Conscious sedation and analgesia in colonoscopy: Ketamine/propofol combination has superior patient satisfaction versus fentanyl/propofol

Background: Colonoscopy is performed without preparing sedation in many countries. However, according to the current literature patients are more satisfied when appropriate sedation is prepared for them. Objectives: We hypothesize that propofol-ketamine may prepare more patient satisfaction compared to propofol-fentanyl combination. Patients and Methods: Sixty adult patients older than 18 with ASA physical status of I, II or III were enrolled in the present study after providing the informed consent. They were prospectively randomized into two equal groups: 1- Group PF: was scheduled to receive IV bolus dose of fentanyl 1μg/kg and propofol 0.5mg/kg. 2- Group PK: was scheduled to receive IV bolus dose of ketamine 0.5mg/kg and propofol 0.5mg/kg. As a primary goal, patient's satisfaction was assessed by the use a Likert five-item scoring system in the recovery. Comparisons of hemodynamic parameters (mean heart rate, mean systolic blood pressure, mean diastolic blood pressure), mean Spo2 values during the procedure and side effects such as nausea, vomiting, and psychological reactions during the recovery period were our secondary goals. Level of sedation during the colonoscopy was assessed with the Observer's Assessment of Alertness/Sedation score (OAA/S). Results: Mean satisfaction scores in the group PK were significantly higher than the group PF (P = 0.005) while the level of sedation during the procedure was similar (P = 0.17). Hemodynamic parameters and SpO2 values were not significantly different (P > 0.05). Incidence of nausea and vomiting was the same in both groups. Conclusions: IV bolus injection of propofol-ketamine can lead to more patients' satisfaction than the other protocols during colonoscopy. © 2013 Iranian Society of Regional Anesthesia and Pain Medicine

Effect of changing journal clubs from traditional method to evidence-based method on psychiatry residents

Farhad Faridhosseini,1 Ali Saghebi,2 Majid Khadem-Rezaiyan,3 Fatemeh Moharari,2 Maliheh Dadgarmoghaddam3 1Psychiatry and Behavioral Sciences Research Center, 2Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center, 3Community Medicine, Faculty of Medicine, Mahhad University of Medical Sciences, Mashhad, Iran Introduction: Journal club is a valuable educational tool in the medical field. This method follows different goals. This study aims to investigate the effect on psychiatry residents of changing journal clubs from the traditional method to the evidence-based method. Method: This study was conducted using a before–after design. First- and second-year residents of psychiatry were included in the study. First, the status quo was evaluated by standardized questionnaire regarding the effect of journal club. Then, ten sessions were held to familiarize the residents with the concept of journal club. After that, evidence-based journal club sessions were held. The questionnaire was given to the residents again after the final session. Data were analyzed through descriptive statistics (frequency and percentage frequency, mean and standard deviation), and analytic statistics (paired t-test) using SPSS 22. Results: Of a total of 20 first- and second-year residents of psychiatry, the data of 18 residents were finally analyzed. Most of the subjects (17 [93.7%]) were females. The mean overall score before and after the intervention was 1.83±0.45 and 2.85±0.57, respectively, which showed a significant increase (P<0.001). Conclusion: Moving toward evidence-based journal clubs seems like an appropriate measure to reach the goals set by this educational tool. Keywords: journal club, evidence-based, residents, education metho

Applying accreditation standards in a self-evaluation process: The experience of Educational Development Center of Tehran University of Medical Sciences

Introduction: Educational Development Centers (EDCs), as the coordinator in education development in Medical Sciences universities, in order to improve their quality should evaluate their activities. In spite of remarkable performance of Tehran University of Medical Sciences (TUMS) EDC in previous national rankings, but it faces many challenges and problems. This paper provided the process, results and lessons learned from a self-evaluation experience conducted at TUMS EDC based on accreditation standards. Method: The present study is an Institutional self-evaluation study based on the national accreditation standards of EDCs (2012). Data were gathered using an open-ended questionnaire developed on the basis of the SWOT format. A directional content analysis applied to analyze the data. Results: In total, 84 point of strengths, 87 weaknesses, 15 opportunities, 24 threats and also 99 recommendations for quality improvement were reported. The most important strengths of the center were the existence of an established mechanism regarding research process in education and scholarship of education, holding various faculty development courses and training standardized patient. The most important weaknesses were the lack of specified procedures in some areas such as monitoring the planning and reviewing of educational programs in the field of educational programs and evaluation of empowerment courses. Conclusion: The present evaluation results will be useful in directing future policies of TUMS EDC such as revising its strategic planning. We hope that the current experience can be helpful for administrators in EDCs in the Ministry of Health and Medical Education and also other Medical Sciences Universities

Prevalence of elimination disorders and comorbid psychiatric disorders in Iranian children and adolescents

PURPOSE: Currently, there is a paucity of studies on the prevalence of Elimination Disorders among Iranian children and adolescents. Due to the ongoing need to monitor the health status of these children and adolescents, the present study aims to investigate the prevalence of Elimination Disorders and comorbid disorders in Iranian children and adolescents. METHODS: In this cross-sectional study, 29,781 children and adolescents age 6 to 18 years old were selected and studied from all the provinces in Iran. The sampling was carried out by employing a multistage cluster sampling method, and several clinical psychologists using semi-structured interviews collected the data. Furthermore, clinical psychologists collected demographic information (including information about gender, age, place of residence, education level, and parental education level). The collected data were analyzed using SPSS version 20. RESULTS: Generally, the prevalence of Elimination Disorders was found to be 5.4 covering both enuresis (p= 5.4, 95 CI = 5.1-5.7) and encopresis (p= 0.13, 95 CI = 0.09-0.2). The total prevalence of comorbid disorders was 38, and among the comorbid disorders, Attention Deficit Hyperactivity Disorder (ADHD) (p= 11, 95 CI = 9.5-12.7) and Separation Anxiety (p= 10.6, 95 CI = 9.1-12.2) were the most prevalent. CONCLUSION: The prevalence of Elimination Disorders in Iranian children and adolescents is moderate compared to similar studies elsewhere. As for comorbid disorders, ADHD and Separation Anxiety were found to be the most prevalent disorders. Since Elimination Disorders coexist with psychiatric disorders in children, further studies of these comorbidities may give better insight into the treatment and prognosis of Elimination Disorders. © 2021 - IOS Press. All rights reserved