A qualitative approach to identify barriers to multi-professional teamwork among medical professors at Iranian teaching hospitals

Background: In some cases of diseases, such as infectious, neurological and chronic ones prevention and treatment is complex. Therefore, a single medical specialty alone cannot effectively manage treatment of patients due to health care needs of them and complexities of treatment. Instead, a team composed of different healthcare disciplines with effective, continuous, and organized communication must follow up various aspects of patient care. In this regard, the present qualitative study aimed to shed light on the experiences of clinical teachers of multi-professional teamwork barriers within Iranian teaching hospitals. Methods: In this qualitative research, the experiences of medical clinical teachers of multi-professional teamwork barriers within teaching hospitals were explained. Sampling was theoretical and the data were collected from experienced clinical teachers and medical students studying at several Universities of Medical Sciences through semi-structured interviews and observation, which were continued until data saturation. Fifteen clinical teachers and five medical students participated in the study. The interviews were analyzed using conventional content analysis. Results: Three main categories were extracted. The first category was �enhancing the culture of interdisciplinary education� included �paving the way for an interdisciplinary culture�, �enhancing teamwork culture�, and �having a general view of medical sciences instead of specialization�. The second category was �barriers of interdisciplinary education� included �influence of the dominant culture of specialization in society�, �poor interdisciplinary education infrastructure�, and �individualism as a value of society�. And the third category was �consequences of specialization� included �medical sciences education under the shadow of specialization�, �possibility to harming patients�, and �distrust of society in the services provided by the 1st and 2nd level centers�. Conclusion: It seems that attitudinal barriers, teamwork difficulties, and the culture of individualism are evident in Iran; more, roles of the healthcare team and the status of each member is not clear. Designing interactive curriculum and arranging clinical settings to facilitate exchange of ideas among clinical teachers and students of different disciplines, is a step forward to achieving a common value concept, language, and common perception, and establishing cooperation and understanding among disciplines involved, which leads to further understanding of the professional responsibilities of other disciplines. © 2021, The Author(s)

Filosofia come stile di vita. Conversazione con Luigi Vero Tarca

OBJECTIVE: To examine factors associated with chronic energy deficiency (CED) and anaemia in disadvantaged Indian adults who are mostly involved in subsistence farming. DESIGN: A cross-sectional study in which we collected information on socio-demographic factors, physical activity, anthropometry, blood haemoglobin concentration, and daily household food intake. These data were used to calculate body mass index (BMI), basal metabolic rate (BMR), daily energy expenditure, and energy and nutrient intake. Multivariable backward stepwise logistic regression was used to assess socioeconomic and lifestyle factors associated with CED (defined as BMI<18 kg/m²) and anaemia. SETTING: The study was conducted in 12 villages, in the Rishi Valley, Andhra Pradesh, India. SUBJECTS: Individuals aged 18 years and above, residing in the 12 villages, were eligible to participate. RESULTS: Data were available for 1178 individuals (45% male, median age 36 years (inter quartile range (IQR 27-50)). The prevalence of CED (38%) and anaemia (25%) was high. Farming was associated with CED in women (2.20, 95% CI: 1.39-3.49) and men (1.71, 95% CI: (1.06-2.74). Low income was also significantly associated with CED, while not completing high school was positively associated with anaemia. Median iron intake was high: 35.7 mg/day (IQR 26-46) in women and 43.4 mg/day (IQR 34-55) in men. CONCLUSIONS: Farming is an important risk factor associated with CED in this rural Indian population and low dietary iron is not the main cause of anaemia. Better farming practice may help to reduce CED in this population

Humanism in clinical education: a mixed methods study on the experiences of clinical instructors in Iran

BACKGROUND: Medical education is currently more considerate about the human dimension. The present qualitative study aimed to explain the experiences of clinical professors with regard to humanism in clinical education in Iran. METHODS: This mixed methods study had two phases, a quanitative phase of scientometrics and a qualitative phase of a content analysis. In the scientometrics phase, Ravar PreMap and VOSviewer software programs were utilized for plotting the conceptual networks. The networks were analyzed at the micro-level based on centrality indices (closeness, degree, and betweenness). The conceptual network was plotted and the prominent topics in clinical education were identified using co-word analysis. In the second qualitative phase on the topic, based on the scientometrics phase, semi-structured interviews were conducted with clinical professors. The interviews were transcribed verbatim and analyzed. RESULTS: On the basis of the analysis of titles, abstracts, and keywords of the retrieved articles on clinical education from ISI Web of Science, Scopus, and PubMed, 1412 keywords were extracted. After the refining process, 356 keywords with 6741 relations remained. Upon plotting the conceptual network, 19 conceptual clusters related to clinical education were obtained. Then, micro-level network analysis (centrality criteria) indicated that the keyword humanism with the frequency of 137 had the highest rate (97.753), closeness (97.802), and betweenness (13.407). Moreover, from the interview data analysis, two themes of "intertwined nature of the human spirit in clinical education" and "humanistic behavior of professors in clinical education" were extracted. CONCLUSION: As a part of the educational culture, humanistic values must be intertwined with the medical education curriculum. In this regard, humanism and clinical reasoning are the two major clusters of clinical teaching; moreover, altruism and adherence to humanistic values, and scientific qualification are other main pillars that should be considered as the criteria for the selection of clinical professors and medical students

Molecular characterization of the Iranian isolates of Giardia lamblia: Application of the glutamate dehydrogenase gene

Background: This study was conducted to determine of molecular epidemiology of the Giardia lamblia by PCR-RFLP method in Tehran, capital of Iran. Methods: Thirty eight stool samples were randomly selected from 125 patients diagnosed with giardiasis using microscopy in Tehran. DNA extraction of some samples were performed by phenol/chloroform/isoamyl alcohol method and to raise the sensitivity of the PCR assay, the genomic DNA of the others were extracted using glass beads and the QIAamp Stool Mini Kit in order to effectively remove the PCR inhibitors. A single step PCR-RFLP assay, targeting the glutamate dehydrogenase (gdh) locus, was used to differentiate within and between assemblages A and B that have been found in humans. Results: Of the 38 isolates, 33 samples (87) were found as G. lamblia (genotype AII), 3 (7.8) belonged to assemblage B, genotype BIII, the mixed of genotype AII and B were detected only in two samples (5.2). Conclusions: PCR-RFLP is a sensitive and powerful analytical tool that allows effective genotype discrimination within and between assemblages at targeting gdh gene, and makes it possible to identify the presence of mixed genotypes. Our data suggest that there is an anthroponotic origin of the infection route, assemblage A group II, in Tehran so it seems that the main reservoir of Giardia infection is humans in the area studies

Finite element analysis of different ferrule heights of endodontically treated tooth

Objective: To investigate the influence of ferrule height on the crown mechanical resistance and stress distribution through the root and luting cement to explain restoration lose and root fracture pattern. Material and methods: Threedimensional models of an adult maxilla and root of incisor tooth were developed from a Computed Tomography scan images. Periodontal ligament, luting cement, crown and custom post were reconstructed on the computer . A static load of 50N was applied to the crown at 70° to the occlusal plan. Results: Design with no ferrule had the most crown displacement and 2mm ferrule had the least. Also 2mm ferrule design had the lowest root and luting cement stress Conclusion: The study suggests that a ferrule increases mechanical resistance of crown. Furthermore, a ferrule decreases stress in dentin and luting cement; consequently, the fracture and losing restoration risk decline

Development of a tactile sensor for Braille pattern recognition: sensor design and simulation

In the work at hand, Immobilized Liquid Membranes - ILM - for gas and vapor separations composed of the ionic liquid [BMIM][Tf2N] in ceramic capillary asymmetric supports are investigated. As becomes clear from a detailed literature review covering publications of the last 16 years, the aforementioned material combination promises more stable ILM in contrast to commonly employed polymeric supports and low-volatile liquids. In opposition to commonly employed ex-situ, manual ILM preparation methods, a novel continuous in-situ ILM preparation method is developed. This method offers the possibility of using oxygen or water sensitive liquids as membrane phase and allows for easier preparation of ILM leading one step further to industrial application. As a means for the novel in-situ ILM preparation method, imbibition kinetics of the porous supports are investigated experimentally by means of three different methods. The experimental results are successfully modelled by means of an approach based on the so-called Washburn Equation for description of capillary imbibition kinetics. Two different support types (hydrophobic and hydrophilic with two different pore diameters of the active layer each) with two liquids (Ionic liquid [BMIM][Tf2N] and a silicone oil as a reference liquid with well documented material properties) are employed. The novel continuous in-situ preparation is investigated in comparison to a manual, i.e. ex-situ preparation method. This ex-situ method allows for preparation of ILM without any pretreatment of the employed ionic liquid and the support yielding a sufficiently stable ILM. However, there is no information on the real thickness of this ILM available and no controlled preparation possible. On the other hand, the in-situ preparation enables the controlled preparation and adjustment of ILM thickness. In this method, a remaining film on the lumen side of the membrane supports poses a limit on the minimum achievable ILM thickness. A model based on classical film theory is set up to account for the film removal during the last step of the preparation method. The proposed model allows for successful design of ILM with designated thickness. Finally, a mathematical model capable of describing the simultaneous vapor separation of a propane/propylene mixture and reaction of propylene to hexene by means of a catalytically active ILM is presented in this section. Sticking to the findings of Eichmann (Marcus Eichmann: Zweiphasige Dimmerisierung von Propen und 1-Buten mit ionischen Flüssigkeiten, Dissertation RWTH Aachen University, 1999), a pseudo first order reaction for the propylene dimerization reaction is assumed. For evaluation of the model, both in-situ and ex-situ prepared ILM are employed for permeation experiments for non-reactive vapor separation of a propane/propylene mixture. Two parametric studies of the non-catalytically active and the catalytically active ILM are presented investigating the influence of the experimental parameters on the selectivity, permeability and propylene/propane absorption ratio of the ILM