Use of Neuroprotective agents for Traumatic Brain Injury

Traumatic brain injury (TBI) is the leading cause of mortality and morbidity especially in young ages, while over 30 years of neuroprotective agents use for TBI management provided neither any recommended agent for favorable outcome nor less adverse effects in TBI management yet. This review got selected keywords? search and ran in known international and local databases, with no limitation up to September 6, 2015. Related to the subject, clinical human studies have been selected for the review. Data from 32 studies were classified into 10 subgroups. About 18 studies with a population of 4637 participants were included in 6 topic reviews and meta-analyses. Oxygen use in acute management of TBI to reduce mortality rates could be recommended. Corticosteroid use in solo acute TBI management is prohibited due to increasing risk of mortalities. However, in dual-diagnosed patients (TBI and spinal cord injury (SCI) together), corticosteroid use should be obtained by a Bracken protocol. The use of citicoline in acute TBI is no more supported. The use of cyclosporine-A for ICP control depends on the resources and physician?s decision. Rivastigmine use for chronic neurocognitive conditions of TBI management had some beneficence in severely impaired participants. However, the use of other agents in TBI has no field of support yet

Flutamide versus a cyproterone acetate-ethinyl estradiol combination in moderate acne: a pilot randomized clinical trial

Background: The use of oral flutamide is rarely investigated in acne therapy. The aim of this study was to compare the efficacy of oral flutamide with that of a cyproterone-estradiol combination in treating acne lesions. Methods: A randomized clinical trial enrolled patients with moderate acne into two equal groups to receive either oral flutamide or the cyproterone-estradiol combination for 6 months. Lesion count, Acne Severity Index, and Global Acne Grading system (GAGS) scores were used to assess improvement in acne lesions. The dichotomous measurement scale for primary endpoint assessment was defined as improvement from moderate to mild acne based on GAGS score. Patient satisfaction and dermal fat were also assessed. Intention to treat and per protocol analyses were done, reporting related effect sizes. Results: Both treatments resulted in substantial improvement in acne lesions. Although flutamide seemed to have higher efficacy, an intention to treat analysis did not find the two treatment protocols to be different. The relative risk in intention to treat analysis was 1.8 (95% confidence interval [CI] 0.89–1.6), and was 1.33 (95% CI 1.03–1.72) for the per protocol analysis. The number needed to treat for flutamide compared with the cyproterone-estradiol combination was 7.7 and 4.2 in the intention to treat and per protocol analyses, respectively. Conclusion: Flutamide appears to be more effective than a cyproterone-estradiol combination in some aspects of acne treatment, but this requires confirmation in a larger trial

Measuring the effect of vehicle safety on road traffic crash severity in Iran: using structural equation modeling

Objective: Vehicle safety plays a key role in reducing the number of road traffic deaths and serious injuries. This study aims to investigate the effect of vehicle safety on the severity of traffic crashes in Iran using structural equation modeling (SEM). Methods: This was a comparative cross-sectional study of all imported vehicles with Aras free trade zone license plate as well as all domestic vehicles (cars produced in Iran) commuting on Tabriz-Jolfa road. The study population included drivers who had accidents on Tabriz-Jolfa road over a period of one year from September 22, 2020 to September 21, 2021 and were injured or  their vehicles had been damaged (n=652). Data was collected using set of questionnaires with 10 sections. The effect of independent variables, as exogenous latent variables (human, vehicle, and environmental factors), on a dependent variable, as an endogenous latent variable (crash severity) was measured using SEM. All data were analyzed using Mplus 8.0 software. Results: In the structure part of the model with foreign vehicles group, the effect sizes of three exogenous variables, i.e., human, environmental, and vehicle factors, on the dependent variables were found to be 0.412, 0.396 and 0.358, respectively. The effect sizes in the model with domestic vehicles were found to be 0.312, 0.702 and 0.820, respectively. Conclusion: Vehicle factors (variables related to car safety) had a high impact on crash severity in the national license plate and domestically manufactured vehicle group, indicating the necessity of improving vehicle safety

Health care managers’ perspectives on the sources of evidence in evidence-based hospital management: A qualitative study in Iran

Background: Evidence-based management (EBMgt) has been developed as a management framework for improving the quality of management decisions. To use that, we need to identify the source of evidence in decision-making.  Therefore, the purpose of this study was to identify the sources of evidence in managing hospitals. Methods: Qualitative methods were used to explore the sources of evidence and to identify hospital managers’ attitudes towards evidence-based management. A series of semi-structured interviews (n=48), with a purposive sample of 48 participants, were conducted in 2016. Also, four focus group discussions (FGDs) were conducted with health managers and specialists in the field of management. A questionnaire was used for collection of demographic characteristics and managers’ perspectives. Results: Six main themes emerged from the interviews including: scientific and research evidence, facts and information of hospital, political-social  development plans, managers’ professional expertise and ethical-moral  evidence. Also, the results showed that the majority of participants believed to use the evidence-based hospital management (95.83%). Conclusions: Our study suggested that a full evidence-based hospital manager someone who is using all the sources of evidence for making hospital decisions. Using hexagon of evidence sources, managers can identify the best available evidence for hospital decisions and to make the best decision in the process of evidence-based decision making.  Keywords: Evidence-based management, management decisions, hospital  managers, health secto

Effect of tamsulosin versus prazosin on clinical and urodynamic parameters in women with voiding difficulty: a randomized clinical trial

Sakineh Hajebrahimi1, Yadollah Ahmadi Asrbadr1, Arash Azaripour1, Homayoun Sadeghi-Bazargani2,31Urology Department, Imam Reza University Hospital, Tabriz, Iran; 2Neuroscience Research Center and RDCC, Tabriz University of Medical Sciences, Tabriz, Iran; 3Karolinska Institute, Stockholm, SwedenObjective: To compare the effects of tamsulosin and prazosin on clinical and urodynamic parameters in women with voiding dysfunction.Methods: Forty women aged 20–65 years with a clinical diagnosis of voiding dysfunction were blindly randomized to two equal groups for treatment with tamsulosin 0.4 mg or 1–2 mg of prazosin daily. Symptom assessment with the American Urological Association Symptom Score (AUASS) and urodynamic evaluation was performed initially and after three months of treatment. Patient satisfaction was evaluated and severe adverse drug effects recorded. Statistical analysis was carried out using the Student’s t-test and Mann–Whitney U test.Results: Although AUASS improved in both groups, the rate of improvement was larger in the tamsulosin group. Urodynamic parameters improved but did not normalize in both groups. Adverse side effects from medication in the prazosin group were more common than in the tamsulosin group. Most of the patients in the tamsulosin group (80%) were satisfied with their treatment compared with those in the prazosin group (45%).Conclusion: Tamsulosin and prazosin are both effective in palliating symptoms of women with voiding dysfunction and improving their urodynamic parameters. Tamsulosin may be the preferred drug to prescribe because of its more amenable side effect profile and greater patient satisfaction.Keywords: tamsulosin, prazosin, voiding dysfunction&nbsp

An Evidence-Based Framework for Evidence-Based Management in Healthcare Organizations: A Delphi Study

BACKGROUND: Evidence-based management (EBMgt) is a growing literature concept in management sciences which claims that management decision-making must be based on the best available evidence. The aim of this paper is to present and provide an evidence-based framework for EBMgt to improve decision-making in healthcare organizations.METHODS: A two-round Delphi survey was used to collect the factors affecting EBMgt. Purposive and snowball sampling methods were used in both rounds. In round 1, we conducted a systematic review and a series of semi-structured interviews (n=45). In round 2, a specific questionnaire with four main parts was designed. The experts (n=21) were asked to rate on a 9-point Likert scale the importance of each factor. The data was collected through Google Forms (n=11) and paper forms (n=10).RESULTS: Participants were mostly men (73%). Overall, 126 factors were selected in round 1. Factors were classified into 4 categories: facilitators, barriers, the sources of evidence and EBMgt process that consisted of 48, 46, 22 and 10 factors, respectively. In round 2, based on median scores, many factors (n=114) were found to be very important. Only, 12 factors have a median score of less than 3 and were excluded from the study. Finally, 114 factors were confirmed.CONCLUSIONS: Confirmed factors played significant roles in affecting the practice of EBMgt among healthcare managers. We tried to facilitate interaction between these factors in the framework. Depending on the type of problem, using six steps of EBMgt process, managers will select the best evidence among six sources of evidence.KEYWORDS: Evidence-based management, evidence-based framework, healthcare organization

A Comprehensive Review on Risk Factors Affecting the Crash Severity

As a matter of growing machinery life, traffic crashes are considered an inevitable source of injuries and costs around the world. Regarding to increasing traffic accident outcomes, controlling the current status is necessary. In this way, identifying risk factors affecting the crash severity is an essential step toward initiating a convincing solution. The core objective of this study was to categorize the risk factors affecting the severity of crashes. Data needed for this study were gathered through searching Web of Science, Google Scholar, and Science Direct databases using the keywords included fatal and crash, injuries and crash, fatal and traffic accident, and injuries and traffic accident. Based on 83 selected studies for review, factors affecting the crash severity divided into five factors and forty-seven sub-factors. The most prevalent sub-factors were age, sex, safety belts, alcohol and drug use, speed, weather conditions, lighting conditions, time of the day and week, vehicle kind, road condition, collision type and crash location. Many risk factors affect crash severity and determination of the most important ones can be a prelude in reducing the effects. Therefore, the conclusion of this review can assist to traffic safety experts, police and contribute to distinguishing and monitoring the risk factors affecting crash severity transportation agencies

Prediction of mortality risk in patients with traffic injury: A case study in tabriz hospitals, Iran

Background: Trauma caused by traffic accidents is one of the main causes of mortality in the world. The trauma is a time-dependent condition. Trauma scoring systems help service providers to determine the severity of the injury and mortality risk and provide appropriate and timely services. This study aimed to predict mortality risk in patients with traffic injuries in Tabriz hospitals. Materials and Methods: This descriptive cross-sectional study included 11,238 traffic-injured patients. Databases of the emergency medicine service and forensic medicine were used to collect information. Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) scoring system, binary logistic regression model, odds ratio with 95 confidence interval, and sensitivity and specificity were used to predict mortality. Results: Overall, 71 cases of death were identified. Pedestrians had the most rates of deaths with 31 cases (43.66). Head trauma with 31 cases (43.66) was the main cause of death. Mean (standard deviation) of the GAP score was 21.8 (1.8). The death rates in high-, moderate-, and low-risk groups were 22.4, 3.18, and 0.42, respectively. The likelihood of death in people with saturation of oxygen (SO2) 95 was 1.96 times higher than those with SO2>95. The likelihood of death increased by 0.001 times each year. Furthermore, when the GAP score was 18, sensitivity was 64, and for the GAP score of 10, sensitivity was 15.5. Conclusion: GAP score seems to be a reliable and easy-to-use scoring method for predicting traffic injury mortality in an Iranian setting and yields reasonable results concerning international standards