OSABSS: An authentic examination for assessing basic surgical skills in surgical residents.

Objectives: This study aimed to develop and validate the OSABSS (Objective Structured Assessment of Basic Surgical Skills), a modified Objective Structured Clinical Examination (OSCE), to assess basic surgical skills in residents. Design: A developmental study conducted in two phases. Basic skills were identified through literature review and gap analysis. The OSABSS was then designed as a modified OSCE. Setting: This study took place at Alborz University of Medical Sciences in Iran. Interventions: The OSABSS was created using Harden's OSCE (Objective Structured Clinical Examination) methodology. Scenarios, checklists, and station configurations were developed through expert panels. The exam was piloted and implemented with residents as participants and faculty as evaluators. Participants: 32 surgical residents in gynecology, general surgery, orthopedics, and neurosurgery participated. 22 faculty members were evaluators. Primary and secondary outcome measures: The primary outcome was OSABSS exam scores. Secondary outcomes were written exam scores, and national residency entrance ranks. Main results: The mean OSABSS score was 16.59 ± 0.19 across all stations. Criterion validity was demonstrated through correlations between OSABSS scores, written scores and entrance ranks. Reliability was high, with a Cronbach's alpha of 0.87. No significant inter-rater score differences were found. Conclusions: The rigorous OSABSS development process produced an exam demonstrating strong validity and reliability for assessing basic surgical skills. The comprehensive station variety evaluates diverse technical and non-technical competencies. Further research should expand participant samples across surgical disciplines.

Potential impacts of climate change on the geographic distribution of Achillea eriophora DC., a medicinal species endemic to Iran in southwestern Asia.

Climate change is considered to rank among the most important global issues affecting species' geographic distributions and biodiversity. Understanding effects of climate change on species can enhance conservation efficacy. In this study, we applied ecological niche modeling (ENM) using maximum entropy (MaxEnt) approaches to predict the potential geographic distribution of Achillea eriophora DC., a medicinal plant species to Iran in southwestern Asia, under current and future climate scenarios. We evaluated potential distributional areas of the species, under two shared socioeconomic pathways (SSP2-4.5 and SSP5-8.5) for the period 2041-2060. Most current potential suitable areas were identified for A. eriophora in montane regions. Our results anticipated that the potential distribution of A. eriophora will expand geographically toward higher elevations and northward. However, the species is expected to experience relatively high losses of suitability in its actual habitats under future climate scenarios. Consequently, we recommend regional-to-national conservation action plans for A. eriophora in its natural habitats.

Breaking down barriers and building up facilitators of lecture free curriculum in medical education: An interpretive structural modeling.

INTRODUCTION: The field of medical education has seen a growing interest in lecture free curriculum. However, it comes with its own set of challenges and obstacles. In this article, we aim to identify the prerequisites, facilitators, challenges, and barriers of lecture-free curriculum in medical education and examine their interrelationships using interpretive structural modeling (ISM) technique. METHODS: In this mixed-method study initially, we performed a scoping review and semi-structured interviews and determined the main prerequisites, facilitators, challenges, and barriers of lecture-free curriculum in medical education using qualitative content analysis approach. The interrelationships among these components were investigated using ISM. Therefore, self-interactive structural matrices were formed, initial and final reachability matrices were achieved, and MICMAC analysis was conducted to classify the factors. RESULTS: Finally, two ISM models of prerequisites and facilitators with 27 factors in 10 levels and challenges and obstacles with 25 factors in eight levels were developed. Each of the models was divided into three parts: key, strategic, and dependent factors. 'Providing relevant evidence regarding lecture free curriculum' emerged as the most important prerequisite and facilitator, and 'insufficient support from the university' was identified as the most critical barrier and challenge. CONCLUSIONS: The study highlights the significant importance of lecture-free curriculum in medical education and provides insights into its prerequisites, facilitators, challenges, and barriers. The findings can be utilized by educational managers and decision-makers to implement necessary changes in the design and implementation of lecture-free in medical education, leading to more effective improvements in the quality and success of education.

The Prevalence of Virulence Factors among ESBLs-Producing Klebsiella pneumoniae Isolated from Khorramabad Hospitals, Iran.

BACKGROUND: Klebsiella pneumoniae is one of the opportunistic bacteria that cause hospital infections. Various virulence factors are involved in its pathogenesis. The purpose of our study was to investigate the prevalence of virulence factor genes entB, mrkD, magA, kfu, iutA, rmpA, ybtS, and k2 among ESBLs-producing Klebsiella pneumoniae isolated from clinical samples of Khorramabad hospitals in Iran. METHODS: In this descriptive, analytical study, the extended-spectrum ß-lactamases (ESBLs) screening phenotypic test was performed by disc diffusion method, and virulence factor genes were detected by PCR method for Klebsiella pneumoniae isolates. Finally, the obtained data were statistically analyzed by SPSS software (version 21) using the chi-squared test. RESULTS: One hundred and ten K. pneumoniae strains were isolated from urine 69 (62.7%), sputum 16 (14.5%), blood 10 (9.1%), wound 9 (8.2%), tissue 3 (2.7%), body fluids 2 (1.8%), and catheter 1(0.9%). Based on an ESBL screening phenotypic test, 57 (51.8%) K. pneumoniae isolates were ESBLs-producing. Among 57 ESBLs-positive K. pneumoniae, the occurrence of mrkD, entB, ybtS, iutA, kfu, k2, and rmpA genes were 88 (80%), 87 (79.1%), 65 (59.1%), 42 (38.2%), 19 (17.3%), 5 (4.5%), 3 (2.7%), and 2 (1.8%), respectively. CONCLUSIONS: The findings of this study revealed, there is no significant association between the occurrence of virulence genes or source of samples with production of ESBLs among K. pneumoniae isolates.

Does coping with pain help the elderly with cardiovascular disease? The association of sense of coherence, spiritual well-being and self-compassion with quality of life through the mediating role of pain self-efficacy.

BACKGROUND: Population ageing is considered one of the biggest challenges facing the world, and the status of the elderly in society and their quality of life (QOL) have proved to be a concern in professional and scientific research circles. As a result, the current study sought to investigate the role of pain self-efficacy (PSE) as a moderator in the relationship between sense of coherence (SOC), spiritual well-being, and self-compassion with QOL in Iranian elderly with cardiovascular disease (CVD). METHOD: This was a correlational study of the path analysis type. The statistical population included all elderly people with CVD who were at least 60 years of age in Kermanshah Province, Iran, in 2022, of whom 298 (181 men and 117 women) were selected using convenience sampling and according to the inclusion and exclusion criteria. The participants answered questionnaires from the World Health Organization on QOL, Paloutzian and Ellison's spiritual well-being, Nicholas's PSE, Antonovsky's SOC, and Raes et al.'s self-compassion. RESULTS: The results of path analysis demonstrated that the hypothesized model of this study has a good fit in the studied sample. There were significant paths between SOC (ß = 0.39), spiritual well-being (ß = 0.13) and self-compassion (ß = 0.44) with PSE. Although there were significant paths between SOC (ß = 0.16) and self-compassion (ß = 0.31) with QOL, there was no significant path between spiritual well-being and QOL (ß = 0.06). Besides, there was a significant path between PSE and QOL (ß = 0.35). Finally, PSE was found to mediate the relationship of SOC, spiritual well-being and self-compassion with QOL. CONCLUSION: The results may provide psychotherapists and counselors working in this field of inquiry with advantageous information to choose or create a useful therapeutic method to work with the elderly with CVD. Meanwhile, other researchers are suggested to examine other variables which may serve a mediating role in the mentioned model.

Clinical and epidemiological profile of ST-segment elevation myocardial infarction patients in a megacity of west of Iran.

Background and Aims: Low- and middle-income nations account for at least three-quarters of cardiovascular disease deaths worldwide. This study aimed to obtain real knowledge about ST segment elevation myocardial infarction (STEMI) patients and provide the context for developing a principles for care quality improvement. Method: This cross-sectional study was conducted from July 2018 through December 2019. The study sample consisted of1169 eligible patients based on inclusion criteria. The data were collected using the standard EROP and three specialized, trained questionnaires. The collected data were checked by the quality control officer and analyzed using Stata Version 14. Results: Patient baseline characteristics showed that body mass index, low-density lipoprotein, high-density lipoprotein, total cholesterol, and triglyceride levels were higher in women. Also, females recorded a considerable history of diabetes mellitus, hypertension, and hypercholesterolemia compared to men. The results also showed that most men were smokers (46.80%). Aspirin (94.27%), statins (91.48%), and clopidogrel (90.68%) were the common medications used at hospital discharge for patients. Conclusion: The present study suggests that identifying and managing modifiable risk factors can improve cardiovascular disease outcomes. Also, considering the early identification of STEMI patients with new therapies can effectively decrease the rate of cardiovascular disease and its attributed health outcomes.

Age and sex-related differences in epidemiology, treatment, and mortality of patients with ST-segment elevation myocardial infarction in Iran.

Introduction: Few studies have investigated the characteristics of patients with ST elevation myocardial infarction (STEMI) according to age and sex in Iran. This study aims to investigate the risk factors profile, treatment, and mortality of STEMI based on age and sex. Methods: From 10th June 2016 to December 2019 a total of 2816, STEMI patients referred to the Imam Ali heart center of Kermanshah were included in the study. Profile of the risk factors, epidemiology, treatment and 30- day mortality for all cases in the age categories of 18-49, 50-64, and≥65 years were studied. Results: There were 1256 (44.6%) middle-aged STEMI patients, and 2181 (77.45%) were male. The elderly had a longer median door-to-balloon and symptom-to-balloon time and received less primary PCI. In the absence of primary PCI, the rate of 30-day mortality in women was higher than in men, and the mortality rate increased with age. The risk of death in middle-aged women was higher than that of men. Also, in the middle-aged group, after multivariable adjustment, previous bypass surgery, diabetes, and Killip class≥2 was associated with significant increase in the risk of death. Conclusion: The present study showed that young people with STEMI had a high risk of heart failure and anterior infarction compared to the older age groups. Women had more risk factors for STEMI and a higher mortality rate than men. Therefore, there is a need to educate young age groups and women to modify their lifestyles and intervene in the risk factors of heart diseases.

Minimal climate change impacts on the geographic distribution of Nepeta glomerulosa, medicinal species endemic to southwestern and central Asia.

Medicinal plants are valuable species, but their geographic distributions may be limited or exposed to extinction by climate change. Therefore, research on medicinal plants in the face of climate change is fundamental for developing conservation strategies. Distributional patterns for a semi-endemic medicinal plant species, Nepeta glomerulosa, distributed in southwestern and central Asia was determined based on a maximum-entropy algorithm. We evaluated potential geographic shifts in suitability patterns for this species under two Shared Socioeconomic Pathways scenarios (SSP2-4.5 and SSP5-8.5) of climate change for 2060. Our models based on climatic features indicate that the species occupies montane areas under current conditions; transfer of the model to future climate scenarios indicated that suitable areas for the species will increase in general, and the species will likely track its favored set of climate conditions. But the types and degrees of these changes differ among areas. Our findings can be used to inform conservation management programs for medicinal, endemic, and endangered species that probably respond similarly to climate change in southwestern and central Asia.

Habitat potential modelling and mapping of Teucrium polium using machine learning techniques.

Determining suitable habitats is important for the successful management and conservation of plant and wildlife species. Teucrium polium L. is a wild plant species found in Iran. It is widely used to treat numerous health problems. The range of this plant is shrinking due to habitat destruction and overexploitation. Therefore, habitat suitability (HS) modeling is critical for conservation. HS modeling can also identify the key characteristics of habitats that support this species. This study models the habitats of T. polium using five data mining models: random forest (RF), flexible discriminant analysis (FDA), multivariate adaptive regression splines (MARS), support vector machine (SVM), and generalized linear model (GLM). A total of 119 T. poliumlocations were identified and mapped. According to the RF model, the most important factors describing T. polium habitat were elevation, soil texture, and mean annual rainfall. HS maps (HSMs) were prepared, and habitat suitability was classified as low, medium, high, or very high. The percentages of the study area assigned high or very high suitability ratings by each of the models were 44.62% for FDA, 43.75% for GLM, 43.12% for SVM, 38.91% for RF, 28.72% for MARS, and 39.16% for their ensemble. Although the six models were reasonably accurate, the ensemble model had the highest AUC value, demonstrating a strong predictive performance. The rank order of the other models in this regard is RF, MARS, SVM, FDA, and GLM. HSMs can provide useful output to support the sustainable management of rangelands, reclamation, and land protection.

Airborne Pollens and Their Association with Meteorological Parameters in the Atmosphere of Shiraz, Southwest Iran.

Airborne pollen is considered one of the causative agents of hay fever, allergic rhinitis, conjunctivitis, and asthma. We aimed to investigate airborne pollens in the context of Shiraz located in the southwest of Iran and find their association with meteorological parameters.  The survey was conducted from October 2017 to September 2018, using seven days of volumetric Burkard spore trap, located in the center of the city. A total of 5810 pollen grains/m3 belonging to 15 taxa were identified and recorded. Among them, 73.8% was the tree, while the grass, shrub, and weed constituted 13.56%, 3.5%, and 9.2% of total reported pollens, respectively. The major pollen types were Platanaceae (28.39%), Oleaceae (21.17%), Pinaceae (15.11%), Amaranthaceae (9.29%), and Brassicaceae (8.02%). A higher number of pollen counts and types were recorded in March, followed by September, while it was lower in May. Meteorological parameters were correlated with the monthly pollen counts. Wind speed was found to have a positive correlation with Platanaceae concentration. The significant correlation between pollen concentration and the temperature was positive for Poaceae, Amaranthaceae, and Plantaginaceae and negative for Rosaceae, Oleaceae, and Ulmaceae.  Poaceae and Amaranthaceae were negatively correlated with humidity and positively with Rosaceae, Oleaceae, and Plantaginaceae. A negative correlation was found between rainfall and Poaceae and Amaranthaceae, while Plantaginaceae had a positive correlation with this parameter. The results of this study may be helpful for allergologists in the diagnosis and treatment of airborne allergic disorders due to pollen grains.

Psychometric Properties of the Persian Version of Cardiovascular Management Self-efficacy Scale.

BACKGROUND: Self-efficacy plays a major role in the management of cardiovascular disease (CVD). The original Cardiovascular Management Self-efficacy Scale (CMSS) was developed in 2016 in Italian patients with CVD; however, no such scale exists for Iranian patients with CVD. OBJECTIVE: We translated the CMSS into Persian and assessed its validity, reliability, and psychometric properties in Iranian patients with CVD. METHODS: This study was conducted for 4 months in 2017 on a group of consenting patients with CVD (N = 363) recruited from a cardiovascular hospital in Kermanshah, Iran. The reliability of the Persian CMSS was evaluated. We assessed validity, including face, content, construct, convergent, divergent, and discriminate validity, using the General Self-efficacy Scale, the Hospital Anxiety and Depression Scale, and the 36-item Short Form Health Survey Scale. Known-group validity was assessed among patients with high blood pressure. RESULTS: The Persian CMSS had acceptable face and content validity. No floor or ceiling effects were found for the total scale. Cronbach α was calculated as .68. Test-retest reliability was confirmed by intraclass correlation coefficient (ICC1,3 = 0.98, P < .001). Using exploratory factor analysis, 3 subscales were identified, similar to the original version. Significant correlations were found between the Persian CMSS and both the General Self-efficacy Scale (r = 0.94, P < .001) and Hospital Anxiety and Depression Scale (r = -0.35, P < .05). Self-efficacy measured using the Persian CMSS was statistically different between 2 levels of patients' health status (P < .05). Patients with hypertension had a lower level of self-efficacy than those in the healthy group (P < .05). CONCLUSIONS: The Persian version of CMSS provides a practical, reliable, and valid scale for evaluating self-efficacy in the clinical management of Persian Iranian patients with CVD.

Comparison of the effect of two teaching methods on surgical technologist students' learning and satisfaction (flashcards vs. mobile-based learning).

BACKGROUND: M-learning is "learning across multiple contexts, through social and content interactions, using simple hand-held technologies, wireless and mobile network. This personal electronic device is a way to facilitate the transfer of learning and improve teaching. Hence, the researchers decided to design a mobile-based learning application to teach surgical instruments comprehensively and compare students' learning and satisfaction in both mobile-based learning and flashcards methods. MATERIALS AND METHODS: An interventional study was conducted on surgical technologist students in Alborz University of medical science (2019). Students were divided into two groups: flashcards (n = 21) and mobile application learning group (n = 21). The difference of pre- and post-test scores was considered for the evaluation of learning level in two groups. Data were entered into SPSS 20.0 software and analyzed by statistics tests. Data were analyzed by a paired t-test, independent t-test, and Pearson's correlation coefficient. RESULTS: There was no significant difference in students' knowledge level between two groups before intervention (P = 0.87) but there was significant difference between groups after the intervention (P = 0.003). In the evaluation of student's satisfaction, the mobile application was preferred by 84.28% of students. CONCLUSION: Given the effectiveness of using both methods (flashcards and mobile application), it is recommended that these methods especially mobile application be used for surgical instruments education.

Isolation and identification of probiotic Lactobacillus from local dairy and evaluating their antagonistic effect on pathogens.

OBJECTIVE: Probiotics such as lactobacilli prevent the development of a wide range of human and animal's pathogens. The aim of this study was evaluation of antagonistic effect of isolated lactobacilli from local dairy products against three standard strains of Staphylococcus aureus, Bacillus subtilis, and Pseudomonas aeruginosa. MATERIALS AND METHODS: Twenty samples of local dairy products including cow milk, buffalo milk, cheese, and yogurt were collected from different areas of Ahwaz city. Antimicrobial disc diffusion method was applied on S. aureus (ATCC-6538), B. subtilis (ATCC-12711), and P. aeruginosa (ATCC-27853). Antimicrobial effects of isolates were evaluated by disc diffusion test on Mueller-Hinton agar medium plated with three pathogens. RESULTS: Obtained results showed that only three strains of isolated lactobacilli of local dairy samples had inhibitory effects on understudy pathogens including Lactobacillus alimentarius, Lactobacillus sake, and Lactobacillus collinoides. All three isolates showed moderate activity (inhibition zone <15 mm) except of L. collinoides and L. alimentarius that had relatively strong activity (inhibition zone ≥15 mm) against P. aeruginosa and B. subtilis, respectively. CONCLUSION: These bacteria can be raised for the production of various kinds of food, pharmaceutical products, and functional foods.

Antifungal effects of Lactobacillus species isolated from local dairy products.

OBJECTIVE: The Lactobacillus is a genus of lactic acid bacteria which are regularly rod-shaped, nonspore, Gram-positive, heterogeneous, and are found in a wide range of inhabitants such as dairy products, plants, and gastrointestinal tract. A variety of antimicrobial compounds and molecules such as bacteriocin are produced by these useful bacteria to inhibit the growth of pathogenic microbes in the food products. This paper aims to examine the isolation of Lactobacillus from local dairies as well as to determine their inhibition effect against a number of pathogens, such as two fungi: Penicillium notatum and Aspergillus fulvous. MATERIALS AND METHODS: Twelve Lactobacillus isolates from several local dairies. After initial dilution (10-1-10-3) and culture on the setting, de Man, Rogosa and Sharpe-agar, the isolates were recognized and separated by phenotypic characteristics and biochemical; then their antifungal effect was examined by two methods. RESULTS: Having separated eight Lactobacillus isolates, about 70% of the isolates have shown the inhabiting areas of antifungus on the agar-based setting, but two species Lactobacillus alimentarius and Lactobacillus delbrueckii have indicated a significant antifungal effect against P. notatum and A. fulvous. Except bacteriocin, lactic acid, and acetic acid, the inhibitor substance is produced by these bacteria. CONCLUSION: Given the vitality of Lactobacillus in human health, recognition and isolation of the species producing compound in antagonist to the pathogens existing in the food products can be a helpful and effective step toward maintaining the valuable native Lactobacillus and using them in the dairy industries.