Background:Evidence-based medicine would come to the result by evidence-based implementation. Clinical Practice Guidelines (CPG) as one of the evidence-based knowledge products requires appropriate interventions after being produced to be applied.Objectives:The aim of this qualitative study was to identify the strategies for application of CPGs produced in Iran.Materials and Methods:The purposive snowball sampling was performed and it continued until reaching the theoretical saturation. In-depth semistructured individual interviews and Focus Group Discussion (FGD) were performed aiming at triangulation. The thematic framework approach was used for the analysis.Results:Twelve interviews were conducted with three health system policy makers and decision makers, four experienced in the production or adaptation of clinical practices, and five experts in evidence-based medicine development and education. In addition, 11 policy makers, managers, and decision makers of the health system took part in FGD. The proposed interventions were classified in the following themes: Health professionals-oriented, Financial, Organizational, Regulatory, and Multifaceted interventions.Conclusions:Along with adaptation and development process of CPGs, their utilization should also be planned; otherwise spent time and money would be in vain. Certainly, imposing above-mentioned interventions with the ultimate goal of sustainable behavior change in health system service providers is beyond the capacity of specific groups or few academic centers. It requires the participation of all practitioners under the monitoring and support of the Ministry of Health and Medical Education. Deployment of the family physician plan and referral system is an opportunity which must be considered a trophy.
A 1-week old, two-humped female camel (Camelus bactrianus) calf with continual whining, epiphora, anorexia, muscle twitching, and lateral recumbency was referred to a veterinary hospital. Although she died shortly after preliminary clinical examination, but necropsy was performed and tissue samples were taken for further microbiological and pathological examinations. On bacteriological investigation, Salmonella typhimurium and Streptococcus agalactiae were isolated. Histopathologically, lesions consisted of hyperemia and hemorrhage in all serosal and mucosal surfaces, gastroenteritis, and purulent ascites, associated with suppurative omphalitis. Acute nutmeg liver demonstrated centrilobular congestion and moderate fatty changes without any inflammatory cell infiltration. The abomasal and intestinal mucosa were hemorrhagic and erosive. The brain was hyperemic with severe fibrinopurulent meningoencephalitis. Except for dromedary camels and llamas, there has been no previous report of an acute, fatal septicemia in a two-humped camel calf due to S. typhimurium accompanied by S. agalactiae.
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