Effectiveness of Gamification in Enhancing Learning and Attitudes: A Study of Statistics Education for Health School Students

Introduction: Gamification is the use of game design elements in non-game contexts. It is considered a student-centeredinstructional design to motivate student learning and academic behavior. In this study, the effects of gamification on learning statistics (hypothesis testing issue) and attitude toward statistics in comparison with the common e-learning approach were investigated. The students’ experience and critical elements of gamification on learning statistics were assessed, too.Methods: In a before and after trial, in a census manner, 64 health faculty students of Guilan University of Medical Sciences, Rasht, Iran, non-randomly were assigned to the intervention (n=42) and control (n=22) groups. Learning activities were gamified in the intervention group, while the control group received traditional problem-solving in the learning management system. Narrative, avatar, level, point, progress bar, scoreboard, challenge and feedback elements were used in the game experience. The implementation of gamification was applied based on Landers’ theory of gamified content. Valid and reliable Persian version of the Survey Attitude toward Statistics questionnaire measuredthe students’ attitude before and after the intervention. The EGameFlow questionnaire and a valid and reliable researchermade exam measured the users’ experience of gamified content and learning hypothesis testing after the intervention. The independent samples T-test, analysis of covariance and the partial eta-squared effect size were calculated by SPSS software, version 26.Results: Compared to the control group, the intervention group had a more positive attitude toward learning difficulty (moderate partial eta-squared 0.099), value and cognitive competency (weak partial eta-squared=0.01 and 0.05). Learning between the two groups was not different (P=0.522). There was a significant correlation between learning and the students’ perceived experience with feedback (r=0.583, P<0.001), concentration (r=0.509, P=0.005), and challenge (r=0.421, P=0.023) of the gamified content.Conclusion: It suggests using gamification on learning statistics while optimizing the design with more focus on the feedback, challenge and concentration elements

Medication Adherence and its Related Factors in Patients Undergoing Coronary Artery Angioplasty

Introduction: Percutaneous Coronary Intervention (PCI) has no effect on coronary artery atherosclerosis, thus the modification of physiological risk factors seems essential to prevent coronary artery disease (CAD). Then PCI patients have to receive multiple drug therapies in an attempt to prevent the recurrence of cardiac events. In spite of the evidence based on medication adherence to prevent post-PCI CAD development, medication adherence is the main concern for health care system. Accordingly, this study aims to determine the medication adherence and its related factors among these patients. Methods: In this cross-sectional study, the statistical community was the patients undergoing PCI at medical educational hospital of Dr. Heshmat in Rasht, Iran. 269 patients were selected by convenient sampling method. The data were collected by a questionnaire consisting of 4 parts, namely the socio-individual factors, Morisky medication adherence scale, hospital anxiety and depression scale and cardiac patient’s self-efficacy scale. Data analysis was done by descriptive statistics and the significance variables in univariate analysis were examined in a multi logistic regression model through considering co-linearity. Results: The results showed that 75 patients (28%) didn’t adhere to the medication. In addition, the majority of them were reported to have clinical anxiety (44.2%) and mild depression (55.8%). Also, based on the results derived from multiple logistic regressions, only the spouse's educational level and family history of coronary artery disease were significant predictors of medication adherence. Conclusion: The current study findings display lack of complete post-PCI medication adherence, which underscores the importance of the existence of cardiac rehabilitation systems in the society. Therefore, it is recommended that cardiac rehabilitation centers be built in the society

Validity and reliability of the Persian version of MISSCARE survey

Background: The MISSCARE survey is a useful instrument measuring the amount and type of missed nursing care and its important reasons, developed by Kalisch and Williams in 2009 and revised in 2019. Objective: The present paper aimed to report the psychometric properties of part A (missed nursing care) and part B (reasons for missed nursing care) of the MISSCARE tool translated into Persian. Materials & Methods: A Persian version of the MISSCARE tool were evaluated by a panel of experts, and the psychometric properties were determined with 326 nurses randomly selected from non-emergency wards of seven educational and medical centers in Rasht, North of Iran. Nurses completed the instruments from January to March 2021. Content validity was evaluated by calculating content validity index (CVI). Confirmatory factor analysis (CFA) was used to assess construct validity. Internal consistency (reliability) was measured using Cronbach's alpha coefficient. Results: CVI was measured 0.82 and 0.79 for parts A and B of the survey. The fit indices of CFA indicated the acceptable fit for the measurement model of part B (missed nursing care reasons). Also, factor loadings of items on three factors of labor, material and communication confirmed the structural validity of part B of the survey. Cronbach’s alpha coefficients for parts A and B were 0.991 and 0.994 in whole, and Cronbach's alpha coefficient for three factors of part B ranged from 0.831 to 0.936 confirmed their reliability. Conclusions: The Persian version of the MISSCARE tool is valid and reliable for measuring missed nursing care and its reasons. It can be used by nursing authorities for evaluation purpose in Iranian hospitals

Association of Lifestyle and Aphthous Stomatitis Among Dentistry Students

Background: Recurrent aphthous stomatitis (RAS) is the most common ulcerative oral lesions. Many factors including genetics, stress, lifestyle, gastric diseases and nutritional habits play a major role in the etiology of recurrent aphthous ulcers. The aim of this study was to evaluate the lifestyle of patients with a history of aphthous stomatitis. Methods: This cross-sectional study was conducted on 99 dentistry students with a history of aphthous stomatitis. The control group consisted of 145 dentistry students without any history of the lesion. Demographic information and lifestyle factors including smoking, body mass index, place of living, marital status, regular exercise were recorded. Nutritional habits were evaluated using a modified Food Frequency Questionnaire containing 95 food variables. Independent t-test and Mann Whitney test were used to compare the two groups. Linear regression analysis were used to determine the predictors. Results: There was no significant difference in nutritional habits of study participants. A family history of RAS was more frequently noticed in the case group (43.1%) rather than control group (27.7). Multivariate logistic regression model showed that the most powerful predictors of aphthous lesions were familial history of lesions (OR = 2.4, 95%CI: 1.11-5.13) and food allergy (OR = 4.71, 95%CI: 2.70 to 8.22) respectively. Conclusion: Based on the results of the present study, life style and diet are not associated with aphthous lesions. Considering that aphthous stomatitis is a multifactorial disease, there is a need to study other risk factors and laboratory tests

Frequency of renal artery stenosis and associated factors in patients undergoing coronary angiography

Background: Coronary artery disease (CAD) is the first cause of mortality in developed and developing countries, including Iran. Identifying high-risk patients can save many from morbidity and mortality. Renal artery stenosis (RAS) seems to be equivalent to CAD in patients with cardiovascular risk. Objectives: The present study aimed to determine the prevalence, severity, and extent of RAS and its predictors in patients with confirmed CAD on coronary angiography. Patients and Methods: All patients suspected of ischemic heart disease (IHD), who underwent diagnostic coronary angiography at Heshmat heart hospital, Iran were recruited (May 2015 to June 2016). Patients with confirmed CAD underwent non-selective renal angiography, which was categorized as mild, moderate or severe based on luminal diameter narrowing more than normal >0% to 50%, between 50%-70% and more than 70%, respectively. Results: Of 233 patients, RAS was observed in 123 (53%). Around 20% were mild, 10% were moderate and 23% were severe. Additionally, RAS in 37% was unilateral and in 16% were bilateral. Besides,19%, 25% and 56% of patients had atherosclerosis in one, two and three vessels, respectively. There was no correlation between the CAD severity and severity of RAS (P=0.807). Conclusions: Higher prevalence of RAS in patients with hyperlipidemia (60% vs. 40%) was detected. Its association with variables affecting CAD indicates that RAS can be a predictor of CAD. Therefore, simultaneous assessment of RAS in coronary angiography can be a good screening method for CAD beside earlier diagnosis of kidney disease

The risk factors for cytomegalovirus reactivation following stem cell transplantation

Objective: Opportunistic infections like cytomegalovirus (CMV) are among the primary causes of morbidity and mortality in patients undergoing hematipoetic stem cell transplantation (HSCT). This infection is frequently seen in early postengraftment period. So we determined to find the risk factors associated with CMV reactivation. Methods: We retrospectively evaluated the medical records of 126 consecutive patients who underwent allogenic-HSCT from peripheral blood stem cells from August 2011 to February 2013 in Shariati Hospital. We included HSCT patients with 15 years of age or older, who survived at least 100 days after transplantation. CMV reactivation was detected based on the weekly PP65 assessment. Patients with 10 or more positive cells per 50,000 cells were defined as having high-level antigenemia. Findings: From 126 patients which included in this study, 76 were male (60%). CMV antigenemia was documented in 43 patients (34%). The median time to CMV infection was 40 days (range: 3–77) after transplantation. The incidence of high-level antigenemia during the first 100 days following HSCT was 11%. Conclusion: We found that the significant risk factor for CMV antigenemia in multivariate analysis was prior graft-versus-host disease (GVHD) experience and higher donor age. For high-level antigenemia, GVHD or duration of its treatment was significant determinant

Is 'self-medication' a useful term to retrieve related publications in the literature? A systematic exploration of related terms.

Self-Medication (SM), i.e. using medications to treat oneself, is a major concern for health researchers and policy makers. The terms "self medication" or "self-medication" (SM terms) have been used to explain various concepts while several terms have also been employed to define this practice. Hence, retrieving relevant publications would require exhaustive literature screening. So, we assessed the current situation of SM terms in the literature to improve the relevancy of search outcomes.In this Systematic exploration, SM terms were searched in the 6 following databases and publisher's portals till April 2012: Web of Science, Scopus, PubMed, Google scholar, ScienceDirect, and Wiley. A simple search query was used to include only publications with SM terms. We used Relative-Risk (RR) to estimate the probability of SM terms use in related compared to unrelated publications. Sensitivity and specificity of SM terms as keywords in search query were also calculated. Relevant terms to SM practice were extracted and their Likelihood Ratio positive and negative (LR+/-) were calculated to assess their effect on the probability of search outcomes relevancy in addition to previous search queries. We also evaluated the content of unrelated publications. All mentioned steps were performed in title (TI) and title or abstract (TIAB) of publications.1999 related and 1917 unrelated publications were found. SM terms RR was 4.5 in TI and 2.1 in TIAB. SM terms sensitivity and specificity respectively were 55.4% and 87.7% in TI and 84.0% and 59.5% in TIAB. "OTC" and "Over-The-Counter Medication", with LR+ 16.78 and 16.30 respectively, provided the most conclusive increase in the probability of the relevancy of publications. The most common unrelated SM themes were self-medication hypothesis, drug abuse and Zoopharmacognosy.Due to relatively low specificity or sensitivity of SM terms, relevant terms should be employed in search queries and clear definitions of SM applications should be applied to improve the relevancy of publications

Study of Potential Drug-Drug Interactions in Prescriptions of University- Based Pharmacies

Background: Drug-Drug Interactions (DDIs) are adverse reactions caused by a combination of drugs; they are often predictable and therefore avoidable or manageable. The objective of this study was to evaluate the nature, type and prevalence of potential DDIs in prescriptions dispensed in university-based community pharmacies in Tehran, Iran. Methods: From July 2012 to February 2014, sample of 1260 prescriptions were collected from community and outpatient hospital pharmacies affiliated to Tehran University of Medical Sciences (TUMS), Iran. The prescriptions were assessed using the reference text “drug interaction facts”. The identified DDIs were categorized according to their level of significance into three classes (minor, moderate, major). Results: At least one drug-drug interaction was present in 339 (26.9%) of prescriptions and a total of 751 cases of interactions were found in prescriptions. Major DDIs represented 7.3% of all DDIs detected, whereas moderate DDIs were 75% of all DDIs. The mean number of drugs per prescriptions was 3.2, with a median of 4 (range, 2-10).There was a positive association between number of prescribed drugs and occurrence of DDIs (OR: 2.14, 95% CI: 1.9-2.4). The prescriptions of medical specialist had greater risk of occurrence of moderate severity DDIs than general practitioners (OR: 1.52, 95%CI: 1.08-2.15). Conclusion: Despite the prescriptions were collected from university-based pharmacies, but the overall prevalence of potential DDIs were high among patients. Physicians should be aware of potentially harmful DDIs. Meanwhile Pharmacists can contribute to the detection and prevention of drug-related injuries. Appropriate education, collaborating drug selection and pharmaceutical care are strongly recommended for physicians and pharmacists

Effect of multimorbidity on quality of life in adult with cardiovascular disease: a cross-sectional study

Abstract Background The aim of present study was to describe the effect of multimorbidity on Health-Related Quality of Life (HRQoL) in patients with coronary artery disease (CAD). Methods A cross-sectional study with a simple sampling method of 296 patients undergoing coronary artery bypass surgery in a referral hospital of the northern part of Iran was conducted between April, 2015 and September, 2016. Multimorbidity was defined as the presence of at least two chronic diseases based on self-reporting and medical records. HRQoL was measured using the 36-item short form (SF-36) health status survey. We used analysis of variance (ANOVA) to assess the effect of multimorbidity on mental and physical component of HRQoL. Results Approximately, 69% of CAD patients had at least one other disease like diabetes or hypertension. Patients without multimorbidity compared with patients with multimorbidity were significantly older (p = 0.012) and more educated (p = 0.002). Both physical and mental component score of HRQoL was better in patients without any morbidity (48.82 vs. 43.93 with 95%CI of mean difference: 3.37–6.42 and 54.85 vs. 50.44 with 95% CI of mean difference: 1.68–7.15, respectively). Both physical and mental component score was significantly lower in female and lower educated patients (physical mean score 43.07 vs. 46.54 with P = .001 and 42.53 vs. 46.82 with P < .001 and mental mean score 49.98 vs. 52.65 with P = .055 and 49.80 vs. 52.75 with P = .022 for sex and education, respectively). Also, two-way ANOVA showed that regards to morbidity, physical component score was greater in patients with lower education level than higher education level (P < .001). Conclusion The findings of this study suggest that women, lower education level and overweight patients reported lower quality of life. HRQoL is affected by multimorbidity among CAD patients specially in less educated

Application of the Multiplicative-Additive Model in the Bone Marrow Transplantation Survival Data Including Competing Risks

Background: Cox proportional hazard model is a popular choice in modeling the survival data, but sometimes proportionality assumption is not satisfied. One of the tools for handling the non-proportional effects is the multiplicative-additive model named “Cox-Aalen model”. Recently these flexible regression models developed for competing risks setting. The aim of this paper is showing the application of the multiplicative-additive model in competing risks setting on real bone marrow transplantation (BMT) data when the proportionality assumption is violated. Methods: The data was from a retrospective study on class III thalassemia patients who undergo hematopoietic stem cell transplantation (HSCT) in BMT ward of Shariatei Hospital, Tehran, Iran. The neutrophil engraftment time as the early outcome of HSCT on37 patients who received mesenchymal stem cell infusion (MSC group) compared with 50 patients who did not. We fit the standard proportional models and flexible Cox-Aalen model in the sub distribution hazards. Results: By day 30 after transplantation, the cumulative incidence of neutrophil recovery was 97% (95%CI: 89%- 100%) and 76%(95%CI: 64%-88%) in MSC and control group, respectively. Based on the Cox-Aalen model for cumulative incidence function, the MSC infusion had a significant delay effect on neutrophil engraftment (P=.044). In patients who did not neutrophil recovery immediately after HSCT, those who received MSC had faster recovery. Conclusion: Cox-Aalen model provides more accurate statistical description for time-varying covariate effects. There is a positive effect of MSCs on the neutrophil recovery, however further study on the advantages and disadvantages of MSCs are neede