The Motives of Medical Students in Tehran University for Choosing Medicine Field and their Outlooks for their Profession: Qualitative versus Quantitative Approach

Background: It seems that in our country choosing medicine as the field of study in university is mostly due to family and society pressures rather than the applicant’s real interest in this field. Objective: To determine medical students’ motives for choosing medicine and their outlooks for this profession by using two qualitative and quantitative approaches. Methods: The qualitative part includes two focus group discussions with interns, and one focus group discussion with fresh students. In the quantitative part, complementary to the qualitative section, the causes of choosing medicine field and the rate of students’ and applicants’ awareness toward the future statue of their profession were studied. For this purpose, 33 fresh students, 107 interns, and 88 applicants of medicine field after taking the entrance examination were selected through convenient and consecutive sampling and were asked to complete the designated questionnaire. Results: In the qualitative part, everybody agreed that the applicants’ own preference is not determining, and almost all of the students mentioned the social prestige of a physician and medical field as the main cause of choosing this field. In the quantitative part, interest in the scientific content of this field (in 42%), the role of physician in health improvement (in 21%), financial income (in 14.3%), the social prestige of physician (in 13%) and the pressure of family and society (in 1%) were mentioned as the main causes of choosing medicine field. On the other hand, participants in the qualitative part of the study didn't have a good outlook for the professional status of general practitioners and some of them believed that continuing studies in medicine field is more difficult than other fields. In the quantitative part of study, as the age of participants increased they more asserted that in medical field the possibility of continuing studies, finding job in good area, and with good income is less compared with other fields. Conclusion: The results of this study revealed that many students have not adequate awareness toward the medicine field and in choosing this field they are mostly under the influence of factors such as the pressure of family and the social prestige of the physicians. Although these aspects were not obvious in the quantitative part of the study, they were confirmed by all of the participants in the qualitative section of the study. This fact denotes the importance of qualitative approaches or the combination of qualitative and quantitative designs. On the other hand, since with increase in the age of students their awareness toward the future statue of their field improves, it is suggested that admission is not confined to academic criteria and appropriate meta-cognitive characteristics of applicants are also considered in admitting the students. Keywords: Medical Students, Choosing Medicine, Medicine, Tehran University of Medical Science, Iran

Exploring the challenges of the Iranian parliament about passing laws for resource allocation in healthcare: a qualitative study

Background: Awareness about the process of law making and the factors that affect the legislative process have an important role in improving legislations that are approved by parliaments. Objective: This study aimed to explore and analyze the process of development and enactment of law in Iran’s parliament, and factors that might affect the enactment of laws that are related to the allocation and distribution of health sector resources in Iran. Methods: In this case study, data were collected through review of literature and national documents, and experts’ interviews. Interviews were performed with selected members of parliament (MPs), ex members of parliament and professionals from the Ministry of Health and Medical Education (MOHME) (15 persons). MAX QDA 10 was used for coding and constructing themes. Data were analyzed in five steps (familiarization, developing a conceptual framework, coding, indexing, and interpretation) using a content analysis with inductive and deductive approaches. Results: The main factors that could affect the approval and enactment of legislations related to allocation of healthcare resources in the Iranian parliament were categorized in seven themes including: Importance of issue, resource availability, legislator’s awareness about the topic, lobbying and unofficial relations with influential officials, mentioning strong reasons by MOHME, weakness of previous laws, and positive feedback related to the same laws. Conclusion: Although the process of law making in parliament, and implementation of them in health organizations have legal stages, the study showed that several key factors affect this trend. In fact, it is suggested the health policy makers and MPs consider extending a range of factors to improve the process of law making and the efficiency of legislation related to allocation of healthcare resource

Is serum prostate-specific antigen a diagnostic marker for benign and malignant breast tumors in women?

Background: Breast cancer is the most common cancer in women. Prostate-specific antigen (PSA) is a marker of prostate gland malignancy, which has been considered in cases with breast cancer in recent years. The goal of this study was to determine total and free PSA levels in cases with malignant and benign breast lesions. Methods: In this case-control study, ninety women with histological proved malignant breast masses and 90 with benign breast masses were enrolled. Total and free PSA levels along with Histological grade and conditions of vascular and perinural invasion, status of hormonal tumor receptors, immune-histo-chemistry markers recorded for all cases. Total and free PSA levels were assessed after treatment in cases with malignant masses. Results: Total and free PSA levels were significantly higher in cases with malignant masses. The best cut-off point for total PSA to differentiate benign and malignant masses was 0.31 with sensitivity and specificity of 100%, 100% (area under the curve [AUC] =1, P < 0.001) and the best cut-off point for free PSA to differentiate benign and malignant masses was 0.19 with sensitivity and specificity of 100% and 100% (AUC = 1, P < 0.001). After treatment, mean free PSA level was significantly lower than free PSA before treatment (0.23 ± 0.1 vs. 0.3 ± 0.08, P < 0.001). Conclusions: Serum PSA level could be applied for differentiating benign and malignant breast masses

Model for Implementing Evidence Based Health Care System in Iran

Background: Regarding the role and importance of paradigm of evidence based practice and its remarkable impact on the effectiveness and efficiency of clinical services and healthcare, development of an integrated system seems necessary in order to manage dispersed data and ensure using evidence in clinical decision making, thus the aim of this study was designing a model for implementing national system of evidence based health care in Iran.Methodos: This paper is a study of comparative type which has been written in three stages: investigation of structure and process of evidence based practice in selected countries, investigation and analysis of current status in Iran in this regard and recommendation of strategies which make model implementation feasible in the country. Such methods as review of literature, focus group discussion and Delphi technique were used for investigation.Results: According to studies, insuring an evidence based practice culture in the country requires a system called National Evidence Based Health Care System which consists of three subsystems including national system of clinical knowledge management, national evidence-based practice system and integrated national network of clinical effectiveness.Conclusion: The ultimate goal of health care system in every country is maintaining and improving community health. Achievement of this goal depends on effectiveness of delivered services and consistency of the services with national and local priorities. In order to achieve clinical effectiveness, the best practice should be realized in the country, implementation of which requires a set of macro and micro strategies enabling facilitation, promotion or guaranteeing clinical knowledge application in the country

شیوه‌نامه اجرایی استقرار خدمات سلامت معنوی در بیمارستان‌های ایران

Background and Aim: Spiritual care can alleviate physical pain and improve mental well-being, but has not been addressed in the hospital. This study was conducted to design an executive instruction for establishment of spiritual health services in Iranian hospitals. Materials and Methods: A descriptive-analytic study was conducted in the form of designing a system in three main stages of review study, qualitative study and designing a placement style sheet. Data were collected using internal and external databases and six focused group discussions. Stakeholder analysis was carried out and the principles of design were formulated and were agreed. Based on the five main components of a system, style sheet of establishing spiritual services was designed in a hospital. Findings: Principles of Executive instruction includes designing a comprehensive spiritual health services and integrating it into the current system, continuing care in mental and social dimensions, participating senior hospital and physician and nursing managers, evidence-based executive guidelines and emphasizing Spiritual Health Services as an organizational value. The expected goals of this instruction are to increase patient satisfaction, facilitate the recovery of acute illnesses and increase resilience to malignant diseases, reduce patient referrals, improve spiritual and religious status and enhance spiritual skills and promote healthy behaviors. The main process of spiritual health services consists of three main components of the evaluation of spiritual health by a physician, the implementation of spiritual health counseling by an elected counselor, support services including hospital facilities at the time of patient hospitalization and patient education at discharge and post-discharge support. Ethical Considerations: The objectives and content of the study were explained to all participants and after obtaining informed consent, the interviews were recorded. Participants were assured that information will be confidential. Conclusion: Implementation of the designed executive introduction requires the establishment of political support structures, structural and operational dimensions, clinical skills and promotion of people behavior and culture. To establish the introduction, managers must capture the financial, human, equipment and information resources needed and pay attention to the feasibility results of the study. &nbsp; Cite this article as: Damari B, Zeinalou AA, Emami Razavi SH, Salarianzadeh H, Vossogh Moghaddam A, Heidari AR. Executive Instruction for Establishment of Spiritual Health Services in Iranian Hospitals. Med Ethics J 2020; 14(45): e18.زمینه و هدف: ارائه مراقبت معنوی می‌تواند موجب کاهش دردهای جسمی و آسایش روانی گردد، ولی به بعد معنوی سلامت در بیمارستان توجه کم‌تری شده است. این مطالعه با هدف طراحی شیوه‌نامه اجرایی استقرار خدمات سلامت معنوی در بیمارستان‌های ایران انجام شد. مواد و روش‌ها: یک مطالعه توصیفی ـ تحلیلی در قالب طراحی یک نظام در سه مرحله اصلی مرور منابع، مطالعه کیفی و طراحی شیوه‌نامه استقرار انجام شد. داده‌ها با استفاده از بررسی پایگاه‌های اطلاعاتی داخلی و خارجی و 6 جلسه بحث گروهی متمرکز جمع‌آوری شد. تحلیل ذی‌نفعان انجام شد و اصول طراحی تدوین و اجماع گردید. بر اساس پنج جزء اصلی یک سیستم، شیوه‌نامه استقرار خدمات سلامت معنوی در یک بیمارستان طراحی شد. یافته‌ها: اصول طراحی شیوه‌نامه اجرایی شامل طراحی خدمات سلامت معنوی جامع و ادغام آن در سیستم موجود، تداوم مراقبت در ابعاد روانی و اجتماعی، مشارکت مدیریت ارشد بیمارستان و پزشکان و پرستاران، مبتنی بر شواهدبودن دستورالعمل‌های اجرایی و تأکید بر خدمات سلامت معنوی به عنوان یک ارزش سازمانی است. اهداف مورد انتظار از اجرای این شیوه‌نامه افزایش رضایت بیماران، تسهیل بهبود بیماری‌های حاد و افزایش تاب‌آوری در بیماری‌های صعب‌العلاج، کاهش مراجعات بیماران بهبود وضعیت‌های معنوی و مذهبی و افزایش مهارت‌های معنوی و افزایش اتخاذ رفتارهای سالم است. فرایند اصلی خدمات سلامت معنوی شامل سه جزء اصلی شیوه اجرایی ارزیابی سلامت معنوی توسط پزشک، اصول اجرایی مشاوره سلامت معنوی توسط مشاور منتخب، خدمات حمایتی شامل تسهیلات بیمارستانی در زمان بستری و آموزش بیمار زمان ترخیص و حمایت‌های پس از ترخیص است. ملاحظات اخلاقی: اهداف و محتوای مطالعه برای همه مشارکت‌کنندگان توضیح شد و پس از کسب رضایت آگاهانه، مصاحبه‌ها ضبط شد. در زمینه محرمانه‌ماندن اطلاعات به شرکت‌کنندگان اطمینان داده شد. نتیجه‌گیری: پیاده‌سازی شیوه‌نامه اجرایی طراحی‌شده، نیازمند ایجاد بسترهای حمایت سیاسی، ابعاد ساختاری و عملیاتی، مهارت‌های بالینی و ارتقای رفتار و فرهنگ مخاطبان است. مدیران اجرایی جهت استقرار شیوه‌نامه باید منابع مالی، انسانی، تجهیزاتی و اطلاعاتی مورد نیاز را جذب نموده و به نتایج امکان‌سنجی حاصل از مطالعه توجه نمایند

Magnetic resonance imaging of transplanted stem cell fate in stroke

Nowadays, scientific findings in the field of regeneration of nervous system have revealed the possibility of stem cell based therapies for damaged brain tissue related disorders like stroke. Furthermore, to achieve desirable outcomes from cellular therapies, one needs to monitor the migration, engraftment, viability, and also functional fate of transplanted stem cells. Magnetic resonance imaging is an extremely versatile technique for this purpose, which has been broadly used to study stroke and assessment of therapeutic role of stem cells. In this review we searched in PubMed search engine by using following keywords; "Stem Cells", "Cell Tracking", "Stroke", "Stem Cell Transplantation", "Nanoparticles", and "Magnetic Resonance Imaging" as entry terms and based on the mentioned key words, the search period was set from 1976 to 2012. The main purpose of this article is describing various advantages of molecular and magnetic resonance imaging of stem cells, with focus on translation of stem cell research to clinical research

Reform in Medical Ethics Curriculum: A Step by Step Approach Based on Available Resources

In this project, we aimed to revise the medical ethics curriculum at the School of Medicine, Tehran University of Medical Sciences, in order to promote the level of students' ethical awareness and enable them to make ethical decisions.Ideal and long term educational objectives were set to determine directions for future reforms and to provide a baseline for future evaluation of the project. However, based on limited available recourses, the first stage of the reform was planned and implemented with a 3 years scope. In revising the curriculum, which was done according to the Harden's ten questions, we focused on moral attitude and ethical reasoning skill in addition to academic knowledge base by using methods such as case discussions, portfolio, and clinical ethics rounds. The revised curriculum was implemented during the first semester of the 2006-2007 academic year for the first time.The student feedback indicated that the new curriculum was successful in increasing the students' awareness of ethical issues and enabled them to understand and accept their professional obligations.Revising the curriculum and its evaluation should be considered as an ongoing process. The present project was a successful experience that motivated faculty members to pursue the next steps of improving the curriculum on medical ethics and proved to be convincing for the authorities and policy makers to support it

Obesity predictors in people with chronic spinal cord injury: an analysis by injury related variables

Background: Despite an elevated obesity risk in people with spinal cord injury (SCI), investigation on the effects of age, obesity predictors, and injury related factors is yet to be unknown within the SCI population. Methods: Obesity predictors were measured in 162 patients. Results: 27.5% of the participants were overweight and 5.6% of them were obese. Mean BMI was different between patients with tetraplegia and paraplegia (p < 0.01). More than 20% of participants had central obesity, significantly patients with higher age and time since injury. Conclusions: Significant positive relationship was found between level of injury and BMI. Participants with higher age and time since injury had higher waist circumference

Adaptacja kulturowa i ocena rzetelności irańskiej wersji skali Functional Assessment Measure u chorych po urazie rdzenia kręgowego

Background and purpose The aim of this study was to translate and validate the Iranian version of the Functional Assessment Measure (FAM) among patients with spinal cord injury (SCI). Material and methods Two hundred patients with SCI participated in this study. A convenience sampling approach was used for selection of the patients. The FAM was translated into Persian language and then independently translated back into English. The reliability of the FAM was assessed by test-retest methods with a 14-day interval for interrater reliability. Intraclass correlation coefficient (ICCs) was calculated and interrater reliability and intrarater reliability were assessed. Results The mean age of the patients was 35.7 years (SD, 7.2) and 86% of patients were male. The Cronbach alpha coefficient for both raters was above 0.70. Intrarater reliability of the Iranian version of the FAM ranged from good to excellent agreement. The highest level of intrarater reliability was observed for Community mobility (ICC = 0.93). There was good to excellent agreement for interrater reliability of the FAM. The FAM could differentiate between subgroups of patients based on the level of injury but not for the time elapsed from the injury. Conclusions Based on the results of this study, the Iranian version of the FAM (FAM-Ir) was highly valid and reliable for evaluation of functional ability in patients with SCI. Therefore, we would suggest that the FAM could also be used as an assessment tool for SCI patients.Wstęp i cel pracy Celem pracy było przetłumaczenie na język perski i walidacja irańskiej wersji skali Functional Assessment Measure (FAM) wśród pacjentów z urazowym uszkodzeniem rdzenia kręgowego. Materiał i metody W badaniu wzięło udział 200 pacjentów z urazowym uszkodzeniem rdzenia kręgowego stanowiących próbę uznaniową (convenience sampling). Skalę FAM przełożono na perski, a następnie dokonano przekładu zwrotnego na język angielski. Porównywalność wyników między badającymi oceniono za pomocą testu powtarzalności badania w odstępie 14 dni. Obliczono współczynnik korelacji wewnątrzklasowej (ICC), oceniono stopień zgodności wyników między badającymi i dla tego samego badającego. Wyniki Średnia wieku pacjentów wyniosła 35,7 roku (SD: 7,2 roku); 86% pacjentów stanowili mężczyźni. Współczynnik alfa Cronbacha dla obu badających wynosił &gt; 0,70. Zgodność oceny tego samego badającego za pomocą irańskiej wersji skali FAM wahała się od zgodności dobrej do doskonałej. Największą zgodność (ICC = 0,93) obserwowano w odniesieniu do elementu Community mobility. Zgodność między badającymi w ocenie FAM była dobra do doskonałej. Na podstawie FAM było możliwe zróżnicowanie podgrup pacjentów w zależności od poziomu uszkodzenia, ale nie w zależności od czasu, który upłynął od urazu. Wnioski Na podstawie bieżącego badania autorzy stwierdzają, że irańska wersji FAM cechuje się dużą trafnością i rzetelnością w ocenie możliwości funkcjonowania pacjentów z urazowym uszkodzeniem rdzenia kręgowego. Autorzy sugerują zatem, aby uwzględnić tę skalę jako narzędzie oceny chorych po urazowym uszkodzeniu rdzenia kręgowego

A new look at an old dogma: wound complications in two methods of skin closure in uncomplicated appendicitis

Background: Appendicitis is more common during the second and third decade of life and appendectomy scar is important in terms of cosmetic issues. The scar is an important factor in the patient's satisfaction. Conventional teaching has an emphasis on the closure of skin incision with "separate" sutures. The aim of this study was to reconsider this dogma. Methods: Among 321 patients with acute appendicitis who came to the emergency unit of Imam Khomeini Hospital in Tehran, Iran since april 2007 till april 2008, 278 (86.6%) patients had uncomplicated appendicitis and were enrolled in our clinical trial. The patients were randomly assigned to two groups of interrupted suture closure (n=139) and subcuticular suture closure (n=139). Anesthesia method and surgical technique were similar between the two groups. All patients were followed up post-operatively (four weeks) for the presence of infectious drainage, pain, erythema, swelling and warmness at the surgical site. Results: The patients' sex and their mean age were not statistically different between the groups. There was no significant difference in the frequency of surgical site complications between the two groups (five cases in the "interrupted" group and eight cases in the "subcuticular" group p=0.415). Conclusion: This study showed that appendectomy incision closure with subcuticular sutures did not increase the risk of wound complications. From the point of better cosmetic outcome of subcuticular sutures, this method may be the method of choice for the closure of appendectomy incisions in uncomplicated appendicitis