Vol 1, No 1 (2017)


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    Background: Given the importance of compliance with quality and price standards in purchasing medical devices and regarding that one of the interventions of Iran’s health transportation plan (HTP) is monitoring the process of purchasing medical devices, this study aimed at determining if the given standards of purchasing medical devices has been complied.
    Methods: A retrospective cross-sectional descriptive study was conducted during year 2016. The study covered a sample of 4 university hospitals in the cities of Isfahan, Najaf Abad, and Shahreza. Data, including name, number, price and brands of medical devices purchased by these hospitals were gathered for a period of 3 months (June 21 to September 21, 2014). These data were available in selected hospitals as well as Medical equipment offices in the University and were compared with standards set by the ministry of health (accessible in the database of IMED). Analysis was performed using the SPSS software.
    Results: The average percentage of compliance with prices and brand standards of medical devices in the studied hospitals were 77.89 and 76.04, respectively. Non-teaching hospitals and those located outside of the capital city (Isfahan), complied with the mentioned standards better than those were teaching hospitals and located in Isfahan city.
    Conclusions: Although the compliance with price and brand standards of purchasing medical devices were good, yet regarding the need to achieve the desired level, more periodic inspections in the area of medical devices purchasing and also greater awareness about the benefits of compliance with defined standards are recommended.

Review Article

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    Context: Application of anti-clot drugs such as recombinant tissue plasminogen activator (rt-PA) to treat patients with strokes is considered as a standard treatment employed through two techniques: intra-arterial and intravenous thrombolysis. The current study aimed at comparing the clinical effectiveness of these two injection techniques.
    Methods: The current systematic review searched Google Scholar, Web of Science, Embase, Cochrane, and PubMed databases. The time span of the searching was from 1990 to 2017. The quality of the selected articles was evaluated. The fixed effects and random effects models were used in the meta-analysis. The results were subject to sensitivity analysis in the specified interval. CMA.2 (Comprehensive Meta-Analysis 2) software was utilized to conduct the meta-analysis; α value was considered 5%.
    Results: Eight studies met the inclusion/exclusion criteria. Intra-arterial thrombolysis was more effective to reduce mortality rate (odds ratio (OR) = 0.40; 95% confidence interval (CI): 0.17 - 0.92; P = 0.032). Intra-arterial thrombolysis was more effective to improve symptoms compared with intravenous thrombolysis (OR = 3.28; CI: 1.91 - 5.65; P < 0.001). Neurological dementia was bigger in the intra-arterial thrombolysis group compared with that of intravenous thrombolysis group. The mean of recanalization was 49% and 50.8% in the intra-arterial and intravenous thrombolysis groups, respectively; the difference between the results was not statistically significant (P > 0.05). Intracranial hemorrhage value was 11.33 % and 9.52 % in the intra-arterial and intravenous thrombolysis groups, respectively, which was not statistically significant (P > 0.05).
    Conclusions: In spite of the low number of robust evidence, it can be concluded that intra-arterial thrombolysis can be more effective than intravenous thrombolysis.

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    Context: Superficial radiation therapy is a low energy radiation therapy that is penetrated only within a short distance under the skin surface, and widely used by dermatologists. This study aimed at investigating the safety and effectiveness of superficial radiation therapy versus other conventional treatments in the treatment of skin diseases.
    Methods: The following databases were searched systematically from March 31st, 2017: PubMed, and the Cochrane Library. MeSH terms and free-text were used for searching the databases. Additional studies were retrieved from a manual search and reference lists of included studies. Only studies written in English were considered and there was no time limit in the inclusion criteria. The quality of included studies was assessed using the Oxford centre for evidence-based Medicine (OCEBM) levels of evidence criteria.
    Results: In total, 12 studies were included in this review. In total, 1985 patients were examined. Most of the eligible studies (11 out of 12 with 1795 patients) compared the effectiveness outcomes (efficacy, improvement rate, failure rate, clinical improvement, time of use, recurrence rate, and cosmetic consequences). About half of them (5 out of 12 with 530 patients) compared the safety outcomes (side effects and the severity of symptoms).
    Conclusions: Based on the available evidence, which was not up to date and generalizable, it could be concluded that superficial radiation therapy had no side effect on the treatment of hand eczema and also had better treatment results and could be used for hand eczema, yet for other indications, further studies need to be performed. The use this technology along with other methods may have better consequences for the patients. In order to make better decisions in this area, new studies must be carried out in various contexts. However, if superficial radiation therapy is licensed to be used in a country, in order to prevent low but serious side effects, there must be a coherent system with the aim of recording its use for each patient.

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    Context: According to WHO statistics, low back pain (LBP) is one of the main causes of disability and problems related to the quality of life in developing and developed countries. Lumbar disc herniation (LDS) is the most common cause of LBP. The goal of this study was to examine the safely and effectiveness of DiscoGel® in the treatment of lumbar disc herniation or sciatica caused by it.
    Methods: To assess the clinical effectiveness and safety of the interventions, first the relevant keywords were specified (i.e. DiscoGel®, DiscoGel® chemonucleolysis, minimally invasive percutaneous technique, RGE, radiopaque gelified ethanol, discal lumbosciatica, chronic discogenic low back pain, lumbar, and cervical intervertebral disk herniations); then, related databases were searched up to 02/02/2017 based on the specified search strategy (Cochrane Library, Ovid MEDLINE, Embase, PubMed, Clinicaltrials.gov) and clinical trials as well as cohorts were examined. In addition to extracting intended outcomes (reduction in pain and side effects), a qualitative analysis of the data was performed to examine the safety and effectiveness indices.
    Results: The systematic review reached 9 relevant articles, which were on the 2b level on the Oxford CEBM levels of evidence. The results of the study, which involved 772 patients, indicated the safety of the intervention and its effectiveness in reduction of pain and side effects; the intervention led to good clinical outcomes (in some cases, even at very early stages after treatment) due to its low invasiveness. It can be argued that DiscoGel® is safe and effective as a new minimally invasive procedure to treat sciatica caused by the herniated lumbar disc and can be used as a substitute for invasive surgery in unsuccessful medical treatments.
    Conclusions: It seems that the percutaneous treatment of vertebral disc leads to better and longerlasting clinical outcomes (pain relief and mobility) compared to noninvasive methods. In addition, noninvasive techniques are significantly more effective and have fewer side effects compared to various surgical options. As a result, these techniques can be suggested as initial treatments or as alternatives to surgery for the treatment of cervical spine and lumbar hernia. However, due to limited sample size and the type of studies, it is necessary to conduct randomized clinical trials to confirm these results.