, respectively. There was a negative and significant correlation between the level of compliance with the guidelines and the average work experience and age of the experts (P=0/17); However, gender did not significantly correlate with the degree of adherence to the guidelines(P=0/596).

According to the obtained results, compliance with the guidelines for registration and labeling of anesthetic drugs in most hospitals was assessed as weak and at an unfavorable level. Considering the importance of this issue in reducing medication errors and increasing patient safety, it is necessary to use empowerment and retraining courses for Anesthesia experts according to the latest guidelines.

Rapid Assessment and Response (RAR) is an approach that has been used in health research since the 1990s, and several guidelines have been designed for it. This study examines and compares different guidelines in this field.

This review study was conducted on the 6 guidelines published in PubMed and Scopus databases. After the initial review, the main dimensions of these guidelines, including the definition and target group, methods used, steps to conduct the research, and time planning were extracted in the form of a comparative table.

In six guidelines, the RAR approach has been defined in relation to the comprehensive and rapid investigation of a health-related problem. There are differences in terms of the number of 'steps' of rapid assessment and response, as well as in 'time planning'; a period of 12 to 16 weeks is considered. Among the methods used in the reviewed guides, the following can be mentioned: reviewing available information, conducting interviews (open, structured, and semi-structured), focused group discussions, and other methods such as observation, surveys, narrative methods, and mapping.

The rapid assessment and response (RAR) can be used as an approach, with high flexibility and consideration of scientific and practical aspects, to assess health problems and high-risk behaviors in hard-to-reach groups.

Hospitalization is a vulnerable period for the elderly. During this period, they are at risk of falling. There are various clinical guidelines for fall prevention, whose usefulness depends on their quality and clinical acceptance. This study was to evaluate the methodological quality of selected clinical guidelines for fall prevention in hospitalized elderly people in Iran using the Appraisal of Guidelines, Research, and Evaluation (AGREE) checklist. 

A systematic search was conducted for clinical guidelines published from 2009 to 2020 using the keywords clinical guideline, falling, prevention, aged, and hospitalization. Of 351 clinical guidelines identified, 4 guidelines were selected based on the inclusion and exclusion criteria and by a purposive sampling method. The quality of the selected guidelines was evaluated by 5 experts independently using the AGREE II checklist. Based on the quality scores, the guidelines were categorized as “highly recommended” or “recommended with modifications”. 

The "Falls Assessment and Prevention of Falls in Older People", "Preventing Falls and Harm From Falls in Older People", and "Preventing Falls and Reducing Injury from Falls" were categorized as highly recommended, while the "Post Fall Multidisciplinary Management Guidelines for Western Australian Health Care Settings" was categorized as “recommended with modifications”. Therefore, they can be localized and used to reduce the risk of falls in hospitalized elderly people in Iran. The mean overall scores of 6 domains for the guidelines were as follows: 91. 1% for “clarity of presentation”, 86. 6% for “scope and purpose”, 83. 6% for “stakeholder involvement” 72. 08% for “editorial independence”, 71. 14% for “rigor of development”, and 66. 66% for “applicability”. 

Evaluation of the methodological quality of clinical guidelines using the AGREE tool should be done to be able to be used in clinical practice. It is recommended to use these tools in updating the current or future clinical guidelines to ensure their methodological quality.

Considering the increasing and alarming trend of overweight and obesity as well as its related complications, in this study, a comprehensive clinical guide for the medical care of patients with obesity was written based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, and it has been adjusted as much as possible based on the conditions in Iran.

A complete search was performed in the available databases without any restrictions with a specific strategy. Using the opinions of experts in this field, the best clinical guidelines were selected and obesity clinical guidelines were written for Iranian adults. Recommendations were given based on a detailed review of available clinical evidence and considering objective factors.

A total of 1788 references were used and in response to 9 clinical questions, 123 recommendations, including 160 special statements, were provided to determine a comprehensive medical care program for obesity. In this article, we discuss the prevention, screening, diagnosis, benefits and goals of obesity treatment. Questions 6 to 9 regarding obesity treatment steps and its individualization will be published in the next part of the article.

The detailed evidence-based questions and recommendations outlined in this study identify clinical considerations that facilitate decision-making in obese patients from screening and diagnosis to goals of treatment.

Nowadays, improving the quality of nursing care by providing a clinical solution in the care of clients with urinary catheterization is significant. In this regard, the present study aimed to design an adaptation the guideline of nursing care after catheterization.

The present study was performed using the clinical guideline adaptation model method in 2021-2022. Based on a literature review, 7 clinical guidelines evaluated with the AGREE instrument were used as baseline guidelines. The nursing practices extracted from these guidelines were evaluated according to the RAND / UCLA Appropriateness Method (RAM) by members of the panel of experts (15 persons) and finally, after making the necessary corrections, the final draft was prepared by AGREE instrument by faculty members. Re-examined.

Findings of the study include 225 recommendations in the field of nursing care after catheterization in the form of 17 sections, as follows: (urinary catheter, urinary bag, catheter removal, when the client is unable to tolerate the catheter, obstruction of the catheter, leakage of urine around the catheter, bladder washing, urine sampling, decreased urine flow, urinary tract infection, skin integrity disorder, bleeding, erectile dysfunction, autonomic dysreflexia, bladder or urethral spasm with general pain and discomfort, purple bladder syndrome, and dysuria after catheterization).

It is hoped that nurses can use the recommendations of this guide to improve their level of awareness and knowledge in the field of care for patients with urinary catheterization and make an informed decision.

Venous thromboembolism is one of the leading causes of death in patients during pregnancy and postpartum. Clinical audit is one of several programs to improve the quality of health services. This study aims to determine the effect of the clinical audit process on the implementation of postpartum venous thromboembolism prevention guidelines.

The present work was a quasi-experimental study before and after using the clinical audit method. A total of second- and third-year obstetrics and gynecology residents in hospitals affiliated with Jundishapur Ahvaz University of Medical Sciences in 2020 were enrolled in the study by the counting method. The intervention was performed in the form of five stages of clinical audit. The ways to complete and implement intravenous thromboembolism prevention guidelines by residents were evaluated using a researcher-made checklist by reviewing the records of 148 patients admitted to the postpartum ward. The collected data were analyzed using the McNemar test and paired t-test.

The mean total score of residents' performance in completing the form and implementing the guidelines before the intervention was 2.67±1.4, while after the intervention was 6.11± 1.36, showing a statistically significant difference (p<0.001). Therefore, a statistically significant difference was observed between the scores before and after the intervention in how to complete the form and implement the guidelines.

The results of this study indicated the positive effect of the clinical audit process on the performance of residents in completing the form and implementing the guidelines for the prevention of venous thromboembolism; thus, it seems that the implementation of this process can help improve the level of service to residents and nurses.

Acute bronchiolitis is the most common cause of lower respiratory tract infection and hospitalization due to respiratory disease during infancy. The disease is mainly diagnosed based on history and clinical examination, with paraclinical investigation being of little value in the diagnosis. The present study aimed to determine the role of paraclinical tests in the management and treatment of children with acute bronchiolitis.

In this retrospective cross-sectional study, the medical records of infants aged 1-24 months admitted to Bahrami Children’s Hospital with initial diagnosis of bronchiolitis were reviewed. Demographic, clinical and laboratory data as well as data related to disease management were reported and the relationship between tests’ results and treatment, prognosis and length of hospital stay was analyzed by statistical methods.

The records of 193 patients (55.4% male, mean age 3.88 ± 5.17 months) were reviewed. Complete Blood cells (CBC), C-reactive protein (CRP) and serum electrolytes (sodium and potassium) were measured in more than 90% of patients, blood culture and urine culture were performed in 50% and blood gas analysis in 65%. Serum electrolytes were in the normal range in all infants. Blood culture was negative in all patients. Active urine analysis was reported in 2.1% which revealed negative results on urine culture. One-third of patients received at least one type of antibiotic and 92.7% received ventolin. The majority (93.3%) of patients were discharged with a final diagnosis of bronchiolitis and the mean length of hospital stay was 2.6 days. There was no statistically significant relationship between laboratory results and PICU admission and length of hospital stay.

The findings of this study showed that laboratory tests and treatments incompatible with pediatric guidelines are widely used in bronchiolitis and do not play a decisive role in the prognosis and management of the disease

Congenital heart defects (CHD) are the most common type of birth defects. The main screening tests used to identify babies with congenital heart defects include prenatal echocardiography and postnatal clinical assessment. Routine pulse oximetry has been reported as an additional screening test that can potentially improve the early diagnosis of critical congenital heart disease (CCHD).

This study is a multi-stage evolutionary study that was conducted for 12 months from March 2021 to March 2022 at Pediatric Cardiovascular Research Center in Cardiovascular Institute, Isfahan, Iran. In the first phase, after identifying the topic and aims of the present study, questions were designed through the PICO method including (population, intervention, control, and outcomes). Then conducting systematic searches, the quality of all existing clinical guidelines (CG) of this field were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument and a committee consisting of pediatric cardiologists and neonatologists in the field. Next, based on the opinions of experts, the quality of 1 out of 6 clinical guidelines for early detection of critical congenital heart disease at birth by pulse oximetry was assessed as optimal. Finally, the clinical guidelines draft was evaluated using the Delphi method and the panel of experts. After expert panel meetings and consensus between members, the final version of the guideline for early detection of critical congenital heart diseases at birth by pulse oximetry was developed.

In the present study, criteria of clinical practice regarding the stages of newborn screening by pulse oximetry at birth were determined based on the evidence and health conditions and were presented in twenty-eight recommendations and six sections. The final recommendations were presented in the results section.

The finding of the present study showed that physicians, nurses, and midwives can apply the recommendations of this clinical guideline for the early detection and referral of neonates with critical congenital heart disease.