Tehran University Medical Journal

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.

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.