An Evolutionary Approach towards Ph.D. Educational System in Medical Sciences in Iran: a Systematic Review of Educational Models in the World’s Leading Universities

Background & Objective : In this study, we aimed to evaluate the status of World’s leading universities in Ph.D. students’ education and to compare it with Iranian universities applying the approach of educational status evaluation in a research based way. Methods: Using a systematic review, all documents present in the webs and related links of universities of first 10 countries in Shanghai’s Academic Ranking of World Universities were systematically reviewed information related to Ph.D. education was systematically collected and analyzed. Results : Reviewing 28 leading universities revealed that the educational model in educating Ph.D. students in 22 of them was research based and the rest are using course based model. Passing taught courses, as an index in course based model, is considered to be among minimum course requirements in most of the universities which are using research based model. In cases where passing such courses is voluntarily, a consultant professor plays a significant role in guiding the students in selecting and attending theoretical courses. Conclusion : Based on the above explanation and similar to other successful countries, it seems that it is time to create various models for training postgraduate students to meet industrial needs. With revisions in educational curriculums, purposeful attempts should be made to solve possible problems and train people who meet country’s developmental needs in regards with the twenty year prospect. Keywords: Postgraduate education, Shanghai’s Academic Ranking, Research based curriculum, Scientific development, Ph.D.

Strategies in Development of Iranian Medical Sciences Universities for Dynamic Presence in the International Arena

Background & Objective: In compatibility with the progress of universities and expansion of knowledge and science around the world, Iran has also had significant academic progress in recent years. However, the vision of Iran for the following decades is very ambitious. Much has to be achieved to reach the highest position in the region in development, economy, science, and technology. This qualitative study was designed to explore the strengths and weaknesses of universities. Methods: This qualitative study had three phases. In the first phase, we explored the topic in brain storming sessions. Then, the themes raised in phase one were discussed deeply in unstructured interviews with selective experts around the country. In the last phase, we asked 30 selective academic staff from different medical sciences universities to categorize the issues based on their importance and their solutions using Delphi method. Results: Our findings showed that improvement of international affairs were frequently stressed by our respondents. In this domain, the English skills of academic staff and students, big revision in rules and regulations, and encouraging the establishment of close scientific communication with academic organizations around the world were highlighted. In addition, most respondents believed that problems were understandable, but our main conflicts were in finding applicable solutions and implementing decisions. Conclusion: Our results showed that for a better presentation of Iranian universities in the international environment a new approach to long term reform programs is necessary. In this plan, special attention must be paid to the educational and research infrastructures. Keywords University ranking University of Medical Sciences Development strategies International arena Critical thinking Skills Medical student

The Projection of Burden of Disease in Islamic Republic of Iran to 2025

Objective: Iran as a developing country is in the transition phase, which might have a big impact on the Burden of Disease and Injury (BOD). This study aims to estimate Burden of Disease and Injury (BOD) in Iran up to 2025 due to four broad cause groups using Disability-Adjusted Life Year (DALY). Methods: The impacts of demographic and epidemiological changes on BOD (DemBOD and EpiBOD) were assessed separately. We estimated DemBOD in nine scenarios, using different projections for life expectancy and total fertility rate. EpiBOD was modeled in two scenarios as a proportion of DemBOD, based on the extracted parameters from an international study. Findings: The BOD is projected to increase from 14.3 million in 2003 to 19.4 million in 2025 (95% uncertainty interval: 16.8, 21.9), which shows an overall increase of 35.3%. Non-communicable diseases (12.7 million DALY, 66.0%), injuries (4.6 million DALY, 24.0%), and communicable diseases, except HIV/AIDS (1.8 million DALY, 9%) will be the leading causes of losing healthy life. Under the most likely scenario, the maximum increase in disease burden due to DemBOD is projected to be observed in HIV/AIDS and Non-communicable diseases (63.9 and 62.4%, respectively) and due to EpiBOD in HIV/AIDS (319.5%). Conclusion: It seems that in the following decades, BOD will have a sharp increase in Iran, mainly due to DemBOD. It seems that communicable diseases (except HIV/AIDS) will have less contribution, and especially non-communicable diseases will play a more significant role

Prevention of Clostridium difficile Infection: A Systematic Survey of Clinical Practice Guidelines

background. Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea. objective. To analyze themethodological quality, content, and supporting evidence among clinical practice guidelines (CPGs) on CDI prevention. design and setting. We searched medical databases and gray literature for CPGs on CDI prevention published January 2004-January 2015. Three reviewers independently screened articles and rated CPG quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, composed of 23 items, rated 1–7, within 6 domains. We reported each domain score as a percentage of its maximum possible score and standardized range. We summarized recommendations, extracted their supporting articles, and rated individually the level of evidence using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. results. Of 2,578 articles screened, 5 guidelines met inclusion criteria. Median AGREE II scores and interquartile ranges were: clarity of presentation, 75.9% (75.9%–79.6%); scope and purpose, 74.1% (68.5%–85.2%); editorial independence, 63.9% (47.2%–66.7%); applicability, 43.1% (19.4%–55.6%); stakeholder involvement, 40.7% (38.9%–44.4%); and rigor of development, 18.1% (17.4%–35.4%). CPGs addressed several common strategies for CDI prevention, including antibiotic stewardship, hypochlorite solutions, probiotic prophylaxis, and bundle strategies. Recommendations were often not consistent with evidence, and most were based on low-level studies. conclusion. CPGs did not adhere well to AGREE II reporting standards. Furthermore, there was limited transparency in moving from evidence to recommendations. CDI prevention CPGs need to better adhere to AGREE-II and be transparent in moving from evidence to recommendations, and recommendations need to be consistent with available evidence

Systematic survey of randomized trials evaluating the impact of alternative diagnostic strategies on patient-important outcomes

Objectives: To provide a perspective on the current practice of randomized clinical trials (RCTs) of diagnostic strategies focusing on patient-important outcomes. Study Design and Setting: We conducted a comprehensive search of MEDLINE and included RCTs published in full-text reports that evaluated alternative diagnostic strategies. Results: Of 56,912 unique citations, we sampled 7,500 and included 103 eligible RCTs, therefore suggesting that MEDLINE includes approximately 781 diagnostic RCTs. The 103 eligible trials reported on: mortality (n = 41; 39.8%); morbidities (n = 63; 61.2%); symptoms/quality of life/functional status (n = 14; 13.6%); and on composite end points (n = 10; 9.7%). Of the studies that reported statistically significant results (n = 12; 11.6%), we judged 7 (58.3%) as at low risk of bias with respect to missing outcome data and 4 (33.3%) as at low risk of bias regarding blinding. Of the 41 RCTs that reported on mortality, only one (2.4%) reported statistically significant results. Of 63 RCTs addressing morbidity outcomes, 11 (17.5%) reported statistically significant results, all of which reported relative effects of greater than 20%. Conclusion: RCTs of diagnostic tests are not uncommon, and sometimes suggest benefits on patient-important outcomes but often suffer from limitations in sample size and conduct. (C) 2017 Elsevier Inc. All rights reserved.Peer reviewe

Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery:An Individual Patient Data Meta-Analysis

IMPORTANCE: Postoperative delirium (POD) is a common and serious complication after surgery. Various predisposing factors are associated with POD, but their magnitude and importance using an individual patient data (IPD) meta-analysis have not been assessed.OBJECTIVE: To identify perioperative factors associated with POD and assess their relative prognostic value among adults undergoing noncardiac surgery.DATA SOURCES: MEDLINE, EMBASE, and CINAHL from inception to May 2020.STUDY SELECTION: Studies were included that (1) enrolled adult patients undergoing noncardiac surgery, (2) assessed perioperative risk factors for POD, and (3) measured the incidence of delirium (measured using a validated approach). Data were analyzed in 2020.DATA EXTRACTION AND SYNTHESIS: Individual patient data were pooled from 21 studies and 1-stage meta-analysis was performed using multilevel mixed-effects logistic regression after a multivariable imputation via chained equations model to impute missing data.MAIN OUTCOMES AND MEASURES: The end point of interest was POD diagnosed up to 10 days after a procedure. A wide range of perioperative risk factors was considered as potentially associated with POD.RESULTS: A total of 192 studies met the eligibility criteria, and IPD were acquired from 21 studies that enrolled 8382 patients. Almost 1 in 5 patients developed POD (18%), and an increased risk of POD was associated with American Society of Anesthesiologists (ASA) status 4 (odds ratio [OR], 2.43; 95% CI, 1.42-4.14), older age (OR for 65-85 years, 2.67; 95% CI, 2.16-3.29; OR for &gt;85 years, 6.24; 95% CI, 4.65-8.37), low body mass index (OR for body mass index &lt;18.5, 2.25; 95% CI, 1.64-3.09), history of delirium (OR, 3.9; 95% CI, 2.69-5.66), preoperative cognitive impairment (OR, 3.99; 95% CI, 2.94-5.43), and preoperative C-reactive protein levels (OR for 5-10 mg/dL, 2.35; 95% CI, 1.59-3.50; OR for &gt;10 mg/dL, 3.56; 95% CI, 2.46-5.17). Completing a college degree or higher was associated with a decreased likelihood of developing POD (OR 0.45; 95% CI, 0.28-0.72).CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of individual patient data, several important factors associated with POD were found that may help identify patients at high risk and may have utility in clinical practice to inform patients and caregivers about the expected risk of developing delirium after surgery. Future studies should explore strategies to reduce delirium after surgery.</p

Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines - 2016 Revision

BACKGROUND: Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update. OBJECTIVE: We sought to provide a targeted update of the ARIA guidelines. METHODS: The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations. RESULTS: The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient. CONCLUSIONS: Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment

Predictors of persistent postsurgical pain following total knee arthroplasty: A protocol for systematic review and meta-analysis

Background: Total knee arthroplasty (TKA) is a commonly performed procedure, primarily when knee joints have been damaged by progressive arthritis; however, over 20% of surgical patients develop persistent postsurgical pain (PPSP). We plan to conduct a systematic review and meta-analysis of factors associated with the development of PPSP following TKA. Methods: We will include peer-reviewed cohort or case–control studies that explore, in an adjusted model, factors associated with the development of PPSP after TKA. We will identify eligible studies, in any language, by a systematic search of MEDLINE, EMBASE, CINAHL, AMED, Scopus, SPORTDiscus, and PsycINFO, from inception of each database. Pairs of reviewers will, independently and in duplicate, screen titles and abstracts of identified citations, review the full texts of potentially eligible studies, and extract information from eligible studies. When possible, we will pool estimates of association for all independent variables reported by more than one study and report both an adjusted odds ratio and the absolute risk increase and associated 95% confidence intervals (Cis). We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to summarize the quality of evidence for all meta-analyses as high, moderate, low, or very low. Discussion: Our results will facilitate identification of patients at risk for the development of PPSP following TKA, highlight promising predictors for further study, and help guide the design of interventional studies to improve prognosis of high-risk patients