Sakineh Hajebrahimi

Tolterodine Immediate Release Improves Sexual Function in Women with Overactive Bladder

INTRODUCTION Quality of life studies indicate that overactive bladder (OAB) has a greater negative impact on everyday life than other serious conditions such as diabetes. The detrimental effect of OAB on female sexual health is more prominent than urinary incontinence. We know that tolterodine immediate release (IR) has a beneficial effect on urinary symptoms in OAB. AIM To evaluate the impact of tolterodine IR on sexual function in patients with OAB. METHODS A total of 30 sexually active women with OAB from 20 to 52 years were included. All patients filled out the International Consultation on Incontinence Questionnaire (ICIQ) and the Arizona Sexual Experience Scale (ASEX) before treatment with tolterodine IR and at the end of each month of treatment until 3 months. MAIN OUTCOME MEASURES Expected outcomes were improvements in the ICIQ and ASEX total score. All ASEX items were expected to improve individually. These improvements indicate better sexual function after treatment. Results. The mean of the total ASEX score improved relative to baseline in the first (P<0.01), second (P<0.01), and third (P<0.01) follow-up. The mean of scores for sexual desire, arousal, vaginal lubrication, orgasm, and orgasm satisfaction improved significantly (P<0.01) with each follow-up. CONCLUSION Tolterodine IR significantly improves sexual function of women with OAB. Improvement is seen in all domains of sexual function.

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

Objective 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.

Developing performance indicators for clinical governance in dimensions of risk management and clinical effectiveness

OBJECTIVE This study has been designed and conducted to develop domestic indicators for evaluating the performance of clinical governance in dimensions of risk management and clinical effectiveness. DESIGN This study implemented a 5-stage process including conducting a comprehensive literature review, expert panel (∼ 1000 h per person per session, 11 experts), semi-structured interviews, a 2-round Delphi study (33 experts were in attendance) and a final expert panel (8 experts were in attendance). SETTING East Azerbaijan-Iran Province. PARTICIPANTS Fifty-six specialists and experts in different fields of medical sciences. MAIN OUTCOME MEASURES Importance and applicability of indicators. RESULTS Using a thorough literature review, 361 indicators (129 risk management indicators in 4 dimensions and 232 clinical effectiveness indicators in 18 dimensions) were found. After conducting expert panels and interviews, the number of indicators decreased to 168 cases (65 risk management indicators in 4 dimensions and 103 clinical effectiveness indicators in 12 dimensions). Two rounds of Delphi identified four indicators that were omitted. The members of the final expert panel agreed on 113 indicators (43 risk management indicators in 4 dimensions and 70 clinical effectiveness indicators in 11 dimensions). CONCLUSION In this study, indicators for assessing clinical governance in domains of risk management and clinical effectiveness were designed that can be used by policy-makers and other authorities for improving the quality of services and evaluating the performance of clinical governance. Those indicators can be used with slight modifications in other countries having healthcare systems similar to that of Iran.

Evidence for the future - Designing a clinical trial

The quality of the evidence is a keystone in the understanding of Evidence Based Medicine. Randomized controlled trials (RCTs) rank first among the research designs providing clinical evidence. Knowing about the design of clinical trials is not only the cornerstone of clinical research, but also is a requirement for any clinician who wants to learn about new findings of clinical research in his/her field. Many clinicians have good understanding as well as some misunderstandings about the design of clinical trials. This article is going to provide some crucial comments to be considered in conducting RCTs in order to help in production of better evidence for future of urology research through RCTs

Shared decision-making and its correlation with demographic characteristics of Iranian patients.

Aims: To evaluate relationship between patient age, location and their preference toward partnership in clinical decision making Place and Duration:A university-based clinic, Tabriz University of medical sciences, Tabriz, Iran from March to September Methods: In a cross-sectional study, 200 patients were randomly selected for the study.

Physicians' Perspectives Toward Shared Decision Making in Developing Countries

Aims: To evaluate Iranian physicians’ perspectives on shared decision making by validating and translating the physician version of a shared decision making questionnaire (SDM-Q-DOC). Place and Duration: Iranian Evidence-Based Medicine Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran, from June 2012 to July 2013. Methods: The physician version of a shared decision making questionnaire (SDM-QDOC) was translated and validated through a pilot study among urologists in one of the hospitals of Tabriz University of Medical Sciences. A validated questionnaire was handed out among Iranian physicians in three main hospitals of Urmia. The results were analyzed using factorial analysis SPSS 16 software. To assess reliability, Cronbach’s alpha coefficient was calculated. Pearson correlation coefficient was used to assess testretest value. Results: The Persian version of the questionnaire showed an acceptable level of Original Research Article British Journal of Medicine & Medical Research, 4(18): 3458-3464, 2014 3459 reliability (Cronbach alpha=0.901). In the implementation phase, Iranian physicians were generally in favor of the SDM process ( mean score=74.4%) but their perspective on different phases of SDM were different, with 93% answering questions evaluating physicians’ clinical explanations to their patients and only 68% agreeing with questions evaluating physicians’ attitudes regarding involving patients in the last treatment option. Conclusion: The physician version of SDM-Q-DOC is a valid and reliable questionnaire assessing physicians’ attitudes toward the SDM process. In this study, Iranian physicians showed a positive view to SDM.

How to teach evidence-based medicine to urologists.

The goal of this article is to help develop, disseminate, and evaluate resources that can be used to practice and teach EBM for urology residents and continuing education of urologists to reduce the gap between research and clinical practice. Urology departments should build capacity for residents to shape the future of quality and safety in healthcare through translating evidence into practice. Cutting edge approaches require knowing how to teach Evidence-based urology, to make Bio-statistics easy to understanding and how to lead improvement at every level. The authors shared their experience about ‘what works’ in a surgical department to building an Evidence-based environment and high quality of cares.

Lifelong Learning in Practice: The Age of Discussion Through Social Media

Ongoing lifelong learning in health-related professions is recognized as one of the most important essential competencies for optimal clinical practice [1]. Continuing medical education (CME) in lifelong learning for physicians focuses on maintaining or upgrading the knowledge and skills of medical graduates to ensure competent practice [2]. The goal of current CME systems for urologists is to improve knowledge and practical skills via formats such as conferences, formal courses, and workshops [3]. In recent years, technological improvements that have shifted education from classrooms to online platforms have significantly changed medical education [4]. Social media have become a valuable tool for e-learning, particularly when incorporated in medical education and clinical practice [5]. To facilitate lifelong learning for urologists, we established two Telegram ‘‘Urologist’’ groups in September 2014. Telegram is a communication application similar to Viber andWhatsapp that allows users to send texts, images, and videos to a contact list. To achieve the goals mentioned above, we used different medical education strategies, including case-based learning, clinical experience, discussion groups, lectures, evidence-based journal clubs, and problem-based learning. Besides the main priority of continuing education, this approach aims to establish an effective consultation system, especially for young urologists, for discussing complex or unusual cases with expert colleagues. Between November 2014 and November 2015, the Telegram urologist groups involved 256 case-based learning discussions, 20 clinical experiences, 12 lectures, and 24 evidence-based journal clubs. Approximately 1180 cases were discussed in this period of time and membership increased from 35 to 408. Telegram groups are an exceptionally easy tool that urologists can use to connect to invaluable resources for which access might otherwise be limited by geographic distance or time barriers [5]. This e-learning tool may be useful in improving clinical knowledge and narrowing the gap between high-quality evidence and clinical practice in developing countries such as Iran. Despite these opportunities, medical education via social media has certain limitations that must be acknowledged. First, the effect of this educational system on clinical skills is unclear, especially for surgical skills in urology. Second, there are still some concerns regarding medical ethics and patient privacy and confidentiality in such programs.

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.

Effect of Entonox for pain management in labor: A systematic review and meta-analysis of randomized controlled trials

Background and aim Entonox was one of the important methods for pain management in the delivery process. In previous years some studies have assessed the effect of this method in Iran. In this regard, the aim of this study was to systematically review studies addressing the effect of Entonox for pain management in labor. Methods This systematic review and meta-analysis study was conducted in 2016. The required data was collected using keywords such as ”Entonox”, “nitrous oxide”, ”vaginal delivery”, ”pain relief”, “obstetric”, “labor pain”, and “labor analgesia”, from databases including Google scholar, PubMed, Science Direct, Magiran, SID, and Scopus, and hand-searching of related and valid journals and references of articles. Articles published from 2000 to 2016 were searched. To conduct meta-analysis, CMA:2 (Comprehensive Meta-analysis) was used. Results Finally, 14 articles were included in the study. Pain relief standard difference in mean between-groups was −1.01 (95% CI: −1.59 to −0.43, Q=148.5, df=8, p=0.02, I2=76) this difference was significant (p<0.05). The overall Apgar score standard difference in mean between-groups (Entonox vs. comparison) was 0.12 (95% CI: 0.01 to 0.23, Q=109.4, df=16, p=0.00, I2=85.3) this difference was significant (p<0.05). The results of mothers’ satisfaction rate show that mothers in Entonox group has a high level of satisfaction rate. Conclusion According to results of studies published in Iran, it seems that Entonox is an effective method for pain relief in vaginal delivery, as well as for improving infant Apgar score and mothers’ satisfaction rate. Pain relief through Entonox can be used as a strategy for cesarean section reduction plan in Iran.