Evaluation of the clinical educational environment based on the DREEM model from the viewpoint of the OR students.

BACKGROUND: The most important part of learning happens in the clinic. To determine the differences between the real educational environment and the desirable environment, the DREEM1 model is used. The present study was conducted to evaluate the clinical educational environment based on the DREEM model from the viewpoint of the OR2 students of the Lorestan University of Medical Sciences. MATERIALS AND METHODS: The present descriptive-analytical cross-sectional study evaluated the viewpoint of 118 students of operation room (OR) technology using the DREEM (Dundee Ready Educational Environment Measure) questionnaire in the hospitals affiliated with the Lorestan University of Medical Sciences during the second semester of 2020. The DREEM questionnaire has 50 statements and is divided into five sections, which are rated on a five-point Likert scale (0-4). The data were analyzed using frequency distribution tables, mean and standard deviation indices, Mann-Whitney and Kruskal-Wallis tests. Data analysis was conducted using IBM SPSS Statistics 22.0. IBM Corp.; 2013. and the level of significance was set at 0.05. RESULTS: The total perception of the students of the clinical educational environment was good and excellent in 73.8% of the cases and of the subscales was also good (50.8%-63.2%). There was a significant relation between the total score of students' perception of the clinical educational environment and age (Z = 5.618, P < 0.001), semester (χ2= 43.929, df = 3, P < 0.001), internship hospital (χ2= 12.948, df = 6, P = 0.044) and also the mean score of the subscales (P < 0.001). As the GPA3 and interest in the major increased, the mean score of total perception and its subscales also increased except for perception from the educators (P < 0.05). CONCLUSION: According to the results, the studied students had a positive perception of the clinical educational environment. It is recommended that the scientific foundation of the educators, the physical facilities of the operating rooms, and social communication should be strengthened to improve the care, treatment, and educational services. It will be useful to use the results to improve the accreditation level of medical centers.

Diagnostic Value of Elastography, Strain Ratio, and Elasticity to B-Mode Ratio and Color Doppler Ultrasonography in Breast Lesions.

PURPOSE: The aim of this study was to investigate the sensitivity, specificity, and diagnostic accuracy of sonoelastography (SE), strain ratio (SR), elasticity to B-mode (E/B) ratio, and color Doppler ultrasonography (US) in suspected breast lesions. MATERIALS AND METHODS: This prospective study was conducted on women referred to Alzahra university hospital of Tabriz for annual screening of breast cancer between May 2017 and December 2018. B-mode US, SE, and color Doppler imaging were conducted in females with suspected mammography reports. The lesions in B-mode were classified according to the Breast Imaging Reporting and Data System (B-RADS). The results of SE imaging were graded based on five-grade SE score. SR and E/B ratio of each lesion were also analyzed in SE images. Color Doppler findings were categorized from 0 (no visible vessel) to 2 (> two vessels) based on the vascularity of the tumor. Pathology results were used as the gold standard to measure the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and diagnostic accuracy of each modality. RESULTS: One-hundred and ten breast lesions of 104 women aged 42.05±10.33 years were included in the study. Seventy-seven of the lesions were benign and 3 were malignant. Sensitivity and specificity of 97.0% and 77.9% for B-mode US, 93.9% and 87.0% for SE score, 81.8% and 66.2% for color Doppler US, 72.7% and 77.6% for E/B ratio (cutoff: 1.05), and 77.3% and 79.6% for SR (cutoff: 1.90) were obtained, respectively. Addition of SE score to B-mode US increased the sensitivity to 93.9%, specificity to 93.5%, and AUC from 0.95 to 0.97. Cumulative color Doppler US with B-mode US did not enhance the diagnostic accuracy of B-mode US. CONCLUSION: SE was more effective than color Doppler US for distinguishing malignant from benign breast lesion. Among the three different SE features, five-grade SE score was superior to E/B ratio and SR.

Effects of Cold Application on Chest Tube Removal Pain in Heart Surgery Patients.

BACKGROUND: Chest tube removal is considered a painful technique, which may not respond well to palliative therapies. There are no standard procedures or guidelines to manage the pain associated with chest tube removal. This study aimed to examine the effects of cold application on pain reduction during and after chest tube removal. MATERIALS AND METHODS: This randomized controlled trial was conducted on 90 hospitalized patients, undergoing heart bypass surgery at the intensive care units where at least a pleural chest tube was inserted. The patients were randomly divided into two groups (45 samples per group). In the cold application group, an ice bag was placed at the designated point for 20 minutes before chest tube removal, while only routine interventions were applied for chest tube removal in the control group. Pain severity was measured in the groups before, during, and 15 minutes after chest tube removal, using the visual analogue scale. Repeated measures ANOVA test was applied for data analysis. RESULTS: There was no significant difference in the baseline pain score between the groups (P= 0.18). However, there was a significant difference in terms of pain severity score between the cold application (3.58±1.09) and control (4.73±0.86) groups during chest tube removal (P< 0.001). On the other hand, there was no significant difference between the groups regarding the score of pain severity at 15 minutes after chest tube removal (P= 0.38). CONCLUSION: Cold application, as a nonpharmacological intervention, may contribute to the alleviation of cryotherapy-related pain.

Evaluation of sleep problems in preeclamptic, healthy pregnant and non-pregnant women.

OBJECTIVE: Sleep problems are common complaints among pregnant women. This study was designed to compare subjective sleep problems in non-pregnancy condition, healthy and preeclamptic pregnancy as a major complication of pregnancy. We hypothesized that some sleep problems are more prevalent in females with preeclampsia. METHODS: In this cross-sectional study, 102 women with preeclampsia, 106 healthy pregnant women in the third trimester and 103 healthy non-pregnant women were selected through random sampling. Age and parity were matched in the three groups. We used Global sleep assessment questionnaire (GSAQ) to check the subjective sleep problems, and then we performed statistical analysis using Analysis of variance (ANOVA) and Pearson Chi-square tests. RESULTS: Our findings revealed significant differences in initial insomnia (p = 0.034), fragmented sleep (p = 0.022), snoring (p<0.001), non-idiopathic insomnia (p = 0.045) and sadness and anxiety (p = 0.001) between the three groups. Some sleep problems were more common in preeclampctic compared to healthy pregnant women including initial insomnia, fragmented sleep, snoring, sleep apnea and non-idiopathic insomnia. Moreover, the subjects with preeclampsia revealed more fragmented sleep, snoring, sadness and anxiety and lack of getting enough sleep due to other activities compared to non-pregnant women. CONCLUSION: Different kinds of sleep problems can occur in subjects with preeclampsia in comparison with the non-pregnant and healthy pregnant subjects. Sleep problems should be evaluated during pregnancy, particularly in pregnant women with preeclampsia, and suitable treatment should be provided for any specific sleep problem.

Sex determination using anthropometric dimensions of the clavicle in Iranian population.

OBJECTIVE: Sometimes only skeletal remains are available for forensic identification. Therefore, sex determination using human skeletal remains is one of the most important components in forensic identification. Different levels of accuracy for sex determination using clavicle have been reported in various studies, and on the other hand, anthropometric dimensions of different bones are unique in each race and geographical region. This study was carried out to assess the accuracy of this bone for sex determination in Iranian population. Based on the results of this research, by using the anthropometric dimensions of the clavicle bone, gender can be estimated with a high accuracy. MATERIALS AND METHODS: This research was carried out on 120 Iranian cadavers. Maximum of length and midshaft circumference of clavicle was measured. SPSS (Version 13.5) was used for statistical analysis. RESULTS: The mean of maximum of the length and the midshaft circumference of clavicle was larger in men (P < 0.001). Using claviclular anthropometric parameters, we could determine sex with 73.3%-88.3% accuracy. CONCLUSION: The results of this research indicate that sex can be determined using clavicle dimensions with relatively high accuracy, when only the clavicle bone is available due to explosion, plane crashes, mutilated bodies, etc.

Estimation of stature from upper limb anthropometry in Iranian population.

OBJECTIVE: Personal identification is an essential issue when mutilated and amputated limbs or parts of the body are found in mass disasters. Estimation of the stature from the size of different parts of the body is one of the most important items in personal identification. The aim of this study was to estimate the stature from upper limb anthropometry. MATERIALS AND METHODS: Height, left upper limb, left arm, left forearm, length and breadth of the left hand, and length of the left second to fifth fingers were measured on 100 right-handed Iranian medical students aged between 21 and 26 years from February to may 2010. RESULTS: After analyzing the datas, it was shown that there is a meaningful relation between the stature and upper limb dimensions (p < 0.05), [correlation coefficients ranged from 0.310 to 0.696 in males and 0.299 to 0.735 in females]. CONCLUSION: The regression formula derived in this study can be used for forensic pathologists and Anthropologists.