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Showing 10 results for Guideline
Pain Control In Cancer Patients By Opiate Use
Mohagheghi M A, Nahvi Jou A, Sedighi Z,
Volume 61, Issue 2 (5-2003)
Abstract
Opioids are increasingly being recognized as the primary treatment for cancer pain management. Optimal treatment of cancer pain involves assessing its characteristics, considering different management strategies, evaluating side effects and adverse drug reactions and establishing the most appropriate therapeutic regimen. This study was designed to review the current status of pain management for advanced cancer cases using opioid analgesics.
Materials and Methods: A questionnaire was used to collect data on demographics, disease characteristics, and opioids use indicators in 700 cases of advanced cancer patients.
Results: A total of 700 cancer cases, 42 percent females and 58 percent males, between 17-80 years age range (Mean age of 57.25) were studied retrospectively. Cancers of breast (21 percent), colorectal (12 percent), lung (7 percent), stomach (7 percent) and bone either primary or metastatic (6 percent ) in women and stomach (17 percent), lung (12 percent), colorectal (11 percent), prostate (9 percent ), and bone (8 percent ) in men were the most common causes of opioids prescription in study group respectively. Advanced primary cancer (in 52 percent), bone metastasis (in 32 percent), and treatment complications (in 7 percent ) were considered as physical basis for pain in patients. Morphine (by injection), Opium (by oral intake) and methadone (injection and/or oral) were the most common opioids prescribed. Using equianalgesic conversion chart, the daily dosages and therapeutics schedules of morphine administration were as follows:
43 percent received 21-30 mg. in 2-4 divided doses
27 percent received >30 mg. in 3-5 divided doses
21 percent received 11-20 mg. in 2-3 divided doses
9 percent received 5-10 mg. in 1-2 divided doses
Conclusion: Pain management of cancer patients is not adequate and opioid use is not rational. New educational and managerial strategies are needed to optimize cancer pain treatment in routine medical practice. To overcome current barriers, WHO stepwise model for cancer pain control and palliative care is recommended. Publishing Standard Treatment Guidelines for different levels of health care system is another recommended approach to optimize cancer pain.

 


Airway: Historical background, preoperative assessment and management of elective and emergency airway problems (review article)
Hosein Khan Z, Arbabi Sh, Ebrahim Soltani A,
Volume 65, Issue 1 (3-2008)
Abstract
Airway management is one of the most important subjects in medicine. This article reviews the history, assessment of airway prior to anesthesia, techniques and equip-ment of airway management and management of patients with anticipated and unan-ticipated difficult airways. This article covers recent literature on airway appliances and devices and their use in different circumstances. Airway assessment methods especially the recent Iranian method have been reviewed and discussed briefly in this article. On the whole the article covers the etiology of difficult airway and offers guidelines for safe practice of anesthesia in patients in whom airway is anticipated to be difficult.
Is lumbosacral MRI in complemetary health insured patients, requested based on scientific guidelines?
Mojtaba Sedaghat , Arash Rashidian , Seyed Davood Hosseini ,
Volume 71, Issue 6 (9-2013)
Abstract
Background: The request for lumbosacral MRI in Iran  based on previous studies is high (almost half of all MRI cases), so, our study is concerned with investigating the necessity of lumbosacral MRI request in patients with low back pain that is covered by  complementary health insurance in Tehran through comparing  MRI practice with valid guidelines.
Methods: Information of 274 complementary insured patients at Dana Insurance Company in Tehran, who had undergone low back MRI was studied. A portion of information in the questionnaire including age, sex, the physician’s field of specialty, and MRI report, was derived from the medical records. Other information based on guidelines indications, including duration of the prolonged back pain, record of associated infection, malignancy or trauma, saddle anesthesia, lower limb motor deficit and incontinence of urine or feces, was elicited from patients orally.
Results: Males represented 35% and females 65% of patients. Also, males were on average 10 years younger than females. Over 90% of MRI scans were requested by three fields of specialty (orthopedic, neurosurgery and neurology). Considering the indications of lumbar spine MRI request (prolonged back pain of more than one month duration, incontinence of urine or feces, lower limb motor deficit, saddle anesthesia, recent related trauma, infection and malignancy), approximately 20% of lumbar spine MRI scans were prescribed in accordance with guidelines.
Conclusion: Out of every five cases of lumbar spine MRI, four cases were not requested based on guidelines, suggesting needs for local guideline design and revising the manner in which MRI scans are prescribed for low back pain in complementary health insured patients in Tehran.

Prescription of ceftriaxone before and after implementation of physi-cian’s guidelines in a teaching hospital: a brief report
Mohammad Abbasinazari , Afshin Mohammad Alizadeh , Yusef Jamshidi,
Volume 72, Issue 3 (6-2014)
Abstract
Background: Judicious use of antibiotics is essential considering the growth of antimi-crobial resistance and escalating costs in health care. Ceftriaxone is a third-generation cephalosporin used widely for the treatment of various infections in outpatient and in-patient. The purpose of this study was to evaluate the ceftriaxone utilization before and after implementation of guidelines and physicians education. Methods: A descriptive cross-sectional, before-after intervention study was performed in 6 wards of a teaching hospital in Tehran, Iran. The study was conducted in three phases: pre-guideline, educational interventions and post guideline implementation. The pre intervention phase included chart analysis of current ceftriaxone use in 200 consecutive patients from the representative wards included in the study. The educational interventions included preparation and distribution of ceftriaxone guidelines as pamphlets among physicians working in the studied wards. Also the clinical pharmacist returned to each ward and trained physicians regarding the correct use of ceftriaxone. In the post intervention phase immediately after the instruction, and in the follow up phase, one month later, a prospective analysis of ceftriaxone utilization was performed by chart review of 200 patients to detect changes in ceftriaxone utilization pattern. Results: Four hundred cases were evaluated during study (200 before and 200 after physician’s education). The correct indication of ceftriaxone was 93% and 96% before and after the educational interventions respectively. Analysis showed that correct indi-cation of ceftriaxone did not change significantly before and after education (P= 0.188). Regarding to proper administration (dose, interval and duration) ceftriaxone utilization significantly changed after education (P< 0.001). Conclusion: Adoption of the guidelines with associated training resulted in significant improvement in ceftriaxone administration pattern in the hospitals.
The burden of statin therapy in urban population of Iran based on new ACC/AHA guideline
Samaneh Asgari , Davood Khalili , Fereidoun Azizi , Fatemeh Eskandari , Narges Sarbazi , Farzad Hadaegh ,
Volume 72, Issue 12 (3-2015)
Abstract
Background: In Nov 2013, the instruction for controlling high cholesterol has been released by the American College of Cardiology (ACC) and the American Heart Association (AHA) which need to be assessed in the different communities. Methods: Of total 6275 individual aged 40-75 years who entered at the Tehran Lipids and Glucose Study from March 1999 to 20 March 2010 in first examination cycle, 5153 with the median follow-up of more than ten years were eligible to enter in this study. The 10-year risk of hard cardiovascular disease (Hard CVD) for Statin therapy based on ACC/AHA clinical guideline was calculated and this risk was calculated for each subgroup of the guideline who recommended for statin therapy comparing to the risk in individuals with prevalent CVD. Results: Of nearly 6.5 million urban population of Iran (according to the 1996 census) about 4 million individuals (2.55 million men and 1.4 million women) were eligible for statin therapy. With respect to the urban population growth from the 1996 to the 2011 census (about 2.5 percent increases) the number of individuals for receiving statin increased by 50% (5 million men and 3 million women). Also, the risk in non-diabetic men with calculated risk of 5-7.5% and diabetic women with calculated risk of <5% for hard CVD was lower than 0.2. By removing these people from total eligible population, the burden of statin therapy will reduced about 8% which is about 540.752 persons, according to the Census 1996 and 1.155.079 individuals based on the census 2011. Conclusion: The new guideline of ACC/AHA for statin therapy is relatively reasonable except for some subgroups. To reduce the burden of medical expenses, statin prescription can be ignored by physicians in these subgroups. Of course further research is required to calculate the net benefit for estimating the clinical usefulness of statin therapy in recommended guideline subgroups.
Clinical guideline for prevention and control of alcohol consumption
Farzad Tajdini, Reza Shekarriz-Foumani , Parinaz Rezapour , Kambiz Abachizade, Maryam Mohseni ,
Volume 76, Issue 12 (3-2019)
Abstract
Background: Using alcohol is one of the most important death factors that can be prevented. Lifestyle-related diseases are at the top cause of mortality and burden of disease, whereas most of them can be prevented. Considering the growing importance of diseases related to lifestyle (including alcohol abuse), providing evidence-based clinical guidelines for diseases and life-style related conditions which are in accordance with the newest scientific findings and with cultural and economic conditions in each country are required. The aim of this study was to develop a clinical guideline for prevention and control of alcohol consumption.
Methods: The type of study is initiation of a method or a scientific/administrative system (health system management studies) that uses the National Pattern of Localization of Clinical Guidelines in 2017 in Taleghani Hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran, by using the reviewed clinical guidelines, which was conducted by the end of 2017 based on organizational criteria, the availability of the full version of the clinical guideline and its up-to-datedness, and the appraisal of guidelines for research and evaluation (AGREE) scoring system. This clinical guideline was developed based on 5A Model (Assess, Advise, Agree, Assist and Arrange).
Results: In order to prevent and control alcohol abuse, a clinical guideline was developed based on five clinical guidelines including United States Preventive Services Task Force (USPSTF), Healthy lifestyle guideline (ICSI), the guidelines for preventive activities in general practice in Australia (RACGP), The Australian population health guide to risky behavioural risk factors in general practice (SNAP), and the guidelines related to lifestyle and wellbeing by the National Institute of Clinical Excellence of England (NICE) in the form of 5A model.
Conclusion: The best practice is according to the existing clinical guidelines for prevention and control of alcohol use screening, brief intervention (1-2 sessions) and behavioral counseling, treatment with cognitive behavioral interventions (2-6 sessions) and, if necessary, referrals to higher treatment centers. Referral is recommended for patients who have signs of substance dependence and need a level of care beyond brief service.

Clinical guideline of neurosurgical practice during the COVID-19 pandemic
Zohreh Habibi, Seyed Morsal Mosallami Aghili , Seyed Amir Hossein Javadi , Arash Seifi, Kourosh Karimi Yarandi, Seyed Ali Dehghan Manshadi , Fereshteh Naderi Behdani ,
Volume 79, Issue 2 (5-2021)
Abstract
Background: Neurosurgery practice conflicts with many challenges during the COVID-19 pandemic; Including the lack of beds in intensive care units, as well as the use of some methods such as drills and trans-nasal and trans-oral approaches that produce aerosols or are directly in contact with patient discharge. Due to these challenges, developing a clinical guideline to help neurosurgeons and medical staff in decision making and improving patients and medical staff safety during the COVID-19 pandemic is the purpose of this study.
Methods: First, all of the relevant clinical guidelines to neurosurgical practice during the COVID-19 pandemic were extracted from the data centers. Finally, five clinical guidelines were selected. The questions and the items were designed according to these guidelines. The answers to each of the questions were extracted from these guidelines. The complementary evidence was extracted by searching in the data centers again. Finally, the answers were edited and the edited answers were considered as the recommendations. These recommendations were sent to 4 experts in the Neurosurgery field and 2 experts in the infectious diseases field. The appraisers evaluated the recommendations according to the AGREE-REX instrument.  This instrument has 9 items and 3 domains including clinical applicability, values and preferences, and implement ability. Recommendations with above 80% agreement were considered as the final recommendations.
Results: The final recommendations were presented as “Clinical guideline of neurosurgical practice during the COVID-19 pandemic” in the results section.
Conclusion: This clinical guideline was developed by using similar guidelines and available evidence. Proper usage of personal protective equipment, reduction of unnecessary contacts between medical staff and patients, use of Telemedicine for follow-up, proper air conditioning, screening patients for COVID-19, reduction of elective surgery, use of less invasive methods, management of aerosol production and reduction of trans-oral and trans-nasal approaches are the most important recommendations of this clinical guideline.

Diagnosis and treatment of diabetic foot infections: adopted IWGDF guidline
Mohammad Reza Amini , Mohammad Reza Mohajeri-Tehrani, Neda Mehrdad, Mahnaz Sanjari, Maryam Aalaa, Neda Alijani,
Volume 79, Issue 2 (5-2021)
Abstract
Background: Diabetic foot infection is the most common complication of diabetic foot ulcer (DFU) leading to amputation. The treatment requires special attention to disease conditions, proper diagnosis, appropriate sampling for cultures, careful selection of antibiotics, rapid determination of the patient’s need for surgical intervention, and wound care. Clearly a systematic approach or, if possible, an evidence-based approach by using clinical guidelines about diabetic foot infections will lead to better outcomes. In this regard, this article aims to adopt the IWGDF clinical practice guideline on DFU infection.
Methods: In this study, the adoption of the international evidence-based clinical guidelines on the DFU infection was carried out using the ADAPTE methodology, which involved three stages of setup, adoption, and finalization. AGREE II tool was used to evaluate the quality of the selected clinical guideline.
Results: The results of this adopted clinical guideline according to the national facilities and access to equipment are described with 26 recommendations along with related reasons for the diagnosis and treatment of diabetic foot ulcer infections. The recommendation categorized into six different categories including Classification/ Diagnosis, Osteomyelitis, Assessing severity, Microbiological considerations, Surgical treatment, Antimicrobial therapy.
Conclusion: The mentioned recommendations in the diagnosis and treatment of diabetic foot ulcer infections extracted based on the methodology of systematic review studies. Actually the opinion of experts have been prepared and adjusted according to the limitations, equipment and facilities in the country. But in general, there are some challenges in diabetic foot infections should be considered as well. So monitoring the treatment of infection, optimal duration of antibiotic treatment, optimal treatment of infection in low-income countries, time and type of imaging studies, selection of medical or surgical treatments and hospitalization conditions are some of these challenges. However the definition and practical clinical application for the concept of bacterial bioburden of the wound for wound healing, evaluating the cost-effectiveness of new technologies in improving treatment and appropriate interpretation of microbiological (genotypic) microbiological tests are important too.

Development of clinical guideline for early detection of critical congenital heart diseases at birth by pulse oximetry
Alireza Ahmadi , Mohammad Reza Sabri , Zohreh Sadat Navabi, Mehdi Ghaderian , Bahar Dehghan,
Volume 80, Issue 5 (8-2022)
Abstract
Background: 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).
Methods: 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.
Results: 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.
Conclusion: 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.

Evaluating the guidelines adherence in the management of NSTE-ACS referred to shahid chamran hospital within six-month period in 2021: a brief report
Mohammad Mahdi Gholamian , Mehrnoush Dianatkhah, Mohammad Kermani-Alghoraishi, Ehsan Shirvani,
Volume 81, Issue 8 (11-2023)
Abstract
Background: 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.
Methods: 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.
Results: 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).
Conclusion: 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.

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