3 research outputs found
Developing criteria for Cesarean Section using the RAND appropriateness method
<p>Abstract</p> <p>Background</p> <p>Cesarean section rates are increasing worldwide, and a rapid increase has been observed in Iran. Disagreement exists between clinicians about when to use cesarean section. We aimed to identify the appropriateness criteria for the use of cesarean section in Iran.</p> <p>Method</p> <p>A consensus development study using a modified version of the RAND Appropriateness Method (RAM). We generated scenarios from valid clinical guidelines and expert opinions. A panel of experts participated in consensus development: first round via mail (12 members), second round face-to-face (9 members). We followed the RAM recommendations for the development of the scenario lists, rating scales, and statistical analyses.</p> <p>Results</p> <p>294 scenarios relevant to cesarean section were identified. 191 scenarios were considered appropriate, of which 125 scenarios were agreed upon. The panel found cesarean inappropriate for 21% of scenarios, and 'equivocal' for 14% of scenarios.</p> <p>Conclusion</p> <p>RAM is useful for identifying stakeholder views in settings with limited resources. The participants' views on appropriateness of certain indications differed with available evidence. A large number of scenarios without agreement may partly explain why it has been difficult to curb the growth in cesarean section rate.</p
Antibiotic use during the first 6 months of COVID-19 pandemic in Iran : a large-scale multi-centre study
WHAT IS KNOWN AND OBJECTIVE: Although antibiotics are ineffective against viral infections, epidemiological studies have revealed that the COVIDâ19 pandemic resulted in the overuse of antibiotics and disruption of antimicrobial stewardship programmes. We investigated the pattern of antibiotic use during the first 6âmonths of the COVIDâ19 pandemic in Iran. METHODS: A multiâcentre retrospective study was designed to investigate the use of 16 broadâspectrum antibiotics in 12 medical centres. The rate of antibiotic use was calculated and reported based on the Defined Daily Dose (DDD) per 100 hospital bedâdays. The bacterial coâinfection rate was also reported. RESULTS AND DISCUSSION: Totally, 43,791 hospitalized COVIDâ19 patients were recruited in this study. It was found that 121.6 DDD of antibiotics were used per 100 hospital bedâdays, which estimated that each patient received approximately 1.21 DDDs of antibiotics every day. However, the bacterial coâinfections were detected only in 14.4% of the cases. A direct correlation was observed between the rate of antibiotic use and mortality (r[142] = 0.237, p = 0.004). The rate of antibiotic consumption was not significantly different between the ICU and nonâICU settings (p = 0.15). WHAT IS NEW AND CONCLUSION: In this study, widespread antibiotic use was detected in the absence of the confirmed bacterial coinfection in COVIDâ19 patients. This overâconsumption of broadâspectrum antibiotics may be associated with increased mortality in hospitalized COVIDâ19 patients, which can be an alarming finding