Evaluating the Satisfaction and Skills of Third Year Residents of Internal Medicine Ward in the Endoscopy Training Program Using Gastric Moulage Prepared in Sina Hospital, Iran

Background & Objective: Considering the possible risks of performing endoscopy training on patients, the use of a moulage prior to training seems reasonable. The aim of this study was to evaluate residents’ rate of satisfaction with the training process and their ability in performing upper gastrointestinal endoscopy using gastric moulage prepared in Sina Hospital, Iran. Methods: This study was conducted on 20 residents of the endoscopy ward at Sina Hospital from September 2012 to September 2013. The endoscopy training program consisted of 3 steps of training with gastric moulage, observation, and training on human subjects. The present educational development plan was evaluated through studying the 2 criteria of residents’ satisfaction and ability. The satisfaction of residents with the endoscopy training course was evaluated by a self-report questionnaire. The residents’ ability in performing upper gastrointestinal endoscopy was evaluated by measuring the time of reaching the gastro-esophageal junction and pyloric valve. Results: The reliability and validity of the self-report questionnaire were 64% (0.60-0.89) and 78% (0.12-0.95), respectively. Over 90% of residents agreed with the items of the self-report questionnaire. The highest rate of agreement belonged to the item that interpreted the effect of this method on lowering residents’ anxiety in performing endoscopy (100%). The mean ± standard deviation of time of reaching the gastro-esophageal junction and pyloric valve were 162.0 ± 13.54 and 272.8 ± 13.75 seconds, respectively. Conclusion: The results of this study showed that training residents using gastric moulage prepared in Sina Hospital was associated with residents’ satisfaction and the successful obtaining of the endoscopy skill. Keywords: Endoscopy; Training; Resident; Satisfaction; Skill; Gastric moulag

The utility of Helicobacter pylori eradication in improving functional dyspepsia in adult population in Iran

Background: This review aimed at investigating the effectiveness of Helicobacter pylori eradication in improving the symptoms of patients with functional dyspepsia in Iranian adult population. Materials and Methods: This study was a systematic review. Data were collected from the Medline database by searching some keywords including "Helicobacter pylori", "eradication", "effectiveness", "dyspepsia", and "Iran". After obtaining the full text of articles, the critical review was performed based on article titles and abstracts. For each article, information regarding benefits, side effects and efficacy was identified. Then, scenarios were extracted according to the mentioned data. Results: From a total of 28 reviewed papers, 6 were systematic reviews (with the level of evidence 1a), 18 articles were randomized interventional trials (with the level of evidence 1b) and 4 articles were longitudinal studies (with the level of evidence 2b). Most studies reported improvement in symptoms, although some of them did not report the statistically significant difference. After extracting data related to the scenarios from the articles, they were rated regarding the clinical advantage and the ability to localize each scenario. Conclusion: Considering the results of analyzing the articles and extracted scenarios, Helicobacter pylori eradication is recommended in Iranian adult patients with functional dyspepsia, normal upper gastrointestinal endoscopy, and documented Helicobacter pylori infection

Evaluation of health related quality of life in irritable bowel syndrome patients

Background: Quality of life (QOL) is an important measure in the management of Irritable Bowel Syndrome (IBS). Controversy exists in the findings of studies evaluating QOL in IBS subtypes, and little is known about this issue in Iranian patients. Determination of the factors affecting QOL in IBS patients may influence treatment outcomes. The aims of this study are to: 1) compare QOL between subtypes in a sample of Iranian IBS patients, 2) determine the factors associated with QOL in IBS. Methods: This cross sectional study included two hundred and fifty IBS patients with the mean age ( ± standard deviation) of 31.62 ( ± 11.93) years that were referred to outpatient gastroenterology clinic. IBS patients were diagnosed based on Rome-3 criteria by a gastroenterologist, and then they were categorized into three subtypes according to the predominant type of bowel habit. The “QOL specific for IBS”, “Stait-trait anxiety inventory”, and “Beck depression inventory-2 ” questioners were used to evaluate QOL, anxiety, and depression symptoms, respectively. Results: The mean QOL scores in IBS mixed subtype (71.7 ± 25.57), constipation predominant subtype (80.28 ± 25.57), and diarrhea predominant subtype (76.43 ± 19.13) were not different. (P value: 0.05) In multivariate linear regression analysis, anxiety symptom scores were inversely correlated with QOL scores. [Standardized beta:-0.43, (95 % confidence interval:-0.70,-0.39), P value: < 0.01] Conclusion: It seems reasonable to manage anxiety symptoms properly in IBS patients since this might increase their QOL

Medical Students’ Satisfaction with a Web-based Training Module of Clinical Reasoning

Background: There is a paucity of literature regarding the medical students’ perspectives on web-based training of clinical reasoning. Objectives: This study aimed to describe the implementation of a web-based training course of clinical reasoning for medical students and to evaluate their satisfaction with the program. Methods: This cross-sectional study was conducted at the Tehran University of Medical Sciences in 2018. Fifty internal medicine interns were consecutively enrolled. The study consisted of two phases. The first phase focused on the development of a web-based training module of clinical reasoning. The second focused on evaluating the trainee’s satisfaction with the virtual course. The educational content of the program was prepared by an expert panel and incorporated in a web-based educational tool designed for virtual training purposes. The students’ satisfaction with the virtual course was assessed using a questionnaire. Each item of the questionnaire was scored from 0 (0) to 1.5 (100). The content validity of the questionnaire determined by an expert panel, and its reliability was measured. Results: The mean score of each item of the questionnaire ranged from 77.3 to 85.3 which showed that the participants agreed with the items of the questionnaire. Also, Cronbach’s alpha coefficient was excellent in nine items of the questionnaire, good in four items, and acceptable in three items. The intraclass correlation coefficient was also estimated as 0.98. Conclusions: The participants were satisfied with the web-based training tool for clinical reasoning, used in the present study. The developed questionnaire also showed good validity and reliability for the assessment of trainees’ satisfaction with the web-based training module of clinical reasoning. Keywords: Logic, Distance Education, Assessment, Medical Studen

The Correlation Between Liver Fat Content and Ulcerative Colitis Disease Severity

To evaluate the association between disease severity and hepatic steatosis in patients with ulcerative colitis (UC) and non-alcoholic steatohepatitis (NASH). Consecutively selected UC patients admitted to the gastroenterology clinic were enrolled in the study. UC severity was assessed by Truelove and Witts classification. Patients with severe UC were excluded from the study. NASH was determined based on persistently elevated serum aminotransferase levels and detection of fatty liver ultrasound. Patients with other etiologies for elevated aminotransferase levels were excluded. Liver fat content (LFC) was assessed by measuring liver fat score (LFS). One hundred patients (42% male) were included in the study. According to liver ultrasound examination, 62 (%) patients were identified with grade 1 fatty liver disease, and 38 (%) patients were classified as advanced (grade 2 and 3) fatty liver disease. Sixty-one patients had left-sided UC and (46%) had mild UC disease severity index. LFS was significantly higher in UC patients with the moderate disease than patients with mild disease (3.53±2.68 vs. 5.89±2.85, respectively; P<0.01). Nevertheless, no significant difference was observed in LFS regarding UC extension. There was no significant difference between NASH ultrasound grades in view of UC severity and extension. LFC might be associated with UC severity

The Comparison of WHOQOL-BREF with Disease Specific Heath Related Quality of Life Questionnaire in Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal disorders particularly affecting the quality of life (QOL). Evaluating QOL in IBS patients is a valuable method of defining a psychobiological pattern of disease. Various disease specific and general instruments are now available to measure health-related QOL (HRQOL) in IBS patients. Though, no comparison has been made between these tools especially in non-western countries. We aimed to compare QOL measures between two specific and general QOL questionnaires in a sample of Iranian IBS patients. A total of 250 IBS patients were diagnosed based on Rome III criteria (mean age 29.6 ± 9.6 years). HRQOL was assessed using disease specific quality of life for IBS (IBS-QOL) and generic World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaires. Patients also completed Speilberger`s “State/Trait Anxiety Inventory” and “Beck Depression Inventory-II” for the evaluation of anxiety and depression symptoms. The severity of symptoms was independently associated with HRQOL in patients using WHOQOL-BREF and IBS-QOL (r = -0.48 and -0.39 respectively, P < 0.001). In linear regression analysis, a strong correlation was observed between the HRQOL scores of IBS-QOL and the WHOQOL-BREF questionnaires (standard β = 0.86 (95%CI: 1.15 - 1.44), P value < 0.001). Controlling for anxiety and depression symptoms did not influence the strength of observed correlation. The WHOQOL-BREF is a psychometrically sound, rapid and convenient instrument whose HRQOL measure is as valid and accurate as the disease-specific IBS-QOL questionnaire. It seems reasonable to use the WHOQOL-BREF alongside the IBS-QOL

Serum Zinc level and liver pathological grading correlation in nonalcoholic steatohepatitis, in a university hospital in Tehran

Background: Nonalcoholic fatty liver disease (NAFLD) includes steatosis, nonalcoholic steatohepatitis, fibrosis and liver cirrhosis. The oxidative stress enzymes are the diagnostic markers to prediction of histologic status of liver in nonalcoholic steatohepatitis disease. The aim of the study was to assessment of relationship between serum Zinc (Zn) levels with pathologic manifestation in patients with nonalcoholic steatohepatitis. Methods: This cohort study was done in patients with nonalcoholic steatohepatitis that had been visited in gastrointestinal clinic of Sina Hospital, Tehran, Iran from April, 2014 to April, 2015. Control group included the patients with no clinical manifestation of nonalcoholic steatohepatitis and normal liver ultrasonography, lab test and liver biopsy. Serum Zn level was measured with atomic absorption spectroscopy. Normal Serum level of Zn was considered 10.7-22.9 &micro;mol/L (70-150 &micro;g/dL) and less than 7 &micro;g/dL was considered as Zn deficiency. Pathological findings were grading according to NAFLD activity score. Results: One hundred twenty patients were selected for the study in two equal groups. Six and 26 patients were excluded in case and control groups, respectively due to no consent to lab test. Finally, 54 patients (35 male/19 female) and 34 patients (22 male/12 female) in control group were participated in data analysis. The mean age on case and control group was 37.02&plusmn;9.82 year and 33.24&plusmn;12.01 year, respectively (P= 0.111). Zn level in case and control groups were 90.82&plusmn;13.69 and 88.82&plusmn;13.10, respectively. There were no statistically significant differences between two group in serum Zn level (P= 0.50). Also, there were no statistically significant differences between pathological grading in case group participants (steatosis: P= 0.640; Lobular inflammation: P= 0.882; fibrosis: P= 0.531). Conclusion: The finding of the study showed no significant association between serum zinc level and hepatic steatosis, lobular inflammation and fibrosis of the liver in nonalcoholic steatohepatitis

The utility of Helicobacter pylori eradication in improving functional dyspepsia in adult population in Iran

Background: This review aimed at investigating the effectiveness of Helicobacter pylori eradication in improving the symptoms of patients with functional dyspepsia in Iranian adult population. Materials and Methods: This study was a systematic review. Data were collected from the Medline database by searching some keywords including "Helicobacter pylori", "eradication", "effectiveness", "dyspepsia", and "Iran". After obtaining the full text of articles, the critical review was performed based on article titles and abstracts. For each article, information regarding benefits, side effects and efficacy was identified. Then, scenarios were extracted according to the mentioned data. Results: From a total of 28 reviewed papers, 6 were systematic reviews (with the level of evidence 1a), 18 articles were randomized interventional trials (with the level of evidence 1b) and 4 articles were longitudinal studies (with the level of evidence 2b). Most studies reported improvement in symptoms, although some of them did not report the statistically significant difference. After extracting data related to the scenarios from the articles, they were rated regarding the clinical advantage and the ability to localize each scenario. Conclusion: Considering the results of analyzing the articles and extracted scenarios, Helicobacter pylori eradication is recommended in Iranian adult patients with functional dyspepsia, normal upper gastrointestinal endoscopy, and documented Helicobacter pylori infection