Farhad Shokraneh

Epidemiology of Traumatic Spinal Cord Injury in Developing Countries: A Systematic Review

Background/Aims: To describe the epidemiology of spinal cord injury (SCI) in the developing world. Methods: Developing countries were selected based on the definition proposed by the International Monetary Fund. A literature search was performed in July 2012 in Medline and Embase. Further article procurement was obtained via the reference lists of the identified articles, websites, and direct contact with the authors of the identified studies. We designed search strategies using the key words: SCI, epidemiology, incidence, and prevalence. According to the inclusion criteria, 64 studies from 28 countries were included. Results: The incidence of SCI in developing countries is 25.5/million/year (95% CI: 21.7-29.4/million/year) and ranges from 2.1 to 130.7/million/year. Males comprised 82.8% (95% CI: 80.3-85.2) of all SCIs with a mean age of 32.4 years (95% CI: 29.7-35.2). The two leading causes of SCI were found to be motor vehicle crashes (41.4%; 95% CI: 35.4-47.4) and falls (34.9%; 95% CI: 26.7-43.1). Complete SCIs were found to be more common than incomplete injuries (complete SCI: 56.5%; 95% CI: 47.6-65.3; incomplete SCI: 43.0%; 95% CI: 34.1-52.0). Similarly, paraplegia was found to be more common than tetraplegia (paraplegia: 58.7%; 95% CI: 51.5-66.0; tetraplegia: 40.6%; 95% CI: 33.3-48.0). Conclusion: Through an understanding of the epidemiology of SCI in developing countries, appropriate preventative strategies and resource allocation may decrease the incidence and improve the care of these injuries.

Incidence of traumatic spinal cord injury worldwide: a systematic review

PurposeTraumatic spinal cord injuries (TSCI) are among the most devastating conditions in developed and developing countries, which can be prevented. The situation of TSCI around the world is not well understood which complicates the preventive policy decision making in fight against TSCI. This study was aimed to gather the available information about incidence of TSCI around the world.MethodsA systematic search strategy was designed and run in Medline and EMBASE, along with extensive grey literature search, personal communications, website searching, and reference checking of related papers.ResultsOverall, 133 resources including 101 papers, 17 trauma registries, 6 conference proceedings, 5 books, 2 theses and 2 personal communication data were retrieved. Data were found for 41 individual countries. The incidence of TSCI ranges from 3.6 to 195.4 patients per million around the world. Australia, Canada, US, and high-income European countries have various valuable reports of TSCI, while African and Asian countries lack the appropriate epidemiologic data on TSCI.ConclusionData of epidemiologic information in TSCI are available for 41 countries of the world, which are mostly European and high-income countries. Researches and efforts should be made to gather information in developing and low-income countries to plan appropriate cost-effective preventive strategies in fight against TSCI.

Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation

Abstract: Background: Lumbar discectomy is a surgery to remove all or part of a disc cushion that helps protect the spinal column. These cushions, called disks, separate the spinal vertebrae/bones. When one of the disks herniates (moves out of place) in patients with protruded disc, the soft gel inside pushes through the wall of the disk. The disk may then place pressure on the spinal cord and nerves that are coming out of the spinal column. The lumbar discectomy procedure remained basically unchanged until the operating microscope enhanced the visualization of the operative field in 1978. This new operation was recognized as lumbar microdiscectomy because it was performed through a smaller incision, with less dissection than standard open lumbar discectomy. Microdiscectomy is regarded generally as a technical modification of standard discectomy, rather than a separate procedure. In a systematic review by Gibson and Waddell, results of microdiscectomy for treatment of lumbar disc prolapse was “broadly comparable” to the standard open lumbar discectomy. (Conventional microdiscectomy is now considered common surgical treatment for lumbar disc herniation). Several minimally invasive surgical approaches have been introduced for the surgical management of symptomatic lumbar disc herniation. The effectiveness of these procedures should be compared with lumbar microdiscectomy. Systematic reviews comparing specific types of minimally invasive lumbar surgery for management of lumbar disc herniation and lumbar radiculopathy, but did not yield conclusive results due to a lack of evidence. In this paper, we perform a systematic review of the literature and draw conclusions about safety and efficacy of minimally invasive discectomy compared to standard microdiscectomy. Keywords: Minimally invasive discectomy, Microdiscectomy, Disk herniation

Epidemiology of primary CNS tumors in Iran: a systematic review

BACKGROUND Although primary malignant CNS tumors are registered in the national cancer registry (NCR) of Iran, there are no available data on the incidence of the primary malignant or benign CNS tumors and their common histopathologies in the country. This study analyzed the 10-year data of the Iranian NCR from March 21, 2000 to March 20, 2010, including a systematic review. MATERIALS AND METHODS The international and national scientific databases were searched using the search keywords CNS, tumor, malignancy, brain, spine, neoplasm and Iran. RESULTS Of the 1,086 primary results, 9 papers were selected and reviewed, along with analysis of 10-year NCR data. The results showed that primary malignant brain tumors have an overall incidence of 2.74 per 100,000 person-years. The analysis of the papers revealed a benign to malignant ratio of 1.07. The most common histopathologies are meningioma, astrocytoma, glioblastoma and ependymoma. These tumors are more common in men (M/F=1.48). Primary malignant spinal cord tumors constitute 7.1% of the primary malignant CNS tumors with incidence of 0.21/100,000. CONCLUSIONS This study shows that CNS tumors in Iran are in compliance with the pattern of CNS tumors in developing countries. The NCR must include benign lesions to understand the definitive epidemiology of primary CNS tumors in Iran.

Study-based registers of randomized controlled trials: Starting a systematic review with data extraction or meta-analysis

Introduction: Despite years of use of study-based registers for storing reports of randomized controlled trials (RCTs), the methodology used in developing such registers/databases has not been documented. Such registers are integral to the process of scientific reviewing. We document and discuss methodological aspects of the development and use of study-based registers. Although the content is focused on the study-based register of randomized/controlled clinical trials, this work applies to developers of databases of all sorts of studies related to the human, animals, cells, genes, and molecules. Methods: We describe necessity, rationale, and steps for the development, utilization and maintenance of study-based registers as well as the challenges and gains for the organizations supporting systematic reviews of the published and unpublished literature. Conclusion: The ultimate goal of having a study-based register is to facilitate efficient production of systematic reviews providing rapid, yet accurate, evidence for the decision-makers. We argue that moving towards study-based registers is an inevitable welcome direction and that infrastructures are ready for such movement.

Comparative efficacy and tolerability of pharmacological interventions for attention-deficit/hyperactivity disorder in children, adolescents and adults: protocol for a systematic review and network meta-analysis

Introduction Attention-deficit/hyperactivity disorder (ADHD) is a major public health issue. Pharmacological treatments play an important role in the multimodal treatment of ADHD. Currently, there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank in terms of efficacy and tolerability, in children or adolescents as well as in adults. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs), to rank pharmacological treatments for ADHD according to their efficacy and tolerability profiles. Methods and analysis We will search a broad range of electronic databases, including PubMed, MEDLINE, EMBASE, PsycINFO, ERIC and Web of Science, with no date or language restrictions. We will also search for unpublished studies using international clinical trial registries and contacting relevant drug companies. We will identify and include available parallel-group, cross-over and cluster randomised trials that compare methylphenidate, dexmethylphenidate, amphetamine derivatives (including lisdexamfetamine), atomoxetine, clonidine, guanfacine, bupropion or modafinil (as oral therapy) either with each other or to placebo, in children, adolescents or adults with ADHD. Primary outcomes will be efficacy (indicated by reduction in severity of ADHD core symptoms measured on a standardised scale) and tolerability (the proportion of patients who left a study early due to side effects). Secondary outcomes will be global functioning, acceptability (proportion of patients who left the study early by any cause) and changes in blood pressure and body weight. NMA will be conducted in STATA within a frequentist framework. The quality of RCTs will be evaluated using the Cochrane risk of bias tool, and the quality of the evidence will be assessed using the GRADE approach. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. Ethics and dissemination No ethical issues are foreseen. Results from this study will be published in a peer-reviewed journal and possibly presented at relevant national and international conferences. Trial registration number CRD42014008976.

Reporting and understanding the safety and adverse effect profile of mobile apps for psychosocial interventions: An update

Recent years have seen a rapidly increasing trend towards the delivery of health technology through mobile devices. Smartphones and tablet devices are thus becoming increasingly popular for accessing information and a wide range of services, including health care services. Modern mobile apps can be used for a variety of reasons, ranging from education for the patients and assistance to clinicians to delivery of interventions. Mobile phone apps have also been established to benefit patients in a scope of interventions across numerous medical specialties and treatment modalities. Medical apps have their advantages and disadvantages. It is important that clinicians have access to knowledge to make decisions regarding the use of medical apps on the basis of risk-benefit ratio. Mobile apps that deliver psycho social interventions offer unique challenges and opportunities. A number of reviews have highlighted the potential use of such apps. There is a need to describe, report and study their side effects too. The adverse effects associated with these apps can broadly be divided into: (1) those resulting from the security and safety concerns; (2) those arising from the use of a particular psycho social intervention; and (3) those due to the interaction with digital technology. There is a need to refine and reconsider the safety and adverse effects in this area. The safety profile of a mobile PSI app should describe its safety profile in: (1) privacy and security; (2) adverse effects of psychotherapy; and (3) adverse effects unique to the use of apps and the internet. This is, however, a very new area and further research and reporting is required to inform clinical decision making.

Social network analysis of Iranian researchers on emergency medicine: a sociogram analysis

Background The purpose of this study was to report interaction patterns among Iranian authors of emergency medicine using social network analysis methodology, focusing on coauthorship network. Methods The bibliographic data of Iranian authors on the ‘emergency medicine’ field during the years 2001–2011 were retrieved from the Science Citation Index Expanded database. Co-occurrence matrices were made by BibExcel and were imported to Ucinet and NetDraw to delineate coauthorship network. To detect structural patterns among authors, we considered some measures of social network analysis, such as density, centralisation indices, component analysis and cut-points. Lastly, subject experts separately analysed the content of papers. Results Of 116 papers published, the network was composed of 10 components, with the largest component having 25 authors. Using social network analysis measures, we identified science bottlenecks in knowledge sharing, hub authors and accelerators of information flow. Topic analysis showed ‘Wounds and Injuries’ as the most recent theme in all components because of existence of national registry for trauma, high burden of road traffic injuries and research priority of injuries in Iran. Conclusions because of Iranian low productivity in the emergency medicine field, social network analysis seems to be a proper option for bibliometrics to identify central authors and detect knowledge structure in this field.

How to select a journal to submit and publish your biomedical paper

INTRODUCTION journal selection for publication purposes is one of the concerns of biomedi-cal researchers. They apply various criteria for choosing appropriate journal. Here, we have tried to collect main criteria biomedical researchers use to select a journal to submit their works. METHODS we collected these criteria through focus group conversations with researchers during our careers, feedbacks from participants of our scientific writing work-shops and non-systematic review of some related literature. RESULTS we have presented a summative and informative guidance in the selection of journals for biomedical paper submission and publication. CONCLUSION Categorized criteria as a mnemonic tool for au-thors may help the authors in journal selection process.

Effectiveness of current policing-related mental health interventions in England and Wales and Crisis Intervention Teams as a future potential model: a systematic review

BackgroundExperiencing mental ill health adds a layer of complexity for individuals in touch with the justice system and for those responsible for working in the justice service with these individuals, such as frontline police officers.In England and Wales, there are three commonly used but not necessarily commonly designed or operated, mental health interventions associated with policing, Liaison and Diversion, Street Triage and specialist staff embedded in Police Contact Control Rooms. A fourth US designed model, Crisis Intervention Teams (CITs), is now attracting some interest in England and Wales, and these four are to be considered in this review. A fifth intervention, Mental Health Courts, was trialed but has now been abandoned in England and Wales and so has been excluded, but remains in use elsewhere.In recent years, there has been an increase in the level of investment related to these intervention options. This has largely been without an evidence base being available to aid design, structure, and consistency of approach. The review will address this gap and provide a systematic review of each of these options. This will provide a baseline of research evidence for those who commission and provide services for individuals experiencing mental ill health and who are in contact with the justice system.MethodsTwenty-nine relevant databases and sources have been selected which will be systematically searched to locate relevant studies. These studies have to meet the set inclusion criteria which require them to report an objective outcome measure(s) in respect of offending or mental health outcomes and to have an experimental or quasi-experimental design including a comparator group(s) or a pre/post comparison. The review will exclude PhD theses, papers in non-English languages and papers published prior to 1980.Keywords have been collected through canvassing experts’ opinion, literature review, controlled vocabulary and reviewing the results of a primary scoping review carried out to aid the development of the PICO, composed of Population/Participants, Intervention/Indicator, Comparator/Control, and Outcomes. For the proposed review, the key elements of the PICO are the following: persons with mental health problems, symptoms or diagnoses who come into contact with the police; interventions involving partnership working between police and mental health nurses and related professionals to divert those with mental health problems away from criminal justice processes; comparisons with control groups or areas where such interventions have not been introduced; and outcomes concerning criminal justice and health outcomes.The results of the searches will be screened using the set criteria and the selected papers reviewed and analysed to allow findings regarding these interventions to be reported.DiscussionThe objectives of the review are firstly to identify and report research on the relevant interventions, nationally and internationally and then secondly to consider, when possible, which interventions or aspects of those interventions are effective. This is judged with regard to changes in mental health status or service use and future offending behaviour.The approaches to be considered have gained a good deal of support and funding over recent years, and this review will provide a systematic review of the underpinning research evidence to inform future commissioning, service design and investment decisions.