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

آگاهي و عملکرد کارورزان از کاربرد کلار گردني در بيماران ترومایی؛ یک مطالعه مقطعی

Introduction: Having the skill for choosing the proper collar and correctly fastening it is very important for preventing neurovascular injuries in patients with head and neck trauma. Therefore, the present study was designed and carried out with the aim of evaluating the knowledge and practice of medical interns regarding use of neck collar for trauma patients. Methods: In this cross-sectional study, the knowledge and practice of medical interns who were admitted to the medical internship program of Guilan University of Medical Sciences in 2009 was assessed in winter of 2017 using a questionnaire, the validity and reliability of which had been approved. Results: 80 medical interns with the mean age of 25.93 ± 1.02 years were studied (76.2% female). Mean knowledge score of the participants was 11.5 ± 2.7 (3 to 19). In addition, their mean practice score was 16.5 ± 2.3 (10 to 20). The highest rate of lack of knowledge was observed regarding factors predicting the rate of damage to neck and spinal cord (98.8%), the importance of injury (95.0%), the maximum time allowed for using neck collar (91.3%) and incorrect measures (91.3%). In addition, the highest rate of error in practice also belonged to leveling external auditory meatus with shoulder after fastening the neck collar in children (98.8%), putting a protective pad behind the rib cage after fastening the collar in children (95%) and employing at least 3 people when fastening the collar and maintaining the immobility of the vertebra before fastening the collar (65.0%), respectively. The score of practice and knowledge had a reversed correlation (p = 0.023, r = -0.225). Conclusion: Based on the findings, the rate of knowledge regarding neck collar usage in more than 70% of the medical interns in the present study was in the intermediate to poor range. In addition, the practice of 60% of them was in the intermediate to poor range. There was no direct correlation between the knowledge and practice of the students in this regard. مقدمه: مهارت در انتخاب کلار مناسب و بستن صحیح آن جهت جلوگيري از آسيب‏هاي عصبی-عروقی در بیماران مبتلا به ترومای سر و گردن از اهمیت بالایی برخوردار است. لذا مطالعه حاضر با هدف ارزیابی آگاهی و عملکرد کارورزان در استفاده از کلار گردنی برای بیماران ترومایی طراحی و اجرا شده است. روش کار: در این مطالعه مقطعی آگاهی و عملکرد کارورزان پزشکی ورودی سال 1388 دانشگاه علوم پزشکی گیلان طی زمستان سال 1395 با استفاده از پرسشنامه ای که روایی و پایایی آن تایید شده بود، مورد سنجش و ارزیابی قرار گرفتند. یافته ها: 80 کارورز با میانگین سنی  02/1 ± 93/25 سال مورد مطالعه قرار گرفتند (2/76 درصد زن). میانگین نمره آگاهی شرکت کنندگان برابر با 7/2 ± 5/11 (3 تا 19) بود. همچنین میانگین نمره عملکرد آنها برابر با 3/2 ± 5/16 (10 تا 20) بود. بیشترین میزان ناآگاهی در مورد فاکتور های پیش­بینی­کننده میزان آسیب گردن و نخاع (8/98 درصد)، میزان اهمیت آسیب (0/95 درصد)، حداکثر مدت مجاز استفاده از کلار گردنی (3/91 درصد) و اقدامات ناصحیح (3/91 درصد) بود. همچنین بیشترین میزان نقص عملکرد نیز به ترتیب مربوط به هم سطح کردن مئاتوس شنوایی خارجی با شانه بعد از بستن کلار گردنی در کودکان (8/98 درصد)، گذاشتن پد محافظ پشت قفسه سینه بعد از بستن کلار در کودکان (0/95 درصد) و استفاده از حداقل 3 نفر هنگام بستن کلار و بی حرکتی ستون فقرات قبل از بستن کلار (0/65 درصد) بود. نمره عملکرد و آگاهی ارتباط معکوس داشتند (225/0-=r، 023/0=p ). نتیجه گیری: بر اساس یافته ها، میزان آگاهی بیش از 70 درصد از کارورزان مطالعه حاضر در مورد استفاده از کلار گردنی در حد متوسط به پایین قرار داشت. همچنین عملکرد 60 درصد از آنها نیز در محدوده متوسط و ضعیف قرار داشت. بین میزان آگاهی و عملکرد دانشجویان در خصوص مذکور ارتباط مستقیمی وجود نداشت