A blueprint for success: lessons learned from developing the official guide to Iranian undergraduate medical education accreditation.

We are excited to contribute our thoughts and insights to the discussion initiated by Gandomkar et al. in their article on the accreditation system in Iran (Gandomkar et al., BMC Med Educ 23:379, 2023). As individuals who have been directly involved in the process of meta-accreditation and possess a comprehensive understanding of the various stages of Undergraduate Medical Education (UME) accreditation in Iran, we would like to highlight additional points that were identified through a rigorous hermeneutic phenomenology process proposed by Gadamer (Gadamer, Truth and Method, 2013) and offer a complementary point of view to the previous work. By sharing our insights, we hope to contribute to the ongoing discourse surrounding UME accreditation.

On the Spot Scaffolding as the Hermeneutic Phenomenology Action Field: Critical Thinking Case for Medical Students in Iran.

Background: A major contribution to the humanities literature has been the development and application of Vygotsky's sociocultural theory in relevant fields. Constructivism as a paradigm is owed to Vygotsky and his efforts. On-the-spot scaffolding in this regard is one of the innovations that can be triangulated with hermeneutic phenomenology to pave the way for a paradigm shift in the educational system in a broad view and for critical thinking for medical students in a narrow view. This study aimed to illuminate the other side of the behavioristic lesson plan, which is on-the-spot scaffolding in implementing one of the modules of essential skills for doctors of medicine (Adab-e Pezeshki), which is critical thinking. Methods: This study was qualitative and longitudinal. It is longitudinal due to the 3 years of involvement and qualitative due to the study design approach and the use of discourse analysis and hermeneutic phenomenology as tools. Results: Three main findings emerged from the study's qualitative nature: first, students who attended the sessions or who merely completed the assignments created an on-the-spot critical thinking scaffolding design, which is an alternative to a behavioristic lesson plan; and second, the students wrote numerous movie reviews in both Persian and English. One of the components of reflective autobiography is these film critics and a student-written, instructor-edited paper submitted to ICHPE 2023. Conclusion: There is an urgent need for a paradigm shift and comparative-historical investigations in the medical education system in Iran.

Mindfulness, empathy and moral sensitivity in nurses: a structural equation modeling analysis.

BACKGROUND: Ethical issues may pose challenges to nurses; moral sensitivity can help them to overcome these challenges. Identifying variables related to moral sensitivity can help in planning to increase nurses' moral sensitivity. This study aimed to investigate the relationship among mindfulness, empathy, and moral sensitivity in a sample of nurses. METHODS: In the present study, a cross-sectional design utilizing Structural Equation Modeling (SEM) was conducted. The nurses in a private hospital in Yazd, Iran, were invited to participate in the study (n=162) using simple random sampling. In order to gather the data, the Freiburg's mindfulness inventory, moral sensitivity questionnaire, and revised Jefferson's empathy scale were used. The hypothesized model was analyzed by SEM. RESULTS: The results show that Mindfulness (ß=0.41, t=5.53, p<0.01) and empathy (ß=0.52, t=6.77, p<0.01) had a significant direct effect on moral sensitivity. However, mindfulness had an indirect effect on nurses' moral sensitivity via empathy improvement (z= 6.25, p<.01). CONCLUSION: Empathy played a significant mediating role in the relationship between mindfulness and moral sensitivity, so mindfulness-based interventions with an emphasis on empathy may provide an opportunity to increase moral sensitivity in nurses.

Psychometric properties of the Persian version of the Physical Activity Scale for the Elderly (PASE).

BACKGROUND: Old age is associated with reduced physical ability. It is necessary to measure and evaluate the physical activity of older people. Implementing appropriate requires a valid and reliable tool. Physical Activity Scale for the Elderly (PASE) is the frequently used self-reported physical activity assessment for older adults. Therefore, this study aimed to determine the translation validity and reliability of the Persian version of the Physical Activity Scale for the Elderly. METHODS: This study is a methodological, descriptive applied research was conducted on 300 older people. The translation process of the English version of PASE into Persian was carried out according to the process of translation and adaptation of scale recommended by the World Health Organization. The reliability of the scale was examined by calculating the Cronbach's alpha, Pearson, and intraclass correlation coefficient (ICC). The reliability and validity of the scale were evaluated by following the "Consensus-Based Standards for the Selection of Health Status Measurement Instruments" (COSMIN) checklist. To assess the face and content validity, impact score (IS), the content validity ratio (CVR), and the content validity index (CVI) were determined. A confirmatory factor analysis was also performed. RESULTS: The experts approved the quality of the Persian version of PASE. The reliability was calculated with a Cronbach's alpha of 0.94, an ICC of 0.99, and a test-retest correlation coefficient of 0.94. The qualitative and quantitative face validity of all questions by expert judgment and IS of greater than 1.5 was considered. Also, CVR and CVI scores of all questions were higher than 0.6 and 0.79, respectively. Confirmatory factor analysis revealed a good fit for the original three-factor structure. CONCLUSIONS: The Persian or Farsi version of PASE was shown to have acceptable validity and reliability. This tool is suitable for measuring the physical activity level in the Persian elderly language special in clinical environments and therapeutic interventions.

The relationship between personality dimensions, spirituality, coping strategies and clinical clerkship satisfaction among intern nursing students: a cross-sectional study.

BACKGROUND: The clinical clerkship is a crucial stage in nursing training, yet a dissatisfaction at this stage may cause a nurse to quit in future. This study aimed to investigate the relationship among personality dimensions, spirituality, coping strategies and clinical clerkship satisfaction among intern nursing students. METHODS: This was a correlational, cross-sectional study. A total of 293 Iranian nursing students, who were fulfilling their clinical clerkship at university-affiliated hospitals in Tehran, were selected using cluster random sampling. All participants were provided with standard questionnaires including personality dimensions (NEO_FFI), spirituality, coping strategies (WoCQ), and satisfaction with clinical clerkship. Data were analyzed using Pearson correlation and hierarchical multiple regression. RESULTS: The results showed that spirituality (ß = 0.32, p < 0.001), problem-focused coping (ß = 0.26, p < 0.001) and extraversion (of personality dimensions, ß = 0.22, p < 0.001) played significant roles in predicting clinical clerkship satisfaction among intern nursing students. Regression analysis showed openness (ß = 0.14, p < 0.01), extraversion (ß = 0.16, p < 0.01), and spirituality (ß = 0.23, p < 0.001) could significantly predict problem-focused coping style among intern nursing students. However, personality dimensions and spirituality were not good predictors for emotion-focused coping among these students (p > 0.05). CONCLUSION: Personality dimensions, coping strategies and, in particular, spirituality are good predictors of clinical clerkship satisfaction among intern nursing students. Therefore, paying attention to spiritual needs in nursing students, improving their problem solving skills in dealing with clinical stress and training extraversion characteristics can be effective in enhancing their satisfaction with clinical clerkship.

Prioritized Criteria for Casualty Distribution following Trauma-related Mass Incidents; a Modified Delphi Study.

INTRODUCTION: In the aftermath of mass casualty incidents (MCIs), many decisions need to be made in a fast and influential manner in a high pressure environment to distribute the limited resources among the numerous demands. This study was planned to rank the criteria influencing distribution of casualties following trauma-related MCI. METHODS: This study utilized a modified Delphi methodology, concentrating on extracted criteria attained from preceding systematic literature reviews. The 114 extracted criteria were classified into eight sections including space, staff, equipment, system and structures, triage, treatment, transport, and uncategorized criteria and were imported into an online survey tool. In the first round, experts were asked to rank each criterion on a five-point Likert scale. The second round incorporated feedbacks from the first round, stating percent and median scores from the panel as a whole. Experts were then called upon to reassess their initial opinions regarding uncertain remarks from the first round, and once again prioritize the presented criteria. RESULTS: Fifty-seven criteria were regarded as relevant to the following sections: space: 70% (7/10); staff: 44% (4/9); system / structure: 80% (4/5); equipment: 39.1% (9/23); treatment; 66.7% (6/9); triage: 73.7% (14/19); transport: 38.7% (12/31) and other sections: 12.5% (1/8). The first round achieved nearly 98% (n=48) response rate. Of the 114 criteria given to the experts, 68 (almost 60%) were approved. The highest percentage of approval belonged to the system and structures sections (4/5=80%). The response rate for the second round was about 86% (n=42). A consensus could be reached about nearly 84% (57) of the 68 criteria presented to experts. CONCLUSION: "Casualty Level of Triage on the Scene" and "Number of Available Ambulances" were the two criteria that obtained the highest level of consensus. On the other hand, "gender of casualty", "Number of Non-Medical staff in each Hospital" and "Desire to transport family members together" got lowest level of consensus. This sorted list could be used as a catalogue for developing a decision support system or tool for distribution of victims following mass casualty incidents.

A novel mutation in CYP17A1 gene leads to congenital adrenal hyperplasia: A case report.

BACKGROUND: Congenital adrenal hyperplasia is a rare autosomal recessive disorder where the mutation in P450 family 17 subfamily A member 1 gene (CYP17A1) is involved in its etiology. The disorder represents itself with low blood levels of estrogens, androgens, and cortisol that generally couples with hypertension, Hypokalemia, sexual primary amenorrhea, infantilism and in affected individuals. CASE: In this study, the CYP17A1 gene in a 14-year-old female was examined. The karyotype of the patient was 46, XX, and the analysis of the CYP17A1 gene by Sanger sequencing revealed a novel homozygous deletion c.1052-1054CCT which led to isolated 17,20-lyase deficiency. CONCLUSION: In conclusion, this study report an in-frame deletion which results in isolated 17, 20-lyase deficiency, and the mutation might be used for diagnosis in other patients with distinctive clinical symptoms.

Development of a National Roadmap for Electronic Prescribing Implementation.

BACKGROUND: In July 2015, Iran Food and Drug Administration convened a multi-stakeholder workgroup (workgroup) to help develop recommendations for electronic prescribing implementation in Iran. OBJECTIVES: In general, the consensus of the workgroup was to focus on solutions that incrementally reduce the burden on patients, providers, and payers, and require minimal rework by using national standards that have already been used for Health Information Interchange. We used a road mapping method which includes a number of systematic steps and is adapted from the standard scientific method. Medical Informatics Experts Developed protocols for Scoping Reviews, Systematic reviews and Health Technology Assessment study and then collected evidence from peer-reviewed scholarly journal publications and gray literature. Health Insurance companies representatives and Electronic Prescribing pilot studies executives were asked to report their experiences in the case of e-prescribing. RESULTS: After five meetings, by comparing and contrasting the national and international evidence, the recommendations were finalized in expert panels. In this paper, we report recommendations from this roadmap.

Design and Evaluation of a Smart Medication Recommendation System for the Electronic Prescription.

BACKGROUND: electronic prescription is shown to have many benefits in terms of reducing medication errors, improving patient safety, productivity, and resource management, but it may cause new errors and physician frustration if not designed and implemented properly. Improving usability and user-centered design is essential for physicians' adoption. OBJECTIVES: To enhance the efficiency of the e-prescribing system by reducing the risk of inappropriate selection of the medication and also to reduce the prescribing time and effort to reach the desired drug. METHODS: Important data fields for predicting medications were determined through interviews with pharmacists. Among those, fields which were available in a claims dataset of 16 million prescriptions were extracted and were used to develop a neural network model to be used by a recommender system that displays the most probable medications on top of the drop-down list in the e-prescription application. RESULTS: Offline and field evaluations both showed that this model could improve performance. CONCLUSION: smart recommenders systems can improve e-prescription usability, safety, and enhanced physicians' adoption.

Posterior pericardiotomy in cardiac surgery: systematic review and meta-analysis.

This systematic review with meta-analysis sought to determine the impact of posterior pericardiotomy on incidences of atrial fibrillation and supraventricular arrhythmias, pericardial effusion, pleural effusion, tamponade, and the length of hospital stay after cardiac surgery. We searched for randomized controlled trials, using Medline, Embase, Elsevier and Sciences online databases as well as Google Scholar literature. The effect sizes measured were odds ratio for categorical variables and standard mean difference with 95% confidence interval for calculating differences between mean values of hospital stay in intervention and control groups. A value of p < 0.1 for Q test or I(2 )> 50% indicated significant heterogeneity between the studies. The literature search of all major databases retrieved 20 studies. After screening, 12 suitable trials were identified, which reported outcomes of 2052 patients undergoing cardiac surgery. Posterior pericardiotomy had an odds ratio of 0.33 [95% confidence interval: 0.18-0.61] p < 0.001 for atrial fibrillation; odds ratio 0.32 [0.15-0.67] p = 0.003 for supraventricular arrhythmias; odds ratio 0.09 [0.04-0.19] p = 0.000 for early pericardial effusion and odds ratio 0.04 [0.02-0.08] p < 0.001 for late pericardial effusion; odds ratio 1.64 [1.23-2.20] p = 0.001 for pleural effusion, odds ratio 0.07 [0.02-0.27] p < 0.001 for tamponade, and standard mean difference = 0.01 [-0.12 to 0.14] p = 0.8 for hospital stay. Posterior pericardiotomy is a simple intraoperative technique that can improve postoperative clinical outcomes. However, the incidence of pleural effusion associated with posterior pericardiotomy might be higher.

Anti Leishmanial Effect of Zinc Sulphate on the Viability of Leishmania tropica and L. major Promastigotes.

BACKGROUND: Cutaneous leishmaniasis (CL) is an endemic disease in developing countries. Although pentamidine orantimonite (Glucantime) has been recommended for cutaneous leishmaniasis treatment by the World Health Organization, there are some concerns too such as high cost, side effects, need for frequent injections, and restricted efficacy. Therefore, different methods have been used for CL treatment so far. OBJECTIVES: This study assessed the sensitivity of two parasite agents of cutaneous leishmaniasis: Leishmania major and L. tropica to zinc sulphate in vitro. In the present study, the zinc sulphate effect on urban and rural strains of cutaneous leishmaniasis, viability of old world, in vitro is under investigation. MATERIALS AND METHODS: The design of the present study was experimental (laboratory-trial) based. Iranian endemic species of L. major and L. tropica were appropriately collected, proliferated, and maintained in the standard culture. Afterward, the proper concentrations of zinc sulphate were provided, sterilized, and added to the cultures containing parasites. In different intervals, parasites were counted by two methods: the slide and cell proliferation ELISA. RESULTS: Both parasite species showed sensitivity to zinc sulphate in vitro and in comparison with the control group, their numbers were reduced. Zinc sulphate (in concentrations of 0.5, 1, 2, and 3 percent) was added to the cultures containing parasites, and the total number of the live parasites was counted through the slide method (Neubauer slide) every day up to the fifth day. The results were analyzed and found statistically significant (P < 0.05). In the second phase, the counting process was repeated with the addition of zinc sulphate compound with different concentrations (3, 4, 5, and 6 percent) and live parasite numbers were counted by ELISA method after 24 hours. The findings revealed that all the cultures containing zinc sulphate showed a slower growth in comparison to the control group. The mentioned difference was statistically significant (P < 0.05). CONCLUSIONS: Considering the safety of zinc sulphate compound in comparison with Glucantime, there is a possibility of using it in the treatment of CL caused by both species of L. major and L. tropica. It is obvious that more researches are mandatory both in vivo and in vitro to figure out its daily dosage, proper concentration, time and duration, and possible side effects.

Fetal radiation doses and subsequent risks from X-ray examinations: Should we be concerned?

BACKGROUND: Pregnant women are sometimes exposed to ionizing radiation in radiology examinations for various reasons. In such cases, the radiation dose to the conceptus and subsequent risks should be estimated. OBJECTIVE: The purpose of this study was the calculation and presentation of fetal dose and subsequent risks resulted from different X-ray examinations. MATERIALS AND METHODS: An analytical simulation study was conducted and six common radiographies in different views and three types of special examinations were evaluated. The entrance skin exposure (ESE) was measured using a solid-state dosimeter. A Monte Carlo program was used in order to simulate different views of X-ray examinations and calculate the radiation doses received by the conceptus for every view of each examination. Then the risk of childhood cancer and small head size were calculated for different radiographies. RESULTS: The fetal doses and consequence risks of the small head size and childhood cancer for the radiographs of chest, skull, and sinuses were negligible but the risks of childhood cancer and small head size due to radiographies of abdomen, lumbar spine, and pelvis areas were ponderable. CONCLUSION: RESULTS of this study can be used for the pregnant women radiographies management.