The impact of cancer incidence on catastrophic health expenditure in Iran with a Bayesian spatio-temporal analysis

Background : We investigated the impact of cancer incidence on CHE in Iran by considering spatial variation across provinces as well as temporal trends. Methods : Data from Household Income-Expenditure Survey were merged with cancer incidence rates during 2011-2016. We developed a Bayesian hierarchical model to explore the spatial and temporal patterns of CHE and its associated factors at provincial level. We used a Besag-York-Mollie2 prior and a random walk prior for spatial and temporal random effects respectively. All statistical analysis was carried out in R software. Results : All-type cancer incidence (OR per SD (95% CrI) = 1.16 (1.02, 1.32)), unemployment rate (1.08 (1.01, 1.15)) and income equity (0.88 (0.81, 0.97)) have important association with CHE. Percentage of urbanization and percentage of poverty were not statistically significant. Conclusion : The results suggest the development of new policies to protect cancer patients against financial hardship, narrow the gap in income inequality and solve the problem of high unemployment rate to reduce the level of CHE at provincial level.Publisher PDFPeer reviewe

Learning Style and Academic Achievement among Students at Tabriz University of Medical Sciences, Iran

Background: Variations in learning styles among students could explain many differences in students’ acquisition of knowledge. This study examined the association between learning styles and academic achievement among students at Tabriz University of Medical Sciences in the northwest of Iran. Methods: This research is part of a longitudinal study entitled, "Health and Lifestyle of University Students" among undergraduate, medical, dentistry, and pharmacy students at Tabriz University of Medical Sciences who entered the university in October 2014. A self-administered questionnaire that consisted of general information and Kolb’s learning style was completed by these students during the first eight weeks of their first semester. Academic achievement was assessed using grade point average (GPA) in the following semesters (1 and 2) of the academic year. Results: A total of 452 students were included in this study with a mean age of 19.16 ±1.03. The most prevalent learning style was convergent and the second most common was accommodative.The average GPA of the students was 15.74 ± 1.57 out of a possible 20. The results of a multivariate regression showed that the effect of learning style on academic achievement, in the presence of other variables, was not statistically significant. Sex was able to predict academic progression (β = 0.188, P = 0.001). In addition, GPA was higher among dentistry students(β = 0.128, P = 0.012) and lower among nursing and medical students (β = =-0.211, P = 0.001;β = -0.127, P = 0.015 respectively). Conclusion: Although students’ academic achievement was correlated with their learning style, the popularity of convergent and accommodative styles should be considered in that acknowledging the prevailing learning styles of students could promote academic achievement

Colony site characteristics of sympatric breeding tern species on the Mond Islands, the Persian Gulf

We have investigated characteristics of colony site of three sympatric breeding tern species on small islands of a subtropical region, the Persian Gulf. The three most populous ground-nesting waterbird species – Bridled Tern Onychoprion anaethetus, Lesser Thalasseus bengalensis and Greater Thalasseus bergii Crested Terns – were studied during the 2009–2011 breeding seasons. The average area size of mixed colonies was 454 m2. The density of nests of the Bridled Tern was 846 nests/ha. The proportion of the number of nests in a mixed colony for Lesser Crested Tern (5546 nests) was approximately 10-fold compared to the Greater Crested Tern (542 nests). The density of Bridled Tern nests/ha was significantly higher in areas with 50–75% vegetation cover (>1200 nests/ha) than in areas of <5% vegetation cover (72–105 nests/ha) (p < 0.05). Mixed colonies of the Lesser and Greater Crested Terns were located on unvegetated land, at an average distance of 4.1 m to vegetation, and on sandy soil (79.4% on average) and above high spring tide water lines (0.59 m on average). There were more potential nesting areas than occupied areas for the mixed colonies of the Lesser and Greater Crested Terns, indicated that they did not face nest site limitation

The Effect of Medical Recording Training on Quantity and Quality of Recording in Gynecology Residents of Tabriz University of Medical Sciences

Introduction: Medical records contain valuable information about a patient's medical history and treatment. Patient safety is one of the most important dimensions of health care quality assurance and performance improvement. Completing the process of documentation is necessary to continue patient care and continuous quality improvement of basic services. The aim of the present study was to evaluate the effect of medical recording education on the quantity and quality of recording in gynecology residents of Tabriz University of Medical Sciences. Methods: This study is a quasi-experimental study and was conducted at Al-Zahra Teaching Hospital, Tabriz, Iran, in 2016. Thirty-two second through fourth year gynecologic residents of Tabriz University of Medical Sciences who were willing to participate in the study were included by census sampling and participated in training workshop. Three evaluators reviewed the residents’ records before and after training course by a checklist. Statistical analyses were performed using SPSS 13 software. P-values less than 0.05 were considered statistically significant. Results: The results showed that before the intervention, there were significant differences in the quantity of information status among the evaluators and no significant difference was observed in the recording of qualitative status. After the workshop, among the 3 evaluators, there were also significant differences in the quantity of data recording status; however, no significant change was observed in recording of qualitative status. Conclusion: The study findings revealed that a sectional training course of correct and standardized medical records has no effect on reforming the process of recording

Identifying outcome-based indicators and developing a curriculum for a continuing medical education programme on rational prescribing using a modified Delphi process

<p>Abstract</p> <p/> <p>Background</p> <p>Continuing medical education (CME) is compulsory for physicians in Iran. Recent studies in Iran show that modifications of CME elements are necessary to improve the effectiveness of the educational programmes. Other studies point to an inappropriate, even irrational drug prescribing. Based on a needs assessment study regarding CME for general physicians in the East Azerbaijan province in Iran, rational prescribing practice was recognized as a high priority issue. Considering different educational methods, outcome-based education has been proposed as a suitable approach for CME. The purpose of the study was to obtain experts' consensus about appropriate educational outcomes of rational prescribing for general physicians in CME and developing curricular contents for this education.</p> <p>Methods</p> <p>The study consisted of two phases: The first phase was conducted using a two-round Delphi consensus process to identify the outcome-based educational indicators regarding rational prescribing for general physicians in primary care (GPs). In the second phase the agreed indicators were submitted to panels of experts for assessment and determination of content for a CME program in the field.</p> <p>Results</p> <p>Twenty one learning outcomes were identified through a modified Delphi process. The indicators were used by the panels of experts and six educational topics were determined for the CME programme and the curricular content of each was defined. The topics were 1) Principles of prescription writing, 2) Adverse drug reactions, 3) Drug interactions, 4) Injections, 5) Antibiotic therapy, and 6) Anti-inflammatory agents therapy. One of the topics was not directly related to any outcome, raising a question about the need for a discussion on constructive alignment.</p> <p>Conclusions</p> <p/> <p>Consensus on learning outcomes was achieved and an educational guideline was designed. Before suggesting widespread use in the country the educational package should be tested in the CME context.</p

Assessment of Emergency Departments of Shahid Beheshti University of Medical Sciences Training Centers

بخش اورژانس هر بیمارستان با فعالیت 24 ساعته، معمولا پذیرای بیشترین مراجعین یک مرکز درمانی در طول شبانه روز است. مراجعین با مشکلات گوناگون و سطح توقعات متفاوت در ساعات مختلف به این واحد مراجعه می کنند و پزشکان و کادر درمان این بخش نیز موظف هستند در تمامی ساعات شبانه روز و تمامی ایام هفته در محل خدمت خود حضور داشته باشند. بیماران در این بخش با هر وضعیت اقتصادی، اجتمادی و نژادی ویزیت می شوند و ترتیب رسیدگی به مراجعین فقط وابسته به شدت و نوع بیماری آنهاست. امروزه یکی از دغدغه های مسئولین بهداشت در کشورهای مختلف ایجاد یک اورژانس کارا با توانایی پاسخگویی بالا به خیل عظیم مراجعین می باشد و بدیهی است که این امر نیازمند رعایت اصول و استانداردهای لازم در این زمینه است. لذا بحث بهبود کارایی و اثربخشی یا به بیانی افزایش بهره وری در این خصوص بیش از پیش اهمیت یافته است. ارزیابی های دوره ای بخش اورژانس می تواند مشکلات و نواقص موجود را نمایان کند و انتقال این مسایل به مسئولین عالی رتبه ذیربط می تواند به حل مشکلات کمک نماید.  طی یک مطالعه توصیفی - مقطعی در سال های 1384 و  1387 وضعیت بخش های اورژانس در شش بیمارستان تابعه دانشگاه علوم پزشکی شهید بهشتی، تهران، شامل بیمارستان های مفید، لقمان حکیم، طالقانی، شهید مدرس، شهدای تجریش و امام حسین به وسیله 340 شاخص مستخرج از استانداردهای اعتبار بخشی ایران و استاندارد های انجمن علمی اورژانس آمریکا مورد بررسی قرار گرفتند. یافته های این مطالعه نشان داد که در سال 1384 بیمارستان های لقمان حکیم با مجموع 129 امتیاز، امام حسین با 128 امتیاز و مفید با 125 امتیاز بیشترین انطباق با استاندارد های مورد ارزیابی را داشتند. بر همین اساس امتیاز اعتبار بخشی تمامی بیمارستان های مورد ارزیابی در سال 1387 افزایش یافته بود. میزان تغییرات نمره کلی بیمارستان های لقمان حکیم، طالقانی، مدرس، شهدای تجریش، مفید، امام حسین به ترتیب 3، 52، 19، 22، 13 و 84 بود. بیشترین ارتقاء امتیاز برای بیمارستان های امام حسین، طالقانی و شهدای تجریش بود. Emergency department of each hospital is active 24 hours a day and usually has the highest number of daily visitors in the health center. The visitors present with a variety of problems and expectations in various times and the physicians and staff should be present in this unit at all times during day and night, on weekdays and weekends. Patients with any financial and social position and race are visited in this department and only the severity and type of their disease determines the order of their treatment. Currently, one of the concerns of the authorities of health care in different countries is developing an efficient emergency department with high capacity for responding to the vast number of visitors, which obviously correlates with adhering to the standards and principles in this regard. Therefore, improving its efficiency has gained importance more than ever. Periodical evaluation of the emergency department can reveal the existing problems and show them to the responsible authorities, which can help relieve them. In a descriptive cross-sectional study in 2005 and 2008, the condition of emergency department was evaluated in 6 hospitals supervised by Shahid Beheshti University of Medical Sciences including Mofid, Loghmane Hakim, Taleghani, Shahid Modarres, Shohadaye Tajrish, and Imam Hossein using 340 indices extracted from Iranian accreditation standards and American Academy Of Emergency Medicine standards. The findings of the study showed that in 2005, Loghmane Hakim Hospital with a total score of 129, Imam Hossein with 128, and Mofid with 125 points were adhering to the evaluated standards the most. In 2008, the accreditation score of all the hospitals had raised. The changes in total score of Loghmen Hakim, Taleghani, Modarres, Shohadaye Tajrish, Mofid, and Imam Hossein hospitals were 3, 52, 19, 22, 13, and 84, respectively. The highest improvement in score belonged to Imam Hossein, Taleghani, and Shohadaye Tajrish hospitals. Maybe improvement of emergency services and their management in Tehran, especially in teaching hospitals, has helped moving towards the standards. Many factors including the rise in the number of certified emergency medicine specialists in Iran, the raise in the budget considered for improving emergency departments, and better education of emergency department staff have led to this. The important point in this study is improvement of data registration systems as well as information management systems that have increased the speed of information access and have led to better cooperation between different hospital units, including emergency physicians, and the patients. This has resulted in the improvement of services provided on one hand and increased patient satisfaction on the other. It seems that repeating these kinds of evaluation and increasing reinforcement mechanisms can help in keeping or even accelerating this trend.

Designing Information Acquisition Tools for Assessing the Status of Outpatient Training for Medical Students

Introduction: Outpatient medical education is one of the important parts of clinical training in medical education which has been given particular attention today due to its deep relationship with the future of the physician's occupation. Lack of proper tools and standards for assessing the status of outpatient education is one of the obstacles to conducting ambulatory education assessment studies. Therefore, this study was aimed at developing instruments for assessing outpatient training of medical students during externship and internship in Clinics Affiliated to the Medical Sciences Universities. Methods: This developmental and psychometric study was conducted to develop an outpatient education assessment instrument in educational clinics. The sources used were included reputable medical education reference books, general medical education curriculum and previous studies. For standardization and calculation of reliability and validity, Cronbach's alpha coefficient and survey of specialists were used respectively. We used SPSS tools for data processing, and Pearson correlation index for inferential analysis. Results: The developed instruments included two educational status assessment questionnaires from the viewpoint of students (reliability 89%, validity 85%) and faculty members (reliability 90%,validity 85%), a patient satisfaction assessment questionnaire (reliability 90%,validity 80%), and an observational checklist for assessment of educational clinics (reliability 95%,validity 82%). Conclusion: The developed instruments in this study compared with the instruments used in previous studies simultaneously evaluates the status of outpatient education from the viewpoint of all the three involved exposures, including tutor, learner, and patient; which is the important positive point. The evaluation of educational clinics of medical universities in the future with the developed instruments in this study while providing a clear image of the status, can provide comparable information between educational centers

Management of Social Accountability in Medical Education at Tabriz University of Medical Sciences

Introduction: Since the ultimate goal of medical education is to improve health, all the efforts of custodians’ and service providers’ training must meet the needs of society. The World Health Organization defines social accountability as guiding commitment toward education, research and medical services in line with the prioritizing the health requirements of the community, region and world. Methods: This cross - sectional study was conducted in two phases, including observation and documenting the activities and programs of the Tabriz University of Medical Sciences. Results: Tabriz University of Medical Sciences has taken some steps towards social accountability in medical education, including determining the priorities of health and disease in the province, presenting health and disease training programs in the local media, preparing appropriate community-based teaching fields, empowering faculty members in new teaching and assessment methods and training the students based on the community health requirements. Conclusion: Despite all of these activities, it is still necessary to evaluate social accountability indicators in this university for further achievements towards comprehensive social accountability

Conformity of Nursing Clinical Courses with Nursing Job Responsibilities in Tabriz University of Medical Sciences

Introduction: One of the problems of nursing education is the conformity of clinical training with nursing job responsibilities. Therefore, the purpose of this study was to assess the conformity of clinical courses of nursing students with nursing job responsibilities from the perspective of temporary employed nurses in Tabriz University of Medical Sciences. Methods: This descriptive study was conducted in 2015. All temporary employed nurses working in 5 teaching hospitals of Tabriz were selected through census method. The sample size was equal to the whole population (145 people). All of the subjects except those who were absent for more than a month in the center were included in the study. Data were collected by a valid and reliable researcher-made questionnaire to assess the conformity of 9 clinical courses. Scores were coded as 1 (very low), 2 (low), 3 (high) and 4 (very high). Descriptive statistics were used to analyze the data. Results: The conformity rates of the nursing clinical courses with clinical responsibilities were 89.69% for nursing principles and skills, 74.48% for community health nursing, 88.03% for health status evaluation, 68.54% for maternity and newborn health, 80.79% for pediatric nursing, 72.13% for medical-surgical nursing, 77.11% for critical care nursing, 77.68% for emergencies and disasters nursing, 77.68 and 75.41% for mental health nursing. These rates were evaluated at very high and high levels. Conclusion: For higher conformity of the courses with the clinical responsibilities of the curriculum, it is recommended that nursing education planners should comprehensively review and revise the syllabus and clinical learning model