BackgroundIranian traditional primary health care (PHC) system, although proven to be successful in some areas in rural populations, suffers major pitfalls in providing PHC services in urban areas especially the slum urban areas. The new government of Iran announced a health reform movement including the health reform in PHC system of Iran. The Health Complex Model (HCM) was chosen as the preferred health reform model for this purpose.MethodsThis paper aims to report a detailed research protocol for the assessment of the effectiveness of the HCM in Iran. An adaptive controlled design is being used in this research. The study is planned to measure multiple endpoints at the baseline and 2 years after the intervention. The assessments will be done both in a population covered by the HCM, as intervention area, and in control populations covered by the traditional health care system as the control area.DiscussionAssessing the effectiveness of the HCM, as the Iranian PHC reform initiative, could help health system policy makers for future decisions on its continuation or modification.

Purpose -Clinical governance (CG) was used as a driver to improve safety and quality of healthcare. CG implementing is a change in health system and all the stakeholders must be participating. The purpose of this paper is to study nurses' experience about CG movement in Tabriz hospitals. Design/methodology/approach -A qualitative study using Focus Group Discussions (FGD) was done. Purposeful Sampling was used to select the objectives including 65 participants. Actually seven FGD's were held. Content analysis was used to extract the meaningful themes. Findings -It is revealed that nurses are the focal point in CG implementation in hospitals. Low commitment of managers and lack of physicians' contribution was experienced by nurses. However, personnel education and development and patient safety have got more attention. Blame culture and increased work stress was reported as challenges. Originality/value -CG as a change in healthcare system, especially in low-and middle-income countries, is faced by several challenges and its implementation would have different experiences. Nursing staff, the major group in hospitals, would be having interesting experiences through CG. Their practical opinions could guide the policy makers to employ proper plans to effectively implement CG. Considering the result of this study in practice would lead to improve CG implementation.

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Intractable chronic headaches are a major challenge for both patients and healthcare professionals. Over the last two decades, implantable electrical neuromodulators, previously established to manage other forms of chronic pain, have been used increasingly for intractable primary and secondary headache disorders. We review the current approaches to the management of refractory headaches using neuromodulation. Indications, operative considerations and complications are discussed based on our experience and a review of the literature. The field of neuromodulation has been rapidly advancing, with many new targets being discovered and novel devices being developed for treating craniofacial pain. We discuss some of these targets, detailing the latest advances in the area of neuromodulation for intractable headaches.

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