Patients' and Physicians' Viewpoints on Interns' Professional Outfit: A Survey in an Iranian Teaching Hospital

Background: A person’s appearance and his/her adherence to the dress code standards are essential in the medical profession. Objectives: This study aimed to investigate patients’ and physicians’ viewpoints on interns’ professional outfits. Methods: This is a cross-sectional study, with the participation of patients and physicians of general departments in a teaching hospital of Kerman University of Medical Sciences in 2018. The patients and physicians were selected through convenience and census method, respectively. To examine the participants’ perspectives on the professional dressing, six schematic images, three for males (1, 2, 3) and three for females (A, B, C) were designed. Data were collected through a structured interview in this way, the schematic images were displayed to the participants and they were asked to express their perspective using a series of questions. Data analyzed using SPSS version20. Results: Totally, 381 patients and 34 physicians participated. The majority of the Participants preferred the professional outfit A for female interns and the professional outfit 1for male interns in response to questions regarding the knowledge, responsibility, patient-care, hygiene, reliability of diagnosis and treatment of diseases, giving emergency consultations, the possibility for discussing sexual and psychiatric problems, as well as life problems. The physicians and patients had the same perspective except for the item about knowledge. (P<0.05). Conclusion: Our study shows that the outfits of physicians were considered by the participants in forming an effective relationship between the doctor and the patient, and the amount of patients' trust.Therefore, training interns for dressing professionally and complying with the necessary standards should be considered. Keywords: Professional Outfits, Hospitals, Physicians, Patients, Professio

A phase III, randomized, two-armed, double-blind, parallel, active controlled, and non-inferiority clinical trial to compare efficacy and safety of biosimilar adalimumab (CinnoRA (R)) to the reference product (Humira (R)) in patients with active rheumatoid arthritis

Background: This study aimed to compare efficacy and safety of test-adalimumab (CinnoRA (R), CinnaGen, Iran) to the innovator product (Humira (R), AbbVie, USA) in adult patients with active rheumatoid arthritis (RA). Methods: In this randomized, double-blind, active-controlled, non-inferiority trial, a total of 136 patients with active RA were randomized to receive 40 mg subcutaneous injections of either CinnoRA (R) or Humira (R) every other week, while receiving methotrexate (15 mg/week), folic acid (1 mg/day), and prednisolone (7.5 mg/day) over a period of 24 weeks. Physical examinations, vital sign evaluations, and laboratory tests were conducted in patients at baseline and at 12-week and 24-week visits. The primary endpoint in this study was the proportion of patients achieving moderate and good disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR)-based European League Against Rheumatism (EULAR) response. The secondary endpoints were the proportion of patients achieving American College of Rheumatology (ACR) criteria for 20% (ACR20), 50% (ACR50), and 70% (ACR70) responses along with the disability index of health assessment questionnaire (HAQ), and safety. Results: Patients who were randomized to CinnoRA (R) or Humira (R) arms had comparable demographic information, laboratory results, and disease characteristics at baseline. The proportion of patients achieving good and moderate EULAR responses in the CinnoRA (R) group was non-inferior to the Humira (R) group at 12 and 24 weeks based on both intention-to-treat (ITT) and per-protocol (PP) populations (all p values >0.05). No significant difference was noted in the proportion of patients attaining ACR20, ACR50, and ACR70 responses in the CinnoRA (R) and Humira (R) groups (all p values >0.05). Further, the difference in HAQ scores and safety outcome measures between treatment arms was not statistically significant. Conclusion: CinnoRA (R) was shown to be non-inferior to Humira (R) in terms of efficacy at week 24 with a comparable safety profile to the reference product

Determining valid criteria for evaluating clinical and theoretical teaching of the faculty of Kerman University of Medical Sciences

Background: To improve the quality of education, evaluating clinical and theoretical teaching and giving feedbacks to the teachers to obviate the drawbacks is of important value. Evaluation results are reliable if the gathered data are correct and precise and it can be achieved only if there are precise tools to gather data. This study was performed to prepare valid forms to evaluate theoretical and clinical teaching. An appropriate weight has been allocated to each item. Method: Separate checklists were designed for students, in order to evaluate theoretical and clinical teaching. Also special forms were developed for teacher evaluations by heads of departments and school deans .School deans ,on the other hand, completed special checklists to evaluate vice-deans and head of departments. Using the expert’s attitudes, the validity was calculated by Delphi method and the weight of different items was calculated by trim mean. Findings: The questionnaire had different categories including discipline, teaching method, scientific level and evaluation. The longest forms had 17 items (theoretical and practical teaching). The highest validity coefficient was 0.9 0.07 and the lowest was 0.83 0.03. The most important item in theoretical teaching was scientific level of teachers and in clinical teaching, it was on time attendance. Conclusion. Designing checklist for assessment of achievement in educational objectives is very essential and it must be precise and correct. The item must be checked because of changing educational context

Co-administration of walnut (Juglans regia) prevents systemic hypertension induced by long-term use of dexamethasone: a promising strategy for steroid consumers

Context: The long-term consumption of glucocorticoids (GCs) may induce serious adverse effects such as hypertension. There is sufficient evidence related to the benefit of walnuts on the cardiovascular system. Objective: This study assesses the effect of methanol extract of walnut [Juglans regia L. (Juglandaceae)] on dexamethasone-induced hypertension and the possible mechanisms in Wistar rats. Material and methods: Animals were randomized into control, kernel extract (100 and 200 mg/kg/d, orally), dexamethasone (0.03 mg/kg/d, subcutaneously), dexamethasone + kernel (100 and 200 mg/kg/d, separately), and dexamethasone + captopril (25 mg/kg/d, orally) groups. Animals were treated with water, kernel extract or captopril by gavage 4 d before and during 11 d of saline or dexamethasone treatment. On the 16th day, blood pressure (BP) was recorded and blood samples were collected to measure nitric oxide (NO). Animal hearts were frozen for measurement of malondialdehyde (MDA) and glutathione peroxidase (GPX). Results: Dexamethasone increased the diastolic BP and MDA/GPX ratio in comparison with control group (128 ± 7 vs. 105 ± 3 mmHg, p < 0.05 and 0.2 ± 0.046 vs. 0.08 ± 0.02, p < 0.05). Combination of dexamethasone and walnut (200 mg/kg) prevented the dexamethasone-induced diastolic hypertension (109 ± 3 vs. 128 ± 7 mmHg; p < 0.05), increased the GPX level (14.8 ± 1.46 vs. 5.1 ± 0.64 unit/mg, p < 0.05), reduced the MDA/GPX ratio (0.16 ± 0.015 vs. 0.2 ± 0.046) and improved serum NO level. Conclusion: Similar to captopril, walnut extract normalized dexamethasone-induced hypertension. A part of this beneficial effect apparently involves maintaining balance of the redox system and NO production