A model for improving the learning environment in high-stress and emotion-bound clinical settings.

INTRODUCTION: In clinical settings, it is necessary to create a clinical learning environment that provides the ground for the learners to acquire competencies especially in high-stress and emotion-bound clinical settings. METHODS: In the present study, a model for improving the learning environment in high-stress and emotion-bound clinical settings was designed by conducting a multi-method study in the form of three sub-studies. RESULTS: This model was designed with 3 pivotal concepts; organizing learning opportunities around safe care, fair participation in learning opportunities and creating a positive emotional climate and 6 peripheral concepts; designing physical space and appropriate equipment for education and care, preparing learners to attend the clinical setting, preparing learners to participate in learning opportunities, balancing the learner role and the care provided by the learners, the presence of a competent educator and providing education to all learners, and acquiring the ability to manage emotions by learners, faculty and staff. CONCLUSIONS: The implementation of the model obtained from this study provides the basis for solving the challenges of clinical learning environments, especially in high-stress and emotion-bound clinical settings, and improves clinical education and the realization of educational and care outcomes.

Identification of SARS-CoV-2 surface therapeutic targets and drugs using molecular modeling methods for inhibition of the virus entry.

Although COVID-19 emerged as a major concern to public health around the world, no licensed medication has been found as of yet to efficiently stop the virus spread and treat the infection. The SARS-CoV-2 entry into the host cell is driven by the direct interaction of the S1 domain with the ACE-2 receptor followed by conformational changes in the S2 domain, as a result of which fusion peptide is inserted into the target cell membrane, and the fusion process is mediated by the specific interactions between the heptad repeats 1 and 2 (HR1 and HR2) that form the six-helical bundle. Since blocking this interaction between HRs stops virus fusion and prevents its subsequent replication, the HRs inhibitors can be used as anti-COVID drugs. The initial drug selection is based on existing molecular databases to screen for molecules that may have a therapeutic effect on coronavirus. Based on these premises, we chose two approved drugs to investigate their interactions with the HRs (based on docking methods). To this end, molecular dynamics simulations and molecular docking were carried out to investigate the changes in the structure of the SARS-CoV-2 spike protein. Our results revealed, cefpiramide has the highest affinity to S protein, thereby revealing its potential to become an anti-COVID-19 clinical medicine. Therefore, this study offers new ways to re-use existing drugs to combat SARS-CoV-2 infection.

Non-communicable diseases in the southwest of Iran: profile and baseline data from the Shahrekord PERSIAN Cohort Study.

BACKGROUND: Critical inter-provincial differences within Iran in the pattern of non-communicable diseases (NCDs) and difficulties inherent to identifying prevention methods to reduce mortality from NCDs have challenged the implementation of the provincial health system plan. The Shahrekord Cohort Study (SCS) was designed to address these gaps in Chaharmahal and Bakhtiari, a province of high altitude in the southwest of Iran, characterized by its large Bakhtiari population, along with Fars and Turk ethnicity groups. METHODS: This ongoing cohort, a prospective, large-scale longitudinal study, includes a unique, rich biobank and was conducted for the first time in Chaharmahal and Bakhtiari Province in Iran. SCS is a part of the PERSIAN (Prospective Epidemiological Research Studies in IrAN) cohort. The study began in 2015, recruited 10075 participants (52.8% female, 47.2% male) from both urban (n=7034) and rural (n=3041) areas, and participants will be annually followed up for at least 15 years. A cross-sectional analysis was conducted using baseline data from the SCS, using descriptive statistics and logistic regression. Data analysis was performed using Stata software. RESULTS: The prevalence of NCDs was 9.8% for type 2 diabetes, 17.1% for hypertension, 11.6% for thyroid disease, 0.2% for multiple sclerosis and 5.7, 0.9 and 1.3% for ischemic heart disease, stroke and myocardial infarction, respectively. The prevalence of multimorbidity (≥2 NCDs) was higher in women (39.1%) than men (24.9%). The means (standard deviations) of age, BMI, systolic blood pressure and fasting blood glucose were 49.5 (9) years, 27.6 (4.6) kg/m2, 115.4 (17.3) mmHg and 96.7 (27.3) mg/dL, respectively. Logistic regression models showed that older age, female gender, living in an urban area, non-native ethnicity, high wealth index, unemployment, obesity, low physical activity, hypertriglyceridemia, high fasting blood sugar, alkaline urine pH and high systolic and diastolic blood pressure were associated with increased prevalence of NCDs. CONCLUSIONS: The SCS provides a platform for epidemiological studies that will be useful to better control NCDs in the southwest of Iran and to foster research collaboration. The SCS will be an essential resource for identifying NCD risk factors in this region and designing relevant public health interventions.

Medical interns; the neglected learners of the maternity ward learning environment.

BACKGROUND: Clinical training during internship is an important part of medical education. The maternity ward is a clinical environment in which medical students pass their obstetrics and gynecology internship to obtain competencies in this field. The present study was conducted to explain medical interns' manner of learning in the maternity ward. MATERIAL AND METHODS: The present study was conducted using a qualitative approach with the inductive content analysis method. This study observed the maternity wards of teaching hospitals affiliated to medical sciences universities of Isfahan and Shahrekord. Data were collected through observation and semi-structured individual interviews. RESULTS: Two main categories and seven subcategories emerged from the analysis of the data. Inadequate participation in learning opportunities included the following three subcategories: the incongruousness of the learning opportunities with the educational goals, inadequate readiness for participation in learning opportunities, and the overlap between learning opportunities and diminished autonomous practice. Inadequate formal and structured education included the following four subcategories: inadequate learning support and direction, subordinate roles and aimless presence, the pale educational role played by the attendants and senior residents, and learning through the support of midwifery educators. CONCLUSION: Participation in and access to learning opportunities in the maternity ward are very difficult for interns. Interns, therefore, need to attend the maternity ward by a structured program and in the company of training supervisors or competent educators to obtain the required competencies in pregnancy and childbirth.

Modeling and forecasting trend of COVID-19 epidemic in Iran until May 13, 2020.

Background: COVID-19 is a new disease and precise data are not available about this illness in Iran and in the world. Thus, this study aimed to determine the epidemic trend and prediction of COVID-19 in Iran. Methods: This was a secondary data analysis and modeling study. The daily reports of definitive COVID-19 patients released by Iran Ministry of Health and Medical Education were used in this study. Epidemic projection models of Gompertz, von Bertalanffy, and least squared error (LSE) with percentage error were used to predict the number of hospitalization cases from April 3, 2020 until May 13, 2020. Results: The prediction of the number of patients on April 3, 2020 by von Bertalanffy, Gompertz, and LSE, with 95% confidence interval (CI), were estimated at 44 200 (39 208-53 809), 47 500 (38 907-52 640), and 48 000 (40 000-57 560), respectively. The number of deceased COVID-19 patients was also estimated to be 3100 (2633-3717) individuals by the von Bertalanffy model, 3700 (2900-4310) by Gompertz's model, and 3850 (3200-4580) by LSE. Making predictions about the flat epidemic curve and number of patients based on Gompertz model, will project 67 000 (61 500-87 000) cases. Based on Gompertz and von models, 7900 (6200- 9300) and 4620 (3930- 5550) deaths will occur from May 13 to June 1, 2020, respectively, and then the curve will flatten. Conclusion: In this study, estimations were made based on severely ill patients who were in need of hospitalization. If enforcement and public behavior interventions continue with current trends, the COVID-19 epidemic will be flat from May 13 until July, 2020 in Iran.

The clinical learning environment of a maternity ward: A qualitative study.

BACKGROUND: Clinical learning environments influence the learning and performance of learners by creating learning opportunities and experiences. The maternity ward offers a major educational opportunity for midwifery students, obstetrics and gynecology residents and medical interns to acquire and improve crucial skills. OBJECTIVES: This study seeks to determine the way in which the clinical learning environment of the maternity ward creates learning opportunities and enables the accumulation of experiences for the noted learners. METHODS: This qualitative study was conducted using inductive content analysis at the Maternity Ward of Shahid Beheshti Hospital, affiliated with University of Medical Sciences. Midwifery students, medical interns and obstetrics and gynecology residents spend a certain period of time in this ward as a mandatory part of their obstetrics and gynecology training. Data were collected through semi-structured individual interviews and observations and were then analyzed in MAXQDA concurrently with data collection. RESULTS: Three main categories emerged from the analysis of the data collected from the interviews and observations: disorganized learning opportunities, heavy emotional load and learners' abandonment in the care-provider and learner role. CONCLUSION: The maternity ward lacked the necessary organization to generate an environment conducive to learning and independent practice for the three groups of learners. The learners' training and acquired skills were thus affected by the clinical learning environment.

Dedication in Caring of Hemodialysis Patients: Perspectives and Experiences of Iranian Family Caregivers.

BACKGROUND: Although dialysis treatment is considered as a life-saving treatment for chronic renal failure patients, the caregivers face challenges in caretaking of these patients. OBJECTIVES: This study is aimed to explain the perspectives and experiences among caregivers of the patients undergoing hemodialysis in Iran. METHODS: A qualitative design, based on a thematic analysis approach, was used to reach the study aim. In this study, 25 hemodialysis family caregivers were selected by purposeful sampling. The data were gathered through in-depth and unstructured interview and field observation and analyzed by the inductive thematic approach. RESULTS: The three main themes were generated from the analysis of the data indicating that the caregivers face challenges such as heavy burden of care, tension in care, and emotional exhaustion. CONCLUSION: Caretaking of the hemodialysis patients is constantly accompanied with challenges and concerns regarding the effective care for patients. Health-care providers need to address these concerns based on both patient- and caregiver-focused approaches, rather than only patient focused, to the design and planning for helping the patients and their caregivers.

COPING SKILLS OF IRANIAN FAMILY CAREGIVERS' IN CARETAKING OF PATIENTS UNDERGOING HAEMODIALYSIS: A QUALITATIVE STUDY.

BACKGROUND: Coping skills enable caregivers to establish and maintain supportive relationships with the haemodialysis patients they care for. These skills are very important in terms of social support, promotion of mental health and social and family relations. The aim of this study is to investigate the coping skills of Iranian family caregivers as they take care of patients undergoing haemodialysis. METHODS: Twenty participants were selected for the study through purposive sampling. The data gathering techniques used for the research were in-depth and unstructured interviews. The researchers used an inductive thematic analysis approach to analyse the data generated from the interviews. RESULTS: Four main themes emerged from the data: help-seeking skills, self-nurturing skills, time management skills and stress management skills. CONCLUSION: The focus of attention was on the stress management coping skills of the caregivers of haemodialysis patients together with their ability to cope with complex problems. Healthcare providers, by taking into account these skills and strategies of empowerment, can help other caregivers of haemodialysis patients cope with their heavy care conditions and better define their purposes in caretaking.

Effect of Topical Application of the Cream Containing Magnesium 2% on Treatment of Diaper Dermatitis and Diaper Rash in Children A Clinical Trial Study.

INTRODUCTION: Diaper dermatitis is referred to the inflammation in outer layers of the skin in the perineal area, lower abdomen, and inner thighs. The lesions are maculopapular and usually itchy, which could cause bacterial or candida infection, and predispose the infants to penis or vaginal and urinary infection and lead to discomfort, irritability, and restlessness. The drugs which have been so far administered for this disease (topical steroids) cause special complications for the sensitive skin in this area. Magnesium (Mg) is known for its anti-inflammatory and wound-healing properties. AIM: The aim of the present study was to study the effect of the cream containing Mg 2% on treatment of diaper dermatitis and diaper rash in children. MATERIALS AND METHODS: In this clinical trial study, 64 children aged less than two years old with diaper dermatitis referring Paediatric Ward of Hajar Hospital were randomly assigned to two groups of 32. Group one was treated with the combined cream Mg 2% and Calendula and group two with Calendula cream alone. The duration of recovery was compared between the two groups. RESULTS: The duration of recovery was significantly lower in the intervention group than the control group (p-value<0.001), but there was no significant difference in the lesions size and diapers' number between the two groups. CONCLUSION: Based on the finding of this study, Mg is effective on treatment of diaper dermatitis and could be used for treating diaper dermatitis and other types of dermatitis.

Therapeutic effects of Ventolin versus hypertonic saline 3% for acute bronchiolitis in children.

BACKGROUND: Complications of Ventolin as the most common drug used for bronchiolitis are widely known. The present study was conducted to determine the efficacy of hypertonic saline 3%, compared with Ventolin, for treatment of acute bronchiolitis in children. METHODS: This double-blinded clinical trial study was conducted in Hajar Hospital, Shahrekord, Iran, from 2011 to 2012. A total of 70 patients under the age of two years with bronchiolitis were divided into two groups of 35 each. Ventolin nebulizer and hypertonic saline 3% nebulizer three times per day were administered in the first (Ventolin) and second (Hypersaline) group, respectively. The length of recovery was compared between the two groups. The data were analyzed by SPSS software (version 22) using chi-square, t-test, paired t-test, and Mann-Whitney. RESULTS: The mean±SD length of recovery was 4.14±0.9 and 3.06±0.6 in the Ventolin and hypersaline groups, respectively. The mean duration of recovery was significantly lower in the hypersaline group (p<0.001). CONCLUSION: Hypertonic saline 3% nebulizer has more pleasant therapeutic effects on acute bronchiolitis than Ventolin. Therefore, use of hypertonic saline 3% nebulizer is recommended for the treatment of acute bronchiolitis in children under two years old.

Retroperitoneal fibrosis associated with propranolol: a case report; is corticosteroid administration necessary after ureterolysis?

INTRODUCTION: Retroperitoneal fibrosis is a rare disease. It can be primary (Ormond's disease) or secondary to inflammation, malignancy or some drugs. Beta-adrenergic blockers including propranolol can cause the retroperitoneal fibrosis disease. CASE: A 44-year-old woman who was taking propranolol for 13 years came to our center with complaints of oliguria and uremia symptoms (malaise, nausea and vomiting). After some investigations, it was found that the disease was retroperitoneal fibrosis. In the first step, she was treated with corticosteroids and then because of inadequate response, bilateral ureterolysis was performed. Then, an additional course of corticosteroid therapy was required after surgery. CONCLUSION: Retroperitoneal fibrosis is an unknown cause disease that can involve ureters and can cause obstructive symptoms. The imaging procedure of choice for diagnosis is abdominal CT scanning with oral and intravenous contrast agents. Corticosteroids are the first option for treatment, however, if they are not effective and in case of severe obstruction, ureterolysis can be performed. Beta- adrenergic blocker drugs that are widely used in heart diseases can be a cause of retroperitoneal fibrosis.

Impact of dialysis access fistula on cardiac function after kidney transplantation.

INTRODUCTION: The cardiovascular impact of a patent arteriovenous fistula (AVF) following kidney transplantation has not been clearly described. This study aimed to evaluate the natural history of AVFs in kidney transplant recipients and the effect of spontaneous AVF closure after kidney transplantation on cardiac status. MATERIALS AND METHODS: Data on vascular access for dialysis were collected from medical charts of kidney transplant recipients between July 2009 and November 2010 at a single center. Echocardiographic re-assessment of the AVF flow and cardiac status was done in selected patients with functioning and nonfunctioning AVFs. RESULTS: Of 180 kidney transplant recipients, 142 had AVFs before transplantation and 99 (69.7%) had a functioning fistula at the time of study after kidney transplantation. Twenty-three patients with a functioning AVF were compared with 17 with spontaneously closed AVFs. The left ventricular ejection fraction improved in both groups posttransplant. In the group with patent fistulas, there was a trend towards lower value of left ventricular end-systolic and end-diastolic diameters, but it did not reach statistical significance. The mean fistula flow was 560 ± 405 mL/min in this group. A significant reduction was observed in the interventricular septum and left ventricular posterior wall diameters in the group with closed AVFs. CONCLUSIONS: Spontaneous AVF closure did not offer a significant cardiac beneficial effect. There are insufficient data to promote systematic closure of AVF after successful kidney transplantation.

Urinary polymerase chain reaction for diagnosis of urogenital tuberculosis.

INTRODUCTION: The aim of this study was to evaluate diagnostic value of urinary polymerase chain reaction (PCR) in urogenital tuberculosis (UTB). MATERIALS AND METHODS: In 33 patients with confirmed diagnosis of UTB by urine culture and/or acid-fast staining, clinical symptoms and laboratory and radiological findings were evaluated. For each patient, 3 consecutive urine samples were examined by PCR for Mycobacterium tuberculosis and the results were compared with the standard microbiological methods and radiological findings. RESULTS: The mean interval between the appearance of the symptoms and the diagnosis was 12.3 +/- 12.2 months. Symptoms were irritative bladder symptoms such as dysuria and diurnal or nocturnal frequency (51.5%), flank pain (27.3%), microscopic hematuria (18.2%), gross hematuria (9.1%), and suprapubic pain (9.1%). The laboratory findings included hematuria (27.3%), pyuria (12.1%), and hematuria with pyuria (48.5%). Diagnosis of UTB was made in 19 patients by positive urine culture for MT in 19 patients (57.6%), positive acid-fast staining in 6 (18.2%), and both in 8 (24.2%). Intravenous urography showed abnormal findings in 16 patients (61.5%), including pyelocaliceal dilatation (26.9%), ureteral stricture and hydroureter (23.1%), multiple small caliceal deformities (15.4%), severe parenchymal destruction (11.5%), autonephrectomy (11.5%), and calcification (7.7%). Urinary PCR was positive in 16 patients (48.5%) and in 10 (62.5%) with abnormal findings on intravenous urography. CONCLUSION: A high index of suspicion is necessary for diagnosis of UTB even in patients with nonspecific manifestations. Urinary PCR is recommended for instant diagnosis and screening before further examinations, but it cannot be the sole diagnostic modality for diagnosis of UTB.