The effectiveness of regionalization of perinatal care services--a systematic review.

BACKGROUND: Several reports recommend the implementation of perinatal regionalization for improvements in maternal and neonatal outcomes, while research evidence on the effectiveness of perinatal regionalization has been limited. The interventional studies have been assessed for robust evidence on the effectiveness of perinatal regionalization on improving maternal and neonatal health outcomes. METHODS: Bibliographic databases of Medline, EMbase, EconLit, HMIC have been searched using sensitive search terms for interventional studies that reported important patient or process outcomes. At least two authors assessed eligibility for inclusion and the risk of biases and extracted data from the included studies. As meta-analysis was not possible, a narrative analysis as well as a 'vote-counting' analysis has been conducted for important outcomes. RESULTS: After initial screenings 53 full text papers were retrieved. Eight studies were included in the review from the USA, Canada and France. Studies varied in their designs, and in the specifications of the intervention and setting. Only three interrupted time series studies had a low risk of bias, of which only one study reported significant reductions in neonatal and infant mortality. Studies of higher risk of bias were more likely to report improvements in outcomes. CONCLUSIONS: Implementing perinatal regionalization programs is correlated with improvements in perinatal outcomes, but it is not possible to establish a causal link. Despite several high profile policy statements, evidence of effect is weak. It is necessary to assess the effectiveness of perinatal regionalization using robust research designs in a more diverse range of countries.

Surgical treatment results of Iranian abdominal trauma casualties in the Iran and Iraq war.

INTRODUCTION: Military medicine is a field to which a great deal of manpower, time, and effort is devoted. Abdominal traumatic injuries in field hospitals are among the major lesions to be treated, and laparotomies have a special role in the treatment of these injuries. This study was performed to assess the care of abdominal lesions in Iranian troops so that the results can be used in future planning programs. MATERIALS AND METHODS: In a cross-sectional descriptive-analytical study, 522 cases of laparotomies were studied by the census method. These troops were injured from 1982 to 1987. Primary site of injury, general medical condition, location of the hospitals, and ensuing complications were studied. RESULTS: Most of the patients were younger than 30 years, and the mortality rate was greater in rearward hospitals. Seventy-four patients had poor general condition at the time of admission; 30% of them ultimately died, which showed a statistically significant difference between the patients in field hospitals and those in rearward hospitals with regard to final prognosis (p > 0.05). The colon, small intestine, and thorax were the most common sites of injuries. The trend of complications somewhat followed the trend of the primary lesions, with some specific variations. DISCUSSION: This study offers a full review of a great number of the abdominal surgical cases, their modes of treatment, and the ensuing complications. Also, the role of field hospitals is emphasized. Patients with poor initial general conditions should receive vigorous attention. In all patients, even the least common sites of injury should not be neglected or lethal complications could ensue.