Electrical stimulation of acupuncture points for analgesia during bone marrow aspiration and biopsy: A randomized double-blind placebo-controlled trial

Background: Bone marrow aspiration and biopsy (BMA/BMB) is a painful procedure mostly used in diagnosing and staging of a broad spectrum of hematological diseases. In spite of local anesthesia, the prevalence and intensity of the pain and patient discomfort caused by this procedure are considerable. The effect of acupuncture and electrical stimulation of acupoints (acupuncture points) in the treatment of many medical conditions, including pain, have been approved. The study is designed to evaluate the effect of electrical stimulation of acupoints to decrease the pain during BMA/BMB in adults. Materials and Methods: In a double-blind controlled clinical trial, 50 patients undergoing BMA/BMB were randomly allocated into two groups, to receive either true or placebo electrical stimulation of acupoints LI-4 (large intestine 4, Hegu) and LI-11 (large intestine 11, Quchi), bilaterally. Both groups received infiltrative local anesthesia. The pain level caused by BMA/BMB was measured using the Visual Analog Scale (VAS). Results: The means of the VAS in the case and control groups were 41.84 ± 20.54 and 69.40 ± 20.06 respectively (P < 0.001). The systolic and diastolic blood pressure and pulse rate rose significantly in both the groups compared to the basal values. The rise was lower in the acupuncture group compared to the placebo group regarding systolic blood pressure and pulse rate (P = 0.018 and P < 0.001, respectively). Conclusions: The results of this study show that the electrical stimulation of acupoints significantly decreases the pain caused by BMA/BMB and some of the complications of the pain

Designing, Conducting, and Assessment of Early Clinical Exposure Course for Practicing Professionalism and Communication Skills

Introduction: Early clinical exposure is a learning strategy, which can expose medical students during their first year of education with clinical environment. In view of this, this study has been carried out a different kind of early clinical exposure to practice medical professionalism. Methods: This study was a development study that was conducted in the academic years 2017-2018. Initially, needs assessment was performed based on literature review and expert panel. Then, the design of early exposure was depicted through a focus-group interview with the presence of Olympiad students. After that, the program was implemented. The topics were presented individually in the workshop and audio podcasts were presented in the Learning Management System. In the second practical round, namely early clinical exposure, the students were divided into multiple groups and practiced communication skills and professionalism in the clinical contexts by a tutor who was in higher level of education. To evaluate this program, satisfaction forms were employed to assess the students' learning through multiple-choice and descriptive tests. Results: In the evaluation, great level of the students' satisfaction was about the selected environments, the educational program (78.1%), the employed methods of the course (73.2%) and recognition of professional responsibilities (73.2%). The least level of the students' satisfaction was the amount of learning opportunities (65.8%). 75.6% of students acknowledged the increase in their professionalism. Conclusion: Early clinical exposure is a rich opportunity for enhancing professionalism and communication skills for medical students who are in the introductory level of medical education. This way, repeating the outcomes of this study in experimental and clinical trials is recommended. Early clinical exposure should be followed seriously for long-term as well