Indicators of Quality of Care in Individuals With Traumatic Spinal Cord Injury: A Scoping Review

Study Design: Scoping review. Objectives: To identify a practical and reproducible approach to organize Quality of Care Indicators (QoCI) in individuals with traumatic spinal cord injury (TSCI). Methods: A comprehensive literature review was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL) (Date: May 2018), MEDLINE (1946 to May 2018), and EMBASE (1974 to May 2018). Two independent reviewers screened 6092 records and included 262 full texts, among which 60 studies were included for qualitative analysis. We included studies, with no language restriction, containing at least 1 quality of care indicator for individuals with traumatic spinal cord injury. Each potential indicator was evaluated in an online, focused group discussion to define its categorization (healthcare system structure, medical process, and individuals with Traumatic Spinal Cord Injury related outcomes), definition, survey options, and scale. Results: A total of 87 indicators were identified from 60 studies screened using our eligibility criteria. We defined each indicator. Out of 87 indicators, 37 appraised the healthcare system structure, 30 evaluated medical processes, and 20 included individuals with TSCI related outcomes. The healthcare system structure included the impact of the cost of hospitalization and rehabilitation, as well as staff and patient perception of treatment. The medical processes included targeting physical activities for improvement of health-related outcomes and complications. Changes in motor score, functional independence, and readmission rates were reported as individuals with TSCI-related outcomes indicators. Conclusion: Indicators of quality of care in the management of individuals with TSCI are important for health policy strategists to standardize healthcare assessment, for clinicians to improve care, and for data collection efforts including registries. © The Author(s) 2021

Designing and evaluating questionnaire for assessment abuse in patients with spinal cord injury during Covid-19 Disease

Background: One of the chronic diseases that causes various challenges for patients is spinal cord injury. On the other hand, apart from the problems that patients and caregivers of patients with SCI experience, the spread and prevalence of Covid-19 disease has been effective as an effective risk factor for abuse. Objectives: the aim of the present study is to determine the abuse prevalence and its effective risk factors among SCI patients in Ilam City during the Covid-19 outbreak. Methods: This cross-sectional descriptive study, population included all SCI patients in Ilam, included in the present study. Moreover, researcher-made forms and questionnaires whose validity and reliability were confirmed, including the demographic characteristics form, perceived abuse researcher-made questionnaire for SCI patients, were used. The perceived abuse questionnaire for SCI patients was a researcher-made questionnaire that was designed using library studies, interviewing patients and determining abuse instances. This instrument consists of 20 questions that are answered using Yes (score 1) and No (score 0). After data collection, statistical analyzes were performed. Data analyzed with spss16 software. Results: According to the results, the mean +/- SD of the perceived abuse score by caregivers and patients was 8.48 +/- 2.31 and 42.45 during the Covid-19 pandemic, respectively. Also, the mean +/- SD of patients' age was 62.86 +/- 19.15 and the patient perceived abuse increased with increasing age (P = 0.000, F = 27.42). Also, the possible abuse score was 0 to 20 that was divided into three categories: low (20, 20.4), moderate (76, 76.5) and high (2, 2). also, significantly higher perceived abuse score among women and patients with a history of more than 10 years of SCI, but there was no significant relationship between abuse prevalence with income and marital status (P>0.05). With regard to age and abuse, results also showed an increase in perceived abuse score with increasing age. Conclusions: necessary to take the necessary measures and preventions in this regard. Also, the prevalence of Covide-19related abuse in patients was hight, which is statistically important and significant. For this reason, while proposing preventive action in this field

Abuse in Patients with Spinal Cord Injury During the COVID-19 Pandemic

Background: One of the chronic diseases with various challenges for patients and caregivers is spinal cord injury (SCI). The spread and prevalence of coronavirus disease 2019 (COVID-19) have been an influential risk factor for abuse. Objectives: The aim of this study was to assess the rate of abuse in patients with SCI during the COVID-19 pandemic. Methods: This cross-sectional descriptive study population was all SCI cases in Ilam, Iran. Researcher-made forms and questionnaires with confirmed validity and reliability, including the demographic characteristics, form and perceived abuse researcher-made questionnaire for people with SCI, were used. The perceived abuse questionnaire for patients with SCI was a researcher-made questionnaire designed based on library studies, interviews with patients, and determination of abuse instances. This instrument consists of 20 questions answered as yes (score 1) or no (score 0). After data collection, statistical analyzes were performed using the SPSS software version 16. Results: According to our results, the mean +/- SD of the perceived abuse score by caregivers and patients was 8.48 +/- 2.31 and 42.45 during the COVID-19 pandemic, respectively. Moreover, the mean +/- SD of the age of patients was 62.86 +/- 19.15 years, and the patient abuse increased with elevation in age (P = 0, F = 27.42). The possible abuse score was 0 - 20 divided into three categories of low (20, 20.4), moderate (76, 76.5), and high (2, 2). The perceived abuse score was significantly higher among women and patients with a history of more than 10 years of SCI. Abuse prevalence did not have a significant relationship with income and marital status. Regarding age and abuse, our results showed a rise in perceived abuse scores with an increase in age. Conclusions: The present study showed that it is necessary to take measures to prevent abuse in patients with SCI. Moreover, the prevalence of abuse related to COVID-19 in patients with SCI was high. Therefore, preventive actions need to be proposed in this field

The effect of Atorvastatin on chronic subdural hematoma status: A systematic review of drug therapy

Atorvastatin (ATO) with its chemical formula of (C33H35FN2O5) is one of the cholesterol-lowering drugs that can also reduce hematoma volume (HV). Considering the importance of pharmacological treatments in improving the patient condition, the aim of this study was to evaluate the ATO effect on chronic subdural hematoma (CSDH) status. In this systematic review (SR) study, all articles about the ATO effect on CSDH status were entered into a study, without time constraints, by two authors who were professional in SR articles. In the initial search, 176 articles were found, of which 73 articles were deleted due to duplicate records, and after further review and removal of unrelated articles, this number reduced to 11 articles, and systematic review data was reported with 11 articles. In all articles, radiological clinical findings were used to diagnose hematoma. In most of the reviewed articles, atorvastatin was effective in reducing subdural hemorrhage. The articles ranged from 2014 to 2021, the total sample size was 1278 patients and the follow-up period varied from 2 months to 4 years. Concerning the ATO effect in reducing HV status in CSDH patients, it is recommended to prescribe this drug to improve HV levels

Evaluation of factors affecting pressure ulcers in patients with brain - Spinal injuries: A cross-sectional descriptive study

Background: Due to the importance of pressure ulcers (PUs), this study was performed to determine the status of pressure ulcers in patients admitted to hospitals in Ilam. Methods: This is a cross-sectional descriptive study that was conducted (sample size=220). Researchers obtained a list of discharged patients from hospitals and contacted patients or their companions. The instruments included a demographic profile form and the Braden Scale for Predicting PU Risks. Data analysis was SPSS ver. 16 software. Results: It showed most of the patients achieved scores in poor and low risk status. Also, the overall score for risk of Pus was low, moderate, and high, and very high in 28 (12.7), 81 (36.7), 105 (47.7), and 6 (2.7) of cases, respectively. The total mean +/- SD of patients with and without Pus was 10.18 +/- 0.77 and 13.01 +/- 1.40, respectively. Also, there was a significant difference between patients with and without Pus in terms of the mean +/- SD of scores obtained in all items of this instrument, except friction and shear (P<0.05). Conclusions: Due to the identification of factors affecting the development of pressure ulcers, it is necessary to take the necessary interventions to reduce them

Evaluation of Laboratory Variables Related to Diffuse Axonal Injury: A Cross-Sectional Study

Background: Diffuse axonal injury (DAI) is an injury that occurs after the onset of traumatic brain injury (TBI), leading to many problems for patients and imposing high costs on the treatment system. Objectives: This study was conducted to investigate the status of laboratory variables in patients with DAI. Methods: This cross-sectional study included 140 patients. Data collection tools were a demographic profile form and magnetic resonance imaging (MRI). Laboratory tests, including glucose, LDL-C, HDL-C, total cholesterol, triglycerides, Hb, HCT, PT, PTT, INR, BUN, creatinine, and CRP were evaluated. Also, specialized devices were used to study the laboratory and radiology variables. Results: Most (61.5) of the patients were male, 47.1 had a non-governmental occupation, and 55.7 were less than 30 years old. Also, in 87.9 of cases, traffic accidents were the cause of DAI and in 65 of patients, the Glasgow Coma Scale (GCS) was less than 7. In all the laboratory variables differences were observed between the experimental and the control groups. Conclusions: The laboratory variables in patients with DAI had a statistically significant difference compared to the case group, which indicates the negative effect of DAI on laboratory variables. Further studies are required to confirm our results

Investigating the Effect of Tranexamic Acid on the Treatment of Subdural Hematoma: A Systematic Review Study

Context: Tranexamic acid (TXA) belongs to the family of lysine-derived antifibrinolytics. TXA requires a simple molecular breakdown in the liver to be metabolized and has a high renal excretion. Objectives: This study aimed to determine the effect of TXA on subdural hematoma (SDH) treatment using the SR method. Methods: Following a systematic review design, this study aimed to evaluate the effect of TXA on SDH treatment using studies published from 2000 to 2020. The search was performed by two researchers who were dominant in various types of SR studies and specialized discussion of neurosurgery. A checklist that contained the following items was used to collect the data: surname, year of study, year of publication, population, sample size, age, intervention, and outcomes. Data were also classified and reported using Word software. Results: Initially, 178 articles were identified, out of which 118 were removed due to the relevance of the title and method, 44 due to duplication, six due to following the SR method, and three due to having a case report design. Seven studies were found as eligible, as follows: the study by Wakabayashi et al. with a sample of 199 patients, Kageyama et al.'s study with 21 patients, Wan et al.'s study with 90 patients, Kutty et al.' study with 27 patients, Tanweer et al.'s study with 14 patients, Yamada et al.'s study with 193 patients, and Lodewijkx et al.'s study with 7 patients. All articles showed that TXA could reduce SH. Conclusions: Regarding the positive effect of TXA on reducing SDH, administration of this medicine is recommended in the treatment of patients with CSDH

Investigating the effect of methylprednisolone pulse on treatment of back pain

Pain is a common problem afflicting humanity. Back pain is a musculoskeletal disorder with a high prevalence; this pain may occur to anyone at least once during their lifetime. The present study was performed to investigate the effect of methylprednisolone pulse on the pain status of patients suffering from back pain in Ilam city. This double-blind study in 2021 in Ilam city with experimental and control. The patients with vertebral disc herniation diagnoses suffering from diffuse pain with the right leg were assigned into experimental and control groups. A methylprednisolone 500 mg IV would be administered to the patient as pulse inside DW 500 cc serum. The extent of pain was compared before and after the intervention at one, two, three, and seven days later. Placebo was applied for the control group patients. The data were analyzed by SPSS 16 and based on descriptive and analytical tests. Results showed no statistically significant difference between the demographic characteristics and pain of patients receiving methylprednisolone and patients in the control group(p0.05). Considering the effect of methylprednisolone on mitigating the pain of patients suffering from back pain, it is suggested to use injective methylprednisolone to reduce the pain of patients suffering from back pain

Investigation of the effect of Duloxetine on pain status of patients with spinal cord injuries: A systematic review of drug therapy

Duloxetine is a series of tricyclic antidepressants that have the potential inhibitory properties of histamine H1 and H2 receptors. The present study aimed at evaluating the effect of a Systematic Review of Investigating the Effect of Duloxetine on the pain status of patients with SCIs. The present systematic review was conducted observing principles of publication ethics and guidelines of systematic reviews and meta-analyzes (PARISMA) aimed to investigate the effect of duloxetine on the pain status of patients with SCIs during 2010-2021. Two researchers who were proficient in SCIs and reviewed review articles performed the search. A checklist including the author's name, publication date, Outcomes, Control, Intervention, Population, and Study design was used for data collection. Using Excel 2007 Software, the collected data were classified and the final report. The result showed that 202 articles were included in the study in the first stage. In the first stage, 154 articles were deleted due to the irrelevance of the title and method of the article. Also, 34 articles were done due to duplication of articles, and 8 articles were done due to non-human studies. Finally, 6 articles entered the systematic review stage. In all reviewed articles, it was shown that doxepin effectively reduces pain and can reduce pain. While in the placebo group, patients' pain did not decrease. Due to the effect of duloxetine on reducing pain in patients with SCIs, it is suggested that duloxetine can reduce pain in patients

Investigating the effect of methylprednisolone pulse on the treatment of back pain

Background: Pain is a common problem afflicting humanity. Back pain is a musculoskeletal disorder with a high prevalence; this pain may occur to anyone at least once during their lifetime. Aim: the present study was performed to investigate the effect of the use of methylprednisolone pulse on the pain status of patients suffering from back pain in Ilam city. Methods: This study is a clinical trial conducted as double-blind in 2021 in Ilam city with pretest and post-test groups plus a control group. The patients referred with vertebral disc herniation diagnosis suffering from diffuse pain in the right leg were assigned into test and control groups. A methylprednisolone 500 mg IV would be administered to the patient as pulse inside DW 500cc serum. The extent of pain was compared before and after the intervention at one, two, three, and seven days later. Placebo was applied for the control group patients. The data were analyzed by SPSS 16 as well as based on descriptive and analytical tests. Results: According to the findings, no statistically significant difference was observed between the demographic characteristics of patients receiving methylprednisolone and patients in the control group (p0.05). Conclusions: Considering the effect of methylprednisolone on mitigating the pain of patients suffering from back pain, it is suggested to use injective methylprednisolone for reducing the pain of patients suffering from back pain