Effects of anethum graveolens and garlic on lipid profile in hyperlipidemic patients

BACKGROUND: hyperlipidemia as a major risk factor of atherosclerosis is treated with different drugs. Concerning length of therapy and vast majority of side effects, herbal medication may be suitable substitute for these drugs. METHODS: In this single-blind, placebo controlled study, lipid profiles of 150 hyperlipidemic patients in cardiology outpatient department of Shiraz University of Medical Sciences were checked at same conditions. They were divided into three equal groups randomly (each composing of 50 patients). They were given enteric-coated garlic powder tablet (equal to 400 mg garlic, 1 mg allicin) twice daily, anethum tablet (650 mg) twice daily, and placebo tablet. All patients were put on NCEP type Π diet and Six weeks later, lipid profiles were checked. RESULTS: In garlic group: total cholesterol (decreased by 26.82 mg/dl, 12.1% reduction, and P-value: .000), and LDL-cholesterol (decreased by 22.18 mg/dl, 17.3% reduction, and P-value: .000) dropped. HDL-cholesterol (increased by 10.02 mg/dl, 15.7% increase, and P-value: .000) increased. Although triglyceride dropped by 13.72 mg/dl (6.3%) but this was not significant statistically (P-value: .222). In anethum group: surprisingly, triglyceride increased by 14.74 mg/dl (6.0%). Anethum could reduce total cholesterol by 0.4 % and LDL-cholesterol by 6.3% but these were not significant statistically (P-value: .828, and .210, respectively). CONCLUSION: Anethum has no significant effect on lipid profile, but garlic tablet has significant favorable effect on cholesterol, LDL-cholesterol, and HDL-cholesterol. Garlic may play an important role in therapy of hypercholesterolemia

Effect of Concept Mapping Education on Critical Thinking Skills of Medical Students: A Quasi-experimental Study

BACKGROUND፡ Fostering critical thinking (CT) is one of the most important missions in medical education. Concept mapping is a method used to plan and create medical care through a diagrammatic representation of patient problems and medical interventions. Concept mapping as a general method can be used to improve CT skills in medical students. The aim of this study was to explore the effect of concept mapping on CT skills of medical students.METHODS: This quasi-experimental study was conducted on 100 second-year medical students which take an anatomy course. Participants were randomly assigned into a control group (lecture-based) and an intervention group (concept mapping). CT levels of medical students were assessed using the California Critical Thinking Skills Test. Data were analyzed using independent sample t-test.RESULTS: Before intervention, CT scores of the intervention and control groups were 6.68 ± 2.55 and 6.64±2.74, respectively, and after intervention, they were 11.64±2.29 and 10.04 ± 3.11, respectively. Comparison of mean score differences for both groups before and after intervention demonstrated that CT scores in the experimental group significantly increased after intervention (P=0.021).CONCLUSIONS: Medical students who were taught through concept mapping showed an increase in CT scores, compared with those in the control group. Medical students require effective CT skills in order to make sound knowledge-based assessment and treatment choices during patient care. Therefore, instructors and planners of medical education are expected to apply this educational strategy for developing CT skills in medical students

Interdisciplinary education of social accountability in short-term workshops of Shiraz University of Medical Sciences

Background: Accountability refers to a set of concepts and social actions by which individuals or organizations have a sense of commitment to explain and to justify their behavior towards the others. Since it is one of the overall objectives of each university, the present study conducted to evaluate the effect of interdisciplinary education of social accountability in short-term workshops on medical student’s knowledge.  Methods: The present study followed a qualitative-quantitative method with the qualitative stage conducted as group interview. In the first phase, eight faculty members were selected in order to determine the scope and the main topics of social accountability. The second phase was training workshops of social accountability using intervention method. Before and after the course, the knowledge of concepts was assessed using a valid and reliable questionnaire.  Results: The main scope and criteria of the social accountability were extracted based on the results of the experts’ group discussion in eight items. The results of investigating the quality of the workshops revealed the student’s satisfaction of the quality of presentations (88%), the appropriate time management (86%), and the new information (85%). Also, the results of the second phase demonstrated the educational effectiveness of social responsibility in the student’s comments (pretest Mean±SD=13.86 and posttest Mean±SD=14.80, P=0.002). The results of the workshop showed a significant effect of social accountability education on the participants.  Conclusion: The students comprehended the purposes of the application. So, the probability of changing the behavior in medical students is possible with the clinical perspective. However, the stability of this achievement needs sufficient enforcement. 

Evaluation of Educational Environment of Residents of Internal Medicine Based on D-RECT Questionnaire at Shiraz University of Medical Sciences, Iran, in 2014-2015: A Step towards Group Accreditation

Background & Objective: Evaluation of the clinical training environment should be considered as an integral component of an optimal learning environment. Therefore, the purpose of this study was to evaluate the educational environment of residents at Shiraz University of Medical Sciences, Iran, based on D-RECT (Dutch Residency Educational Climate Test) questionnaire toward educational group accreditation in 2014-2015. Methods: This mixed-method study was conducted in two phases. The statistical population consisted of all residents in the field of internal medicine (n = 50). The first phase of the present study was performed quantitatively and using D-RECT questionnaire. The second phase of the study was performed a qualitatively through semi-structured interviews with the target group. The face validity and reliability of the questionnaire were approved using the views of 5 educational experts and Cronbach’s alpha (α = 0.90), respectively. The collected data were analyzed using Pearson coefficient and independent t-test in SPSS software. Results: The results of this study demonstrated a meaningful correlation between the fields of professors' role, formal education, guiding and evaluation, and decision making for patients' treatment. The highest correlation was related to the two fields of formal education and decision making for patients' treatment (P = 0.001) and the least correlation was related to professors' role and formal education (P = 0.009). In qualitative analysis, the strengthens of the group were regular attendance of classes, morning reports, and planning. The weaknesses included revising the educational environment, high load of clinical work, high number of shifts, little amount of time for theoretical studying, and lack of attention to specialty skills. Conclusion: According to the results, the head of educational groups should move toward improving the quality of education in terms of residents' cooperation and team work. Key Words: Evaluation, Residents, Educational environment, Clinical training, Accreditation, D-REC

Impact of Omega-3 Supplementation on High Sensitive C-Reactive Protein Level and 30-Day Major Adverse Cardiac Events After the Implementation of Coronary Stent in Patients with Chronic Kidney Disease: A Randomized Clinical Study

Purpose: Studies have revealed that patients with chronic kidney disease (CKD) are more susceptible to adverse effects of percutaneous coronary intervention (PCI). In addition, the role of elevated high sensitive C-reactive protein (hs-CRP) in the prediction of adverse cardiac outcomes after coronary stent implantation has already been shown. Therefore, in this study, we aimed to evaluate the effect of omega-3 supplementation on hs-CRP and 30-day major adverse cardiac events (MACE) in patients with CKD undergoing elective PCI. Methods: In this randomized trial, 80 CKD patients who were candidates for elective PCI, were randomly assigned to two groups; the first group received a single dose of omega-3 (2500 mg, 12 h before PCI) as well as the standard drug regimen of PCI and the second group received placebo plus the standard therapy (325 mg loading dose of aspirin, 600 mg loading dose of clopidogrel, and weight-adjusted intravenous heparin). Hs-CRP levels were measured at baseline and 24 h after the intervention as a primary endpoint. The secondary endpoint was the incidence of MACE over a 30-day period after PCI. Results: Omega-3 did not significantly decrease post-PCI serum level of hs-CRP; however, the overall 30-day MACE was significantly lower in the omega-3 group compared to the control group (p=0.05). Conclusion: Our results revealed the positive effect of the omega-3 supplement on decreasing 30-day MACE; hence, omega-3 may be considered as an effective adjunctive therapy to the standard drug regimen used before PCI. The evaluation of the effect of omega-3 on long-term MACE is recommended for future studies

An evaluation study of Virtual Master of Public Health in family Medicine in Shiraz University of Medical Sciences, Iran

Background & Objective: Master of public health (MPH) Course is designed for Increasing competency in family physicians employed in Iran's health system. The Contents of this course is based on society needs for increasing managing and public health. This study was designed to evaluate the virtual education in MPH Course in Shiraz University of Medical Sciences. Methods: This research was a qualitative and quantitative study. The evaluation was according Kirkpatrick's Model. The study was done on 25 family physicians in Shiraz University of medical Sciences. We used questionnaire which included goal attainment, learning assessment, compact disc (CD) quality and Dundee Ready Educational Environment Measure (DREEM) questionnaire. Data was gathered and then analyzed with SPSS software. Also, an Objective Structured Clinical Examination (OSCE) was designed in education development center for third level evaluation according to Kirkpatrick's Model. For qualitative evaluation, we did a semi structured interview with teachers. Open questionnaires also were designed for students and data were extracted. Results: 15 physicians full filled the questionnaires and 12 of them participated the OSCE. The most interested and practical lessons were about geriatrics diseases out patient management and epidemiology basics. The least interested lessons were about health promotion, case management and managed health cares. In OSCE, the best scores were for obstetrics – gynecology and the least scores for pediatrics lessons. Conclusion: According to participants' viewpoints, the disadvantages of the course were low quality compact discs, future employment participants, compact course and assessment methods. The best advantages of this course were efficient learning and increasing knowledges of the students. Keywords General physician Master of public health Family medicine Evaluation Virtual educatio

Effect of "no added salt diet" on blood pressure control and 24 hour urinary sodium excretion in mild to moderate hypertension

<p>Abstract</p> <p>Background</p> <p>The incidence of Hypertension as a major cardiovascular threat is increasing. The best known diet for hypertensives is 'no added salt diet'.</p> <p>In this study we evaluated the effect of 'no added salt diet' on a hypertensive population with high dietary sodium intake by measuring 24 hour urinary sodium excretion.</p> <p>Methods</p> <p>In this single center randomized study 80 patients (60 cases and 20 controls) not on any drug therapy for hypertension with mild to moderate hypertension were enrolled. 24 hour holter monitoring of BP and 24 hour urinary sodium excretion were measured before and after 6 weeks of 'no added salt diet'.</p> <p>Results</p> <p>There was no statistically significant difference between age, weight, sex, Hyperlipidemia, family history of hypertension, mean systolic and diastolic BP during the day and at night and mean urinary sodium excretion in 24 hour urine of case and control groups. Seventy eight percent of all patients had moderate to high salt intake.</p> <p>After 6 week of 'no added salt diet' systolic and diastolic BP significantly decreased during the day (mean decrease: 12.1/6.8 mmhg) and at night (mean decrease: 11.1/5.9 mmhg) which is statistically significant in comparison to control group (P 0.001 and 0.01).</p> <p>Urinary sodium excretion of 24 hour urine decreased by 37.1 meq/d ± 39,67 mg/dl in case group which is statistically significant in comparison to control group (p: 0.001).</p> <p>Only 36% of the patients, after no added salt diet, reached the pretreatment goal of 24 hour urinary sodium excretion of below 100 meq/dl (P:0.001).</p> <p>Conclusion</p> <p>Despite modest effect on dietary sodium restriction, no added salt diet significantly decreased systolic and diastolic BP and so it should be advised to every hypertensive patient.</p> <p>Trial Registration</p> <p>Clinicaltrial.govnumber NCT00491881</p

An innovative method to assess clinical reasoning skills: Clinical reasoning tests in the second national medical science Olympiad in Iran

BACKGROUND: Clinical reasoning plays a major role in the ability of doctors to make a diagnosis and reach treatment decisions. This paper describes the use of four clinical reasoning tests in the second National Medical Science Olympiad in Iran: key features (KF), script concordance (SCT), clinical reasoning problems (CRP) and comprehensive integrative puzzles (CIP). The purpose of the study was to design a multi instrument for multiple roles approach in clinical reasoning field based on the theoretical framework, KF was used to measure data gathering, CRP was used to measure hypothesis formation, SCT and CIP were used to measure hypothesis evaluation and investigating the combined use of these tests in the Olympiad. A bank of clinical reasoning test items was developed for emergency medicine by a scientific expert committee representing all the medical schools in the country. These items were pretested by a reference group and the results were analyzed to select items that could be omitted. Then 135 top-ranked medical students from 45 medical universities in Iran participated in the clinical domain of the Olympiad. The reliability of each test was calculated by Cronbach's alpha. Item difficulty and the correlation between each item and the total score were measured. The correlation between the students' final grade and each of the clinical reasoning tests was calculated, as was the correlation between final grades and another measure of knowledge, i.e., the students' grade point average. RESULTS: The combined reliability for all four clinical reasoning tests was 0.91. Of the four clinical reasoning tests we compared, reliability was highest for CIP (0.91). The reliability was 0.83 for KF, 0.78 for SCT and 0.71 for CRP. Most of the tests had an acceptable item difficulty level between 0.2 and 0.8. The correlation between the score for each item and the total test score for each of the four tests was positive. The correlations between scores for each test and total score were highest for KF and CIP. The correlation between scores for each test and grade point average was low to intermediate for all four of the tests. CONCLUSION: The combination of these four clinical reasoning tests is a reliable evaluation tool that can be implemented to assess clinical reasoning skills in talented undergraduate medical students, however these data may not generalizable to whole medical students population. The CIP and KF tests showed the greatest potential to measure clinical reasoning skills. Grade point averages did not necessarily predict performance in the clinical domain of the national competitive examination for medical school students

QT dispersion in patients with systemic lupus erythematosus: the impact of disease activity

<p>Abstract</p> <p>Background</p> <p>Patients with systemic lupus erythematosus (SLE) have increased cardiovascular morbidity and mortality. Although autopsy studies have documented that the heart is affected in most SLE patients, clinical manifestations occur in less than 10%. QT dispersion is a new parameter that can be used to assess homogeneity of cardiac repolarization and autonomic function. We compared the increase in QT dispersion in SLE patients with high disease activity and mild or moderate disease activity.</p> <p>Methods and Results</p> <p>One hundred twenty-four patients with SLE were enrolled in the study. Complete history and physical exam, ECG, echocardiography, exercise test and SLE disease activity index (SLEDAI) were recorded. Twenty patients were excluded on the basis of our exclusion criteria. The patients were divided to two groups based on SLEDAI: 54 in the high-score group (SLEDAI > 10) and 50 in the low-score group (SLEDAI < 10).</p> <p>QT dispersion was significantly higher in high-score group (58.31 ± 18.66 vs. 47.90 ± 17.41 respectively; <it>P </it>< 0.004). QT dispersion was not significantly higher in patients who had received hydroxychloroquine (54.17 ± 19.36 vs. 50.82 ± 15.96, <it>P </it>= 0.45) or corticosteroids (53.58 ± 19.16 vs. 50.40 + 11.59, <it>P </it>= 0.47). There was a statistically significant correlation between abnormal echocardiographic findings (abnormalities of pericardial effusion, pericarditis, pulmonary hypertension and Libman-Sacks endocarditis) and SLEADI (<it>P </it>< 0.004).</p> <p>Conclusions</p> <p>QT dispersion can be a useful, simple noninvasive method for the early detection of cardiac involvement in SLE patients with active disease. Concerning high chance of cardiac involvement, cardiovascular evaluation for every SLE patient with a SLEDAI higher than 10 may be recommended.</p> <p>Trial registration</p> <p>Clinicaltrial.gov registration <a href="http://www.clinicaltrials.gov/ct2/show/NCT01031797">NCT01031797</a></p