Sustaining the National Spinal Cord Injury Registry of Iran (NSCIR-IR) in a Regional Center: Challenges and Solutions

Background: The National Traumatic Spinal Cord Injury Registry in Iran (NSCIR-IR), was implemented initially in three hospitals as a pilot phase from 11 Oct 2015 to 19 Jun 2016 and has been active in eight centers from 19 Jun 2016. Poursina Hospital, a trauma care referral center in Rasht, Guilan Province of Iran is one of the registry sites, and has been involved in registering eligible patients since 1 Jan 2016. This study aimed to identify the challenges and solutions for sustaining the NSCIR-IR in a regional center. Methods: This was a mixed-methods study. For the quantitative analysis, a retrospective observational design was used to measure case capture or case identification rate, mapping cases in the registry against those eligible for registry inclusion amongst the register of hospital admissions. For the qualitative component, data was collected using focus group discussions and semi-structured interviews, followed by thematic analysis. Results: From 19 Jun 2016 to 24 Jan 2018, the proportion of case capture (case identification rate) was 17%. The median time between case identification and data entry to the system was 30.5 d (range: 2 to 193 d). Thematic analysis identified a lack of trained human resources as the most important cause of low case identification rate and delay in data completion. Conclusion: Recruitment and education to increase trained human resources are needed to improve case capture, the timeliness of data input and registry sustainability in a regional participating site

The association between the outcomes of trauma, education and some socio-economic indicators

Background: There are many debates on socioeconomic indicators influencing trauma outcomes.Objectives: This study aimed to determine the association between education as a socioeconomic indicator and trauma outcomes.Methods: This descriptive-analytical study was conducted on 30,448 trauma patients during 2016-2021. The data were based on the minimum dataset of the National Trauma Registry of Iran (NTRI) from six different trauma centers in various cities of the country. The variables used in this study included age, education level, marital status, cause of injury, Glasgow Coma Scale (GCS), intensive care unit (ICU) admission, Injury Severity Score (ISS), and in-hospital mortality. Logistic regression was used to investigate the association between independent variables and trauma outcomes.Results: The study included 30,448 trauma patients with male predominance (75.8%). The mean age was 36.9 years. The most frequent education level was secondary education, with 14,228 (46.6%). Education levels had significant relationships with ISS, death, and ICU admission (P<0.001). Moreover, after applying the multiple logistic regression, the odds of deaths for trauma patients with no formal, primary, and secondary education levels were 3.36, 5.03, and 3.65 times, respectively, more than the odds of deaths at the higher education level after controlling for other factors (all Ps<0.05). However, there were no such relationships between education levels and the odds of ICU admission.Conclusion: Findings of the present study showed a significant association between the education levels and trauma outcomes. Adjusted for other covariates, the chance of death for trauma patients with no formal, primary, or secondary education levels was higher than that at the higher education level

The Study of job conflicts among females organization stuff(The case of selected educational formations in Hamedan)

Introduction In modern society's organizations is one the mean development tools. Human resources are basic to access on high function in bureaucracy systems. Nowadays, women's participation in social activities as part of their social rights, but cultural and social barriers there are many in this way. Many researchers believe that stuff is one of the main sources of manpower and stimulating development. So if the use of human resources opportunities, has developed one of the parameters necessary for the realization of this important provision of equitable participation of all segments of society, including women. Social participation of women in various fields in Iran has been increasing over recent decades. One of the most important areas of economic and social transformation, presence and participation of women in organizations and government organizations but at The same with this increasing we are seeing some limitations and conflicts for women as job and role conflict's. Then Iranian society generally and on a smaller scale in the province, while the phenomenon of female participation is considered an opportunity for women. On the one hand, traditional community structures (Hamadan) in the social participation of women  of women alongside men in the public are  looks with suspicion and even  sometimes do resistance act against it. On the other hand there are many challenges within organizations. If we accept that socio-cultural structure of cities such as Hamadan  have  a high potential of  against the new changes, still somewhat cautious, it is natural that the corporate culture of the environment in terms of  Hofstede and Edgar Schein are affected. For example, high and middle level managerial positions in organizations typically "male-dominated" are defined. Product of the interaction of social, emotional or sexual discrimination experienced by women within the organization. One of the components of organizational culture view of the status of women in the administrative structure.     Martials and methods Here we used survey as research method by using a questionnaire was developed by researchers. total number of the female stuff as population who worked in governmental administrative in Hamadan, were about 4,500 people .base on Morgan statistics sampling, sample size selected 350 women those who working in the three selected organizations (Bu-Ali Sina University , Department of education and the University of Hamedan medical Sciences) then to find questionnaire validate and reliability researchers done a pretests among 30 responds. After analyzing of pretest data's  Cronbach's alpha for the whole questionnaire  obtain / 72 respectively.   Discussion of results and conclusions: based on Iranian culture and expectations from women as mother and wife the those females that decided to option employment accrue with many challenges in organization and at the same time in their families. The findings showed that there is a significant difference between conflict of job and family problems among different socio-economic situation peoples. Women in high cultural capital households  faced low difficulties in compare with low conditions. As well as gender stereotypes, cultural capital, having children, marital status, social support and family problems with the conflict there is a significant relationship. people in the family after the conflict goes without saying that one of the important factors that affect the family. Individual factors - such as multiple family roles and the stress of having a child, unfavorable physical characteristics, low achievement motivation, fear of failure, adverse parental occupation and education status of job conflicts affect women. significantly indicates the importance of family problems job working women in conflict.  All this is due to gender patterns .base on  social learning and cognitive  theory both observational learning as one of the most important factors of gender patterns are emphasized. According to this theory, children appropriate behavior in situations mimic the same sex. Different characteristics in each community based on the gender of the people expected them to be, the product of sexual socialization process that is based on it ((the men for masculinity and femininity of women)) in accordance with the definitions contained in any social community are. There is no doubt that children and adults about the stance defined by culture where women and men share what it means. Gender stereotypes in the broader culture and in social interactions are mastered and the beginning of life, children are bombarded with gender stereotypes

Animal-related injuries in hospitalized patients

Introduction: Injury from animal attacks is an important public health problem with high morbidity and mortality. As we cannot neglect or underestimate these hazardous conditions, we aimed to assess animal-related injuries in Iranian patients and compare the results.Methods: In this cross-sectional study conducted on data from the National Trauma Registry of Iran, trauma patients admitted to the hospital due to animal attacks from January 15, 2018, to November 1, 2021, were assessed. A checklist gathered data consisting of baseline characteristics such as sex, age, activity, place at the time of the attack, and injury site. In addition, we extracted the clinical features of these patients, including injury severity score, Glasgow coma scale, intensive care unit (ICU) admission, hospital length of stay, surgery, and discharge status.Results: One hundred thirty-one patients were registered in the study. Most of the patients were male (80.9%), aged 16 to 44 years (59.5%), and encountered animal attacks when they were in agricultural areas (45%). Ninety-six patients (73.3%) underwent surgery, and three were hospitalized in ICUs. We recorded 172 injuries, consisting of 92 (53.5%) injuries in the upper extremities as the most common region of the body. The males were aged 16-44 years (66%), and the females were aged 45-65 (52%) (P=0.005). Fifty percent of males and 24% of females were injured in the agricultural areas. Moreover, 24% of females and 6.6% of males were injured at home.Conclusion: This study showed a high incidence animal attacks in Iran. Most injuries were in middle aged males and in the agricultural area

Epidemiology of Fatal Injuries among Patients Admitted at Sina Hospital, the National Trauma Registry of Iran, 2016-2019

Introduction: Injuries cause high rates of mortality and harm to millions of people annually.&nbsp;Objective: The aims of this study were to assess some characteristics of hospitalized trauma patients and determine the variables which were associated with increased rates of mortality.&nbsp;Methods: Data were extracted from the National Trauma Registry of Iran (NTRI) data bank. Among all trauma patients admitted to Sina Hospital, those who had one of the following were registered in the NTRI: hospitalization for more than 24 hours, death less than 24 hours in the hospital, and transferring from the intensive care unit (ICU) of another hospital. Recorded data relating to the interval between 24 July 2016 and 10 October 2019 were analyzed.&nbsp;Results: A total number of 3430 patients were studied, of whom 78 (0.02%) did not survive. The mean age of survivors was 38.4 (±18.5) and it was 58.1 (±23.7) for non-survivors (p&lt;0.001). The mean Glasgow coma scale (GCS) of survivors was 14.9 (±0.7) and it was 11.7 (±4.4) for non-survivors (p&lt;0.001). The most important predictors of death were ICU admission (OR 4.31; 95% CI 1.65-11.26) and not having surgical operation (OR 6.08; 95% CI 2.30-16.03). The injuries with higher injury severity score (ISS) had higher risks of death (OR 1.20; 95% CI 1.06-1.36).&nbsp;Conclusions: In this study, Road Traffic Crashes (RTCs) were the main cause of injuries. The elder age, lower GCS score, ICU admission, higher ISS and not having surgical operation were the worst factors of death. More studies are needed to reveal other prognostic factors of fatal injuries

The data set development for the National Spinal Cord Injury Registry of Iran (NSCIR-IR): progress toward improving the quality of care.

Study designDescriptive study.ObjectivesThe aim of this manuscript is to describe the development process of the data set for the National Spinal Cord Injury Registry of Iran (NSCIR-IR).SettingSCI community in Iran.MethodsThe NSCIR-IR data set was developed in 8 months, from March 2015 to October 2015. An expert panel of 14 members was formed. After a review of data sets of similar registries in developed countries, the selection and modification of the basic framework were performed over 16 meetings, based on the objectives and feasibility of the registry.ResultsThe final version of the data set was composed of 376 data elements including sociodemographic, hospital admission, injury incidence, prehospital procedures, emergency department visit, medical history, vertebral injury, spinal cord injury details, interventions, complications, and discharge data. It also includes 163 components of the International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) and 65 data elements related to quality of life, pressure ulcers, pain, and spasticity.ConclusionThe NSCIR-IR data set was developed in order to meet the quality improvement objectives of the registry. The process was centered around choosing the data elements assessing care provided to individuals in the acute and chronic phases of SCI in hospital settings. The International Spinal Cord Injury Data Set was selected as a basic framework, helped by comparison with data from other countries. Expert panel modifications facilitated the implementation of the registry process with the current clinical workflow in hospitals

Feasibility and Data Quality of the National Spinal Cord Injury Registry of Iran (NSCIR-IR): A Pilot Study.

BACKGROUND: Spinal cord injury (SCI) is one of the most disabling consequences of trauma with unparalleled economic, social, and personal burden. Any attempt aimed at improving quality of care should be based on comprehensive and reliable data. This pilot investigation studied the feasibility of implementing the National Spinal Cord and Column Injury Registry of Iran (NSCIR-IR) and scrutinized the quality of the registered data. METHODS: From October 2015 to May 2016, over an 8-month period, 65 eligible trauma patients who were admitted to hospitals in three academic centers in mainland Iran were included in this pilot study. Certified registered nurses and neurosurgeons were in charge of data collection, quality verification, and registration. RESULTS: Sixty-five patients with vertebral column fracture dislocations were registered in the study, of whom 14 (21.5%) patients had evidence of SCI. Mechanisms of injury included mechanical falls in 30 patients (46.2%) and motor vehicle accidents in 29 (44.6%). The case identification rate i.e. clinical and radiographic confirmation of spine and SCI, ranged from 10.0% to 88.9% in different registry centers. The completion rate of all data items was 100%, except for five data elements in patients who could not provide clinical information because of their medical status. Consistency i.e. identification of the same elements by all the registrars, was 100% and accuracy of identification of the same pathology ranged from 66.6% to 100%. CONCLUSIONS: Our pilot study showed both the feasibility and acceptable data quality of the NSCIR-IR. However, effective and successful implementation of NSCIR-IR data use requires some modifications such as presence of a dedicated registrar in each center, verification of data by a neurosurgeon, and continuous assessment of patients\u27 neurological status and complications