راهنماي باليني ارايه خدمات جراحي مغز و اعصاب در پاندمي كوويد-19

Clinical guideline of neurosurgical practice during the COVID-19 pandemic

جراحي اعصاب در بحران پاندمي كوويد-19 با چالش هاي بسياري روبه رو است. به همين جهت، راهنماي حاضر جهت كمك به تصميم گيري جراحان اعصاب و كادر درمان و همچنين حفاظت جان بيماران و كادر درمان در شرايط بحران كرونا تهيه گرديده است. روش بررسي ابتدا راهنماهاي باليني مرتبط با موضوع، با جستجو در پايگاه هاي اطلاعاتي استخراج شدند و تعداد پنج راهنماي باليني انتخاب شدند. به كمك اين راهنماها آيتم ها و سوالات و همچنين پاسخ هر يك از سوالات نيز استخراج شد. براي يافتن شواهد تكميلي براي پاسخ دادن به سوالات مطرح شده، مجددا در پايگاه ها جستجو انجام شد. در نهايت، پاسخ ها به صورت توصيه، ويرايش شد و به صورت يك دست درآمد. اين توصيه ها براي چهار نفر از صاحب نظران متخصص جراحي مغز و اعصاب و دو نفر از صاحب نظران متخصص عفوني ارسال شد. اساتيد صاحب نظر، نمره دهي به توصيه ها را طبق معيار ارزيابي AGREE-REX (در سه حوزه كاربرد باليني، ارزش ها و منافع و قابليت اجرا) انجام دادند. حداقل ميزان توافق در هر حوزه ارزيابي 80% در نظر گرفته شد و توصيه هاي مورد توافق به عنوان توصيه نهايي در نظر گرفته شدند. يافته ها: توصيه هاي نهايي، در بخش يافته ها آورده شده است. نتيجه گيري: استفاده از وسايل حفاظت فردي، كاهش ارتباط غيرضروري كادر درمان با بيماران، استفاده از تله مديسين، تهويه مناسب هوا، غربالگري بيماران، كاهش اعمال جراحي الكتيو، استفاده از روش هاي كمتر تهاجمي و مديريت توليد آيروسول ها، كاهش روش ترانس اورال و ترانس نازال از مهم ترين توصيه هاي اين راهنما هستند.

Neurosurgery practice conflicts with many challenges during the COVID-19 pandemic; Including the lack of beds in intensive care units, as well as the use of some methods such as drills and trans-nasal and trans-oral approaches that produce aerosols or are directly in contact with patient discharge. Due to these challenges, developing a clinical guideline to help neurosurgeons and medical staff in decision making and improving patients and medical staff safety during the COVID-19 pandemic is the purpose of this study. Methods First, all of the relevant clinical guidelines to neurosurgical practice during the COVID-19 pandemic were extracted from the data centers. Finally, five clinical guidelines were selected. The questions and the items were designed according to these guidelines. The answers to each of the questions were extracted from these guidelines. The complementary evidence was extracted by searching in the data centers again. Finally, the answers were edited and the edited answers were considered as the recommendations. These recommendations were sent to 4 experts in the Neurosurgery field and 2 experts in the infectious diseases field. The appraisers evaluated the recommendations according to the AGREE-REX instrument. This instrument has 9 items and 3 domains including clinical applicability, values and preferences, and implement ability. Recommendations with above 80% agreement were considered as the final recommendations. Results The final recommendations were presented as “Clinical guideline of neurosurgical practice during the COVID-19 pandemic” in the results section. Conclusion This clinical guideline was developed by using similar guidelines and available evidence. Proper usage of personal protective equipment, reduction of unnecessary contacts between medical staff and patients, use of Telemedicine for follow-up, proper air conditioning, screening patients for COVID-19, reduction of elective surgery, use of less invasive methods, management of aerosol production and reduction of trans-oral and trans-nasal approaches are the most important recommendations of this clinical guideline.