تعهدگریزی اخلاقی در پزشکی و پرستاری: مروری روایتی

Background and Aim: Moral disengagement includes the cognitive mechanisms which are formed in the doer’s mind while performing unethical actions or deciding not to perform ethical actions, which influences the occurrence of unethical actions or not performing ethical behaviors. The Present study aims to narratively review the studies that have examined the role of this variable in medical and nursing settings. Methods: Through Google scholar and PubMed databases, besides using the search section of the websites of the journals related to medical and nursing ethics, the keywords moral disengagement, medical ethics and nursing ethics were searched; the articles which had studied moral disengagement in medicine and nursing until 2022 were reviewed. Ethical Considerations: The results of the studies have been mentioned without bias, while observing trustworthiness in reporting the contents of the articles. Results: Moral disengagement was found to be prevalent among the nurses and the physicians. Moral disengagement was accompanied by decreasing moral reasoning, behaviors and traits, as well as increasing unethical and unproductive behaviors among the physicians and the nurses. In addition, these mechanisms increased in the medical environments with higher levels of stress, more perceived injustice and higher power. On the other hand, they decreased in managerial conditions in the form of moral leadership. These mechanisms were more prevalent among the physicians and the nurses who had stress, unstable moods, negative emotions, as well as the desire for power. Conclusion: Considering the modifiability of moral disengagement through certain educational interventions, it is necessary to add some lessons or courses in order to introduce and reduce the mechanisms of moral disengagement in academic programs and the in-service courses of doctors and nurses In addition, considering the role of variables such as job stress, perceived injustice and having uncontrolled power, it can be possible to reduce the aforementioned variables and consequently, moral disengagement through applying certain management reforms such as applying ethical leadership. Please cite this article as: Azimpour A, Karimian N, Azarnioushan M, Johari L. Moral Disengagement in Medicine and Nursing: A Narrative Review. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2022; 16(47): e9.زمینه و هدف: تعهدگریزی اخلاقی شامل سازوکارهایی شناختی است که هنگام انجام اعمال غیر اخلاقی و یا تصمیم به عدم انجام اعمال اخلاقی، در ذهن فرد شکل گرفته و در بروز رفتاهای غیر اخلاقی یا عدم انجام رفتارهای اخلاقی تأثیر دارد. پژوهش حاضر به مرور روایتی تحقیقاتی می‌پردازد که نقش این متغیر در موقعیت‌های پزشکی و پرستاری را بررسی کرده‌اند. روش: از طریق پایگاه‌های داده Google Scholar، Pubmed و همچنین با مراجعه به قسمت جستجوی تارنمای مجلات مرتبط با اخلاق پزشکی و پرستاری، واژه کلیدی Moral Disengagement در کنار Medical Ethics و Nursing Ethics جستجو شد و مقالاتی که تا سال ۲۰۲۲ تعهدگریزی اخلاقی را در پزشکی و پرستاری بررسی کرده بودند، بازبینی شد. ملاحظات اخلاقی: نتایج پژوهش‌ها بدون سوگیری و با رعایت امانتداری در گزارش محتوای مقالات، ذکر شد. یافته‌ها: مرور مطالعات نشان داد تعهدگریزی اخلاقی در بین پزشکان و پرستاران رایج بود. تعهدگریزی اخلاقی با کاهش استدلال‌ها، رفتارها و صفات اخلاقی و افزایش رفتارهای غیر اخلاقی و غیر مولد پزشکان و پرستاران همراه بود، به علاوه این سازوکارها در محیط‌های درمانی با استرس و احساس بی‌عدالتی بیشتر و همچنین قدرت بالاتر افزایش یافته و در شرایط مدیریتی به شکل رهبری اخلاقی کاهش می‌یافت. این سازوکارها در پزشکان و پرستارانی با استرس، نااستواری خلق، عاطفه منفی و همچنین میل به قدرت، بیشتر بود. نتیجه‌گیری: با توجه به قابل اصلاح‌بودن تعهدگریزی اخلاقی از طریق برخی مداخلات آموزشی، لازم است با اضافه‌کردن برخی دروس یا دوره‌های آموزشی به آشناسازی و کاهش سازوکارهای تعهدگریزی اخلاقی در دوره‌های تحصیلی و ضمن خدمت پزشکان و پرستاران مبادرت ورزید، به علاوه با توجه به نقش متغیرهایی چون استرس کاری، بی‌عدالتی ادراک شده و داشتن قدرت بی‌‌حد ‌و حصر، شاید بتوان با اعمال برخی اصلاحات مدیریتی چون اعمال رهبری اخلاقی، متغیرهای فوق و به تبع آن تعهدگریزی اخلاقی را کاهش داد

Students’ Perception toward Elements of Globalization in Four Interdisciplinary Summer Schools in Shiraz University of Medical Sciences in Iran

Background & Objective: Globalization is one of the most important topics in higher education today, which presents a powerful challenge and an opportunity for medical sciences university and healthcare provider. Nowadays, increasingly faced with healthcare challenges that require an understanding of global health trends and practices, yet little is known about what constitutes appropriate global health training. The main purpose of this research was to review the association between perception of globalization and information mastery and curriculum planning. Methods: This was a descriptive-analytical study on medical students. The study population consisted of 180 medical sciences students who were selected with random sampling methods. In order to measure attitudes of students towards globalization, measures were developed and used by researchers. For the purpose of evaluating of the validity of the measures, construct validity was utilized by factor analysis. In order to determine the reliability of the measures Cronbach's alpha was used, as well. Results: Findings indicated that the total respondents agreed or had positive approach towards globalization. Based on the results of the factor analysis, four factors i.e. personal and social attitude with 15 questions, sociopolitical attitude, and 7 question, two questions for performance and the fourth factor was the resource management concept of globalization which were identified with only one question in the questionnaire. Analysis of variance (ANOVA) results showed that there was no statistically significant association the students' perspective and demographic variables gender, school and age. Conclusion: The positive perception of globalization highlighted the needs of global health educational competencies and approaches used in medical schools and the need to facilitate greater consensus amongst medical educators and students on appropriate global health training for future health care providers. This process led to world integration, density of human awareness and world culture formation Keywords Globalization Medical sciences students Factor analysi

Senescent CD153+ T Lymphocytes Increase in the Peripheral Blood of Patients with Thromboangiitis Obliterans

Background: Buerger’s disease, also known as Thromboangiitis Obliterans (TAO), is a progressive, inflammatory vascular disease with unknown etiology.Objective: To address the degree of T cell immunosenescence in this inflammatory disease, the frequency of senescent T cells expressing CD57 and/or CD153 (CD30L) in patients with TAO.Methods: In this study, nine male cigarette smoker patients with TAO, nine male healthy cigarette smokers, and nine male healthy non-smoker blood donors were enrolled. PBMCs were extracted from the blood of all participants and stored in liquid nitrogen before use. The percentages of senescent T cells were detected by flow cytometry. The results were analyzed using non-parametric statistical tests.Results: The frequencies of senescent CD3+CD4+CD57+CD153+ and CD3+CD4+CD57-CD153+ T cells significantly increased in patients compared with the non-smoker controls (p=0.01 and p=0.04, respectively). The frequency of senescent CD3+CD4-CD57-CD153+ T cells was higher in patients compared with the smoker controls (p=0.02). In patients with TAO, CD57+CD153- cells were more frequent in CD3hiCD4- and CD3hiCD4+ T cells compared with the CD3loCD4- and CD3loCD4+ T cells (p=0.008 and p=0.0002, respectively). Conversely, the frequency of CD57-CD153+ T cells was significantly higher in CD3loCD4- T cells compared with the CD3hiCD4- T cells (p=0.004). The percentage of CD3+CD4+CD57+CD153- T cells correlated negatively with smoking level in smoker controls (p=0.02, Spearman r=-0.80).Conclusion: Elevated frequencies of senescent CD4+CD57+CD153+ and CD4+CD57-CD153+ T cells in patients compared with non-smoker and smoker controls suggest the contribution of immunosenescence in TAO

Nano-suspension coating as a technique to modulate the drug release from controlled porosity osmotic pumps for a soluble agent

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Epidemiology and predictors of multimorbidity in Kharameh cohort study: A population‐based cross‐sectional study in southern Iran

Abstract Background and Aim Multimorbidity is one of the problems and concerns of public health. The aim of this study was to estimate the prevalence and identify the risk factors associated with multimorbidity based on the data of the Kherameh cohort study. Methods This cross‐sectional study was performed on 10,663 individuals aged 40–70 years in the south of Iran in 2015 to 2017. Demographic and behavioral characteristics were investigated. Multimorbidity was defined as the coexistence of two or more of two chronic diseases in a person. In this study, the prevalence of multimorbidity was calculated. Logistic regression was used to identify the predictors of multimorbidity. Results The prevalence of multimorbidity was 24.4%. The age‐standardized prevalence rate was 18.01% in males and 29.6% in females. The most common underlying diseases were gastroesophageal reflux disease with hypertension (33.5%). Multiple logistic regression results showed that the age of 45–55 years (adjusted odds ratio [ORadj]] = 1.22, 95% confidence interval [CI], 1.07–1.38), age of over 55 years (ORadj = 1.21, 95% CI, 1.06–1.37), obesity (ORadj = 3.65, 95% CI, 2.55–5.24), and overweight (ORadj = 2.92, 95% CI, 2.05–4.14) were the risk factors of multimorbidity. Also, subjects with high socioeconomic status (ORadj = 1.27, 95% CI, 1.1–1.45) and very high level of socioeconomic status (ORadj = 1.53, 95% CI, 1.31–1.79) had a higher chance of having multimorbidity. The high level of education, alcohol consumption, having job, and high physical activity had a protective role against it. Conclusion The prevalence of multimorbidity was relatively high in the study area. According to the results of our study, age, obesity, and overweight had an important effect on multimorbidity. Therefore, determining interventional strategies for weight loss and control and treatment of chronic diseases, especially in the elderly, is very useful

A Review on Some Aspects of Patient’ Rights in Clinical Education

Clinical education will be possible with involving patients. Many patients who seek medical and diagnostic care can be involved in clinical training. Therefore, teachers and students need to know the legal aspects of patient involvement and adhere to these aspects in order to attract patients’ participation and satisfaction. This study reviewed the importance and necessity of legal aspects, including patient consent, confidentiality and privacy during clinical education. This article described how to take patient consent for participating in training as well as several measures to maintain patient privacy. Giving informed choices without a threat to the patient is emphasized. Finally, it is suggested to prepare leaflets about how to obtain patient consent and maintain confidentiality to inform teachers and students in this regard

The prevalence and predictors of cardiovascular diseases in Kherameh cohort study: a population-based study on 10,663 people in southern Iran

Background The prevalence of cardiovascular disease (CVD) is rapidly increasing in the world. The present study aimed to assess the prevalence and Predictors factors of CVD based on the data of Kherameh cohort study. Methods The present cross-sectional, analytical study was done based on the data of Kherameh cohort study, as a branch of the Prospective Epidemiological Studies in Iran (PERSIAN). The participants consisted of 10,663 people aged 40–70 years. CVD was defined as suffering from ischemic heart diseases including heart failure, angina, and myocardial infarction. Logistic regression was used to model and predict the factors related to CVD. Additionally, the age-standardized prevalence rate (ASPR) of CVD was determined using the standard Asian population. Results The ASPR of CVD was 10.39% in males (95% CI 10.2–10.6%) and 10.21% in females (95% CI 9.9–10.4%). The prevalence of CVD was higher among the individuals with high blood pressure (58.3%, p < 0.001) as well as among those who smoked (28.3%, p = 0.018), used opium (18.2%, p = 0.039), had high triglyceride levels (31.6%, p = 0.011), were overweight and obese (66.2%, p < 0.001), were unmarried (83.9%, p < 0.001), were illiterate (64.2%, p < 0.001), were unemployed (60.9%, p < 0.001), and suffered from diabetes mellitus (28.1%, p < 0.001). The results of multivariable logistic regression analysis showed that the odds of having CVD was 2.25 times higher among the individuals aged 50–60 years compared to those aged 40–50 years, 1.66 folds higher in opium users than in non-opium users, 1.37 times higher in smokers compared to non-smokers, 2.03 folds higher in regular users of sleeping pills than in non-consumers, and 4.02 times higher in hypertensive individuals than in normotensive ones. Conclusion The prevalence of CVD was found to be relatively higher in Kherameh (southern Iran) compared to other places. Moreover, old age, obesity, taking sleeping pills, hypertension, drug use, and chronic obstructive pulmonary disease had the highest odds ratios of CVD.Medicine, Faculty ofNon UBCExperimental Medicine, Division ofMedicine, Department ofReviewedFacultyResearche

An unusual case of cystic fibrosis with pancytopenia due to copper deficiency and blindness caused by vitamin A deficiency: A case-report

Cystic fibrosis (CF) is a multi-systemic autosomal recessive disease which mostly involves the respiratory, digestive, and reproductive systems, but it can present with various clinical presentations, especially in adulthood. We describe a 19-year-old boy, a known case of CF who presented with less known clinical presentations of CF, blindness, liver cirrhosis, vitamin A deficiency, and pancytopenia

The Pro12Ala polymorphism in the PPAR­γ2 gene is not associated with an increased risk of NAFLD in Iranian patients with type 2 diabetes mellitus

Abstract Background The peroxisome proliferator-activated receptors (PPARs) are ligand-activated transcription factors that belong to the nuclear hormone receptor superfamily. Several studies have demonstrated a significant association between Pro12Ala polymorphism of the PPAR­γ2 gene and metabolic disorders. Therefore, this study aimed to evaluate the association of Pro12Ala polymorphism with increased risk of NAFLD in Iranian patients with type 2 diabetes mellitus. Methods This cross-sectional study was performed on 145 healthy control subjects and 145 NAFLD patients with a history of type 2 diabetes. Pro12Ala polymorphism genotyping was performed using PCR–restriction fragment length polymorphism (RFLP) technique with the Bs1I restriction enzyme. Results Our results demonstrated that CC and GG genotypes of Pro12Ala were found in the participants, but there was no statistically significant difference between NAFLD patients and healthy controls (P = 0.64 and χ2 = 0.21). Conclusion This study suggests that Pro12Ala polymorphism of the PPAR­γ2 gene cannot be considered as a risk factor for NAFLD in the Iranian population