Basic Needs of Mothers with Children Undergoing Hemodialysis: A Meta-synthesis of Qualitative Studies

Background: Mothers of children undergoing hemodialysis encounter severe changes in their daily lives. It is of utmost importance to raise the awareness of treatment teams about the needs of these specific groups of mothers and different problems they may experience. The reason is that it can help health care professionals to support the mothers to fulfill their roles as the primary caregivers of such children. Aim: This study aimed to identify basic needs in mothers of children undergoing hemodialysis. Method: This meta-synthesis review of qualitative studies investigating the needs and experience of mothers whose children had kidney disease and published from January 1997 to October 2017. The articles were searched in four databases, including Web of Science, EMBASE, PubMed, and ProQuest. The search process was accomplished using the keywords “chronic kidney disease,” “hemodialysis,” “children,” “mothers,” “parents,” “caregivers,” “needs,” “experiences,” “perspectives,” and “perceptions”. Finally, 7 articles were chosen out of 567 papers and theses. The MAXQDA software was used to facilitate data management. Results: The systematic review of the qualitative studies revealed three main themes, including the need for child care management skills, the need to maintain family cohesion, and the need for emotional–psychological support. Implications for Practice: Mothers of children under hemodialysis should be considered as nursing clients. Accordingly, a multidisciplinary team can empower mothers to take care of the children under hemodialysis and preserve family coherence, as well as supporting them emotionally and psychologically

Educational Evaluation of Medical Student in Health Centers Using Portfolios: A Pilot Study

Background & Objective: The desire for portfolio application, as a suitable method for evaluation of clinical students, has recently expanded. This study investigated the implementation of portfolio in the evaluation of medical students. Methods: In the current study, medical students in their educational rotations in health centers in Mashhad, Iran, in 2011 were evaluated by using portfolio. The scores of medical students' performance and health centers supervisors' evaluation of them were assessed during 10 months and compared with scores from a similar period in the past. Data were analyzed using t-test and SPSS software. Results: Portfolios were completed by all medical students during their rotation in health centers and and evaluation of student was done based on portfolio scoring. Mean performance scores of medical students and health center supervisors' evaluation of them had increased compared of them by portfolio evaluation had increased compared with traditional students' evaluation method in similar past period. Conclusion: Using portfolios for evaluation of medical students' performance in community educational fields is proposed as a performance-based approach. Key Words: Portfolio, Evaluation, Medical students, Health center

Screening Characteristics of Bedside Ultrasonography in Confirming Endotracheal Tube Placement; a Diagnostic Accuracy Study

Introduction: Confirmation of proper endotracheal tube placement is one of the most important and lifesaving issues of tracheal intubation. The present study was aimed to evaluate the accuracy of tracheal ultrasonography by emergency residents in this regard.  Method: This was a prospective, cross sectional study for evaluating the diagnostic accuracy of ultrasonography in endotracheal tube placement confirmation compared to a combination of 4 clinical confirmation methods of chest and epigastric auscultation, direct laryngoscopy, aspiration of the tube, and pulse oximetry (as reference test).Results: 150 patients with the mean age of 58.52 ± 1.73 years were included (56.6% male). Sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio of tracheal ultrasonography in endotracheal tube confirmation were 96 (95% CI: 92-99), 88 (95% CI: 62-97), 98 (95% CI: 94-99), 78 (95% CI: 53-93), 64 (95% CI: 16-255), and 0.2 (95% CI: 0.1-0.6), respectively.Conclusion: The present study showed that tracheal ultrasonography by trained emergency medicine residents had excellent sensitivity (>90%) and good specificity (80-90) for confirming endotracheal tube placement. Therefore, it seems that ultrasonography is a proper screening tool in determining endotracheal tube placement

Infertile couples' perceived needs after unsuccessful fertility treatment: A qualitative study

Introduction: Infertility is a major medical issue. Investigations and treatment of infertility are the beginning of a complex, time-consuming and stressful process for couples that may fail well. The present study explored the needs of infertile couples following treatment failure with Assisted Reproductive Technologies (ARTs). Methods: A descriptive qualitative study was conducted in an Iranian infertility center, in the Northeast of the country between April 2016 and June 2017. The researchers recruited 29 individuals including 9 couples, 9 women and two men with primary infertility through purposive sampling. The data were collected using semi-structured interviews and analyzed iteratively, using conventional content analysis with MAXQDA software. Results: The main concepts obtained from the data were classified into one theme titled: ""The need for support"" and four main categories along with their subcategories, and included the need for psychological support, the need for more useful information, the need for social support and the need to access to supplementary services. Conclusion: The findings show that following treatment failure, the infertile patients’ expressed needs and preferences were not met. Identifying and meeting their needs may help the infertile couples to deal with ARTs failure and to reach a decision about future treatment

Iranian infertile couples' strategies to manage social interactions after unsuccessful treatments with assisted reproductive technologies

Many infertile couples feel vulnerable after failed treatment cycles and find insensitive remarks or inappropriate support distressing. They fear that the stress of failed treatment cycles may affect their marriage and lead to marriage breakdown. This study explored the strategies a sample of infertile couples used to manage social interactions after unsuccessful treatment with assisted reproductive technologies. A descriptive qualitative study was conducted with 34 participants including nine infertile couples, nine infertile women and two infertile men with primary infertility, two relatives, and three fertility clinic staff. The participants were selected through purposive sampling at an infertility centre in Iran, between 2016 and 2017. Data were collected using semi-structured face-to-face interviews and analysed by qualitative content analysis approach. Participants found some social interactions after failed assisted reproductive treatment cycles to be distressing and painful. They described tolerating painful emotions which cause them sadness and sorrow as well as feeling embarrassed. As a result, they found they needed to maintain their adopting concealment strategies with their families through not permitting speculation, selective disclosure, not giving details and hiding the truth. This study showed that social interactions following failed assisted reproductive cycles can be upsetting for infertile couples. Couples use different strategies to manage potentially distressing social interactions. Healthcare providers and psychologists may provide a space for safe social interactions in order to help couples to use appropriate strategies in these circumstances

Comparing the Criteria for Promoting Faculty Members of Iranian Medical Universities with Selected Universities of the World: A Comparative Study

Introduction: Comparative studies are one of the research methods in reviewing educational programs. This study endeavored to describe, interprete, and compare the criteria for promoting Iranian medical  with selected universities in the world. Methods: This is a descriptive-comparative study that first studied the new regulations for the promotion of faculty members of Iranian universities of medical sciences, then the latest criteria for the promotion of professors in other universities and research conducted in this regard, Searched, translated, and studied by searching the sites of various universities and the Google-scholar, Scupos, Pubmed sites, and the Proquest and Magiran magazines. The four prominent universities in Shanghai International Rankings, including Harvard, Stanford, Will Cornell and John Hopkins, were selected as the research sample. The applied model in this study was a Beredy model that identifies four stages of description, interpretation, proximity, and comparison in comparative studies. Results: In the studies, it was determined that the criteria in the selected universities are in the fields of: education, research, skills and innovation, or clinical care, and in some cases program construction. The candidate chooses to upgrade a field. There is also a support criterion consisting of achievement in all specific areas and activities. In Iran, educational, research-technology, scientific-executive and cultural-social training criteria are the main criteria. Conclusion: The results obtained allow the country's scientific policymakers to develop, revise and modify the criteria for promoting faculty members with a broader vision which in turn set the stage for the ground for the comprehensive promotion of scientific and research education in the country

Cross-Cultural Competence, an Unknown Necessity in Medical Sciences Education a Review Article

Introduction: Cross-cultural competence as a core component in professionalism has a unique role in medical sciences due to cultural diversity clients (especially university students and patients). Despite its importance, yet many aspects of this competence are unknown in our country. Therefore this paper presents a review of cultural competence, its significance in the medical community, and its position in Iran as well as how it is assessed and educated. Methods: In this review article, we searched in library and electronic resources such as Sceince Direct, Magiran, SID, PubMed, and Proquest. Keywords used were cross-cultural competence, assessment, education, and faculty members, both alone and in combination. All documents were reviewed. Then relevant documents were selected and the related content and information were extracted. Results: Out of 131 investigated articles in total, documents of 67 relevent and credible articles were obtained. With regard to the diversity of the aspect of this subject, articles were classified in three categories of “importance of cultural competence”, “cultural competency education,” and “cultural competency assessment”. Cultural competence is a set of congruent behaviors, attitudes, and policies that come together and enable the person to work effectively in cross-cultural situations. In the care area, there is an obvious link between the cultural competence, quality improvement, health outcomes enhancement, and elimination of ethnic inequalities. In the education area, a culturally competent school is a place wherein new opportunities are provided for students in support of individual development as well as different cultural groups. Therefore medical educators must have multicultural attitude, behavior, and knowledge to help different types of clients (especially students and patients) appropriately. Conclusion: Since cultural variables are affected by various factors in our country, it is necessary to investigate this phenomenon in our own cultural setting. Moreover, a comprehensive plan must be developed for its educational strategies and assessment among faculty members and students

Cluster analytical approach to Lifestyle characteristics: A population based study in Shiraz, Iran

Introduction: A limited number of risky behaviors cause most morbidity and mortality. The aim of this study was to determine the possible clustering of lifestyle behaviors, including transportation behaviors, diet, physical activity, and smoking in Shiraz, Iran. Methods: There were 776 representative Shirazi adults who participated in this cross-sectional study. The questionnaires were completed via person-to-person interviews. The datasets were searched for any clustering patterns. Cluster analysis was used for statistical analysis, and the data were analyzed using SPSS version 11.5. Results: Three distinct clusters were identified. Cluster 1 was named "Healthy," and it included non-smokers, safe drivers, appropriate or acceptable fruit, vegetable, and fast-food consumers, and physically-active people. Cluster 2, "Moderately Healthy," was relatively risky drivers who had appropriate behaviors on the rest of the health-related behaviors. Cluster 3, "Unhealthy," was smokers, risky drivers, inappropriate or unacceptable fruit, vegetable & fast-food consumers, and a sedentary lifestyle. Conclusions: It was obvious that health-related behaviors were clustered together and unhealthy behaviors were not established in isolatio