Spirituality as a sociocultural determinant of health in the context of medical curriculum: A call for action

Background: This study aimed to investigate the state of spirituality in the general medicine curricula in Iran. Methods: Reference books for general medicine were reviewed and data were analyzed according to the qualitative content analysis method. Results: After reviewing references, it was found that only 35 paragraphs of the educational reference pages dealt with this subject. Related topics to spirituality had 2 major themes: (a) spirituality and care (assessment, treatment, palliative care, and bereavement); (b) spirituality and professionalism (considering culture and medical ethics). Conclusion: This study showed that despite the importance of the subject and much evidence on spirituality and medicine, medical references have limitations. The authors suggested some strategies to develop a specific course and integrate all educational references with the objectives of the general medical education course in Iran. © Iran University of Medical Sciences

Questionnaires measuring patients' spiritual needs: A narrative literature review

Context: The objective of the present review was to collect published spiritual needs questionnaires and to present a clear image of the research condition of this domain. Evidence Acquisition: First, an electronic search was conducted with no limits on time span (until June 2015) or language in the following databases: PubMed, Scopus, Ovid, ProQuest and Google Scholar. All derivations of the keywords religion and spiritual alongside need and its synonyms were included in the search. Researches that introduced new tools was then selected and included in the study. Due to the limited quantity of questionnaires in this domain and with no consideration given to the existence or lack of exact standardization information, all of the questionnaires were included in the final report. Results: Eight questionnaires were found: patients spiritual needs assessment scale (PSNAS), spiritual needs inventory (SNI), spiritual interests related to illness tool (SpIRIT), spiritual needs questionnaire (SpNQ), spiritual needs assessment for patients (SNAP), spiritual needs scale (SNS), spiritual care needs inventory (SCNI), and spiritual needs questionnaire for palliative care. Conclusions: These questionnaires have been designed from a limited medical perspective and often involve cultural concepts which complicate their cross-cultural applicability. © 2016, Mazandaran University of Medical Sciences

Participating in university entrance exam despite repeated failure: a qualitative study of participants' experiences

Objectives: To explore the experiences of general practitioners who continue to sit a highly-competitive residency entrance examination, despite repeated failure. Methods: This qualitative, exploratory study employed semi-structured, in-depth interviews with 35 candidates of a residency entrance exam who had failed the examination at least twice and were preparing to sit it again. Interview questions addressed the challenges they faced and how they managed these challenges. Interview data were audiotaped, transcribed, and analysed to identify themes. Results: The results demonstrated that more than 50 (n=19) of candidates struggled continuously and internally with different aspects of the exam. These include being under a great deal of pressure to succeed, failing to prioritize study materials, inefficient review during the final days  of preparation, and sitting the exam with an afflicted body. Furthermore, during the examination, they frequently used inefficient strategies to answer questions. Afterwards, they experienced feelings of freedom associated with having finished the exam. Conclusions: Participation in a highly-competitive examination exerts a considerable amount pressure on low-performing candidates. This climate not only results in burn out of participants, but it also influences their learning styles and identities as future physicians. It is therefore necessary to design a syllabus for both test candidates and policy makers, in order better to manage this environment. Candidates also should be aware of their individual weaknesses in order to improve their studying skills

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Anorgasmia in Iranian Culture: The Queen�s Passivity

The studies conducted on the prevalence of the lifelong form of anorgasmia in Iran indicate clear differences in its prevalence in women in Iranian culture compared to western culture. The authors have attributed such differences to the differences in assessment tools, sample size, and poor study methods, as well as cultural barriers to the use of questionnaires, and the effects of culture on sexual disorders. In this article this issue has been formulated from a cultural concept of passivity. In Iranian culture, passivity is regarded as one of the dominant roles of women in sex, which can be called �The Queen�s Passivity�. Indeed, this special kind of passivity before men has certain privileges for the woman as a queen. This is �passivity resulting in authority�, which is an important feature of this culture and all evidence suggests that passivity and anorgasmia accompany each other in this culture and the profound meaning of its suffering should be somewhat sought in the �man king-queen�s passivity� relationship, which has denied many Iranian women the experience of pleasure of orgasm for thousands of years. This hypothesis has been explained by making reference to important cultural and religious resources in Iranian culture in this article and it has been argued that if anorgasmia can be better explained culturally, then this problem should not be considered a psychiatric disorder. This point is not taken into account in DSM5 diagnostic criteria for anorgasmia and the lack of attention to this issue can be one of the reasons for the greater report of anorgasmia in Iran. © 2020, Springer Science+Business Media, LLC, part of Springer Nature

Improvement of restless legs syndrome by nabat: A case series and new hypotheses for research

Background: Although many hypotheses have been suggested, the pathophysiology of restless legs syndrome (RLS) has not been fully understood. In this case series, we describe eleven cases with RLS whose symptoms subsided by the use of crystallized sucrose. This kind of sugar, known as nabat, is used in traditional Iranian medicine. Methods: Case series. Results: All patients felt relief 30-60 min after taking 100 grams of dissolved nabat. Conclusions: Sucrose seems to carry a special benefit for patients with RLS, and it provides evidence for growing literature demonstrating the different underlying mechanisms of RLS. Possible causes for this concurrence are also discussed. © 2016 by De Gruyter