Electronic nicotine delivery systems and/or electronic non-nicotine delivery systems for tobacco smoking cessation or reduction: a systematic review and meta-analysis

Objective A systematic review and meta-analysis to investigate the impact of electronic nicotine delivery systems (ENDS) and/or electronic non-nicotine delivery systems (ENNDS) versus no smoking cessation aid, or alternative smoking cessation aids, in cigarette smokers on long-term tobacco use. Data sources Searches of MEDLINE, EMBASE, PsycInfo, CINAHL, CENTRAL and Web of Science up to December 2015. Study selection Randomised controlled trials (RCTs) and prospective cohort studies. Data extraction Three pairs of reviewers independently screened potentially eligible articles, extracted data from included studies on populations, interventions and outcomes and assessed their risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence by outcome. Data synthesis Three randomised trials including 1007 participants and nine cohorts including 13?115 participants proved eligible. Results provided by only two RCTs suggest a possible increase in tobacco smoking cessation with ENDS in comparison with ENNDS (RR 2.03, 95% CI 0.94 to 4.38; p=0.07; I2=0%, risk difference (RD) 64/1000 over 6 to 12?months, low-certainty evidence). Results from cohort studies suggested a possible reduction in quit rates with use of ENDS compared with no use of ENDS (OR 0.74, 95% CI 0.55 to 1.00; p=0.051; I2=56%, very low certainty). Conclusions There is very limited evidence regarding the impact of ENDS or ENNDS on tobacco smoking cessation, reduction or adverse effects: data from RCTs are of low certainty and observational studies of very low certainty. The limitations of the cohort studies led us to a rating of very low-certainty evidence from which no credible inferences can be drawn. Lack of usefulness with regard to address the question of e-cigarettes\u27 efficacy on smoking reduction and cessation was largely due to poor reporting. This review underlines the need to conduct well-designed trials measuring biochemically validated outcomes and adverse effects

Trend of Recent Changes in Medical Education Curriculum in the World: The Location of Iranian Medical Education Curriculum

Introduction: Academic General Practitioner training program has begun in 18th century, although it has a long history initiated before Christ. This study is aimed at investigating the historical trend of GP training program from 1765 to 2011 and exploring influential factors inducing changes in the medical education curriculum. Finally, it is to analyze medical education curriculum in Iran with respect to global trend of medical education changes. Methods: This is a narrative review in the field of General Practitioner training program history in the World and Iran. Results: History of academic GP training program in the world can be studied in five phases: 1765-1870 with the dominance of apprenticeship model followed by the emergence of newer models: 1871-1950 discipline based model, 1951-1970 system oriented model, 1971-1990 problem based learning model and 1991 to present competency based model. In Iran, academic medical education refers to establishment of Dar-Al-Fonoon school in 1849. Since that time on, medical education in Iran has been discipline based for more than 150 years. Recently reforms have been planned and implemented in several Iranian medical schools to adopt the curriculum for more innovative models. Discussion: In conclusion, although the challenges in medical education in Iran are the same as the other parts of the world, the dominant model of medical education curriculum is yet discipline-based model which is non-efficient with respect to the mentioned challenges. A historical perspective approach on the medical education curriculum seems to yield possible solutions obtained from scientific findings and texts and their local application

Investigating morningness-eveningness typology of medical students and its relationship with their academic merits and course difficulty

Introduction: Learning and performance of different people is influenced by an intrinsic clock and they can be classified into three groups: morningness, eveningness and non morningness-non eveningness. Cognitive performance of people is congruent with such rules and it approach maximum at different times of day. In higher education curriculum planning it is accepted to arrange difficult courses be presented early morning to seek better learning. This study is aimed at investigating the relationship of medical students’ academic merits with their morningness-eveningness schedule with regard to difficult and easy courses. Methods: this research is a retrograde descriptive –analytic study. Fifth semester medical students involved in this study. Their morningness-eveningness schedule was defined by the use of a 19 items questionnaire and they were asked to determine difficulty of different courses. The critical threshold for difficulty of each course was considered by 50%. Students’ manuscripts extracted from medical school educational officials. SPSS software (ver 11.5) was used for data analysis through “t”, ANOVA and multiple regression. Results: 63(67% female and 33% male) students participate in the study. Physiology, pathology and parasitology were considered as difficult courses and Islamic ethics, nutrition, analytical history of islam, practical parasitology and physiology considered as easy courses. 11%, 60% and 29% of students were considered morningness, nonmorningness-noneveningness and eveningness, respectively. As a result, eveningness females have a considerable decrease in difficult courses (Pvalue of physiology=0.009, pathology=0.005 and parasitology=0.059). Such decrease in males was not significant. Discussion: Although, it is believed that difficult courses should be presented in early morning for better learning this study shows that eveningness students’ performance may decline significantly and it is recommended to arrange for difficult courses to be presented in special times for better performance of all students categorie

Teaching and evaluation of field training course for health services management undergraduates: conventional and logbook methods

Introduction: One of the strongest tools for teaching and evaluation of students, especially medical students and related fields is Logbook. The aim of this research was to design, implement and measure teachers and students’ satisfaction with the logbook in the field training 2 course for health services management undergraduate students. Methods: This descriptive study was performed on 44 health service management undergraduate students and six faculty members of field training at School of Management and Medical Information, Isfahan University of Medical Sciences in 2015. Participants were selected through census method. The research consisted of two stages: design and implementation of the logbook, and satisfaction survey through a researcher-made questionnaire. Data were analyzed using descriptive statistics and Mann-Whitney and Chi-square tests. Results: In the first stage, a 21 section logbook was developed for field training and implemented with a group of 22 students; results were then compared with the control group. The mean score of faculty members’ satisfaction with the conventional method was 38± 4.6 and with the logbook method was 36.7±8.1; the difference was statistically insignificant using the Mann-Whitney test (P=0.87). The mean score of students’ satisfaction with the conventional method was 37.8± 6.3 and with the logbook method was 41.6±8 and the difference was significant (P=0.047, Z=175.5). Conclusion: Using the logbook for teaching and evaluation of field training for health services management undergraduates while motivating students and increasing their satisfaction, provides a consistent method in the educational process of field training. However, in order to achieve all of the goals and minimum learning essentials, the logbook should be reviewed and further investigated for implementation

Evaluation of Basic Sciences Curriculum Modifications in Isfahan University of Medical Sciences: The Students’ Viewpoint

Introduction: Basic sciences curriculum faces various challenges in Iran. Proper curriculum designing can have a major impact on learning, performance, educational achievement and satisfaction of students of medicine. This study was carried out in order to evaluate the effectiveness of the rearrangement of basic sciences curriculum in Isfahan University of Medical Sciences from the viewpoint of the students. Methods: In this descriptive study with interrupted time series design, students of medicine at Isfahan University of Medical Sciences admitted at 2005-2006 academic years were selected through convenient sampling. The case group were students in the new curriculum design, and the control group were the students in the traditional curriculum design. Data collection tool was a valid and reliable researcher-made questionnaire. The collected data were analyzed using descriptive statistics and an independent t-test. Results: Students’ satisfaction rate with the new curriculum (2.95± 0.48 out of 5) was significantly (P = 0.00, t = -3.25) more than students’ satisfaction in the traditional curriculum (2.78±.68). Students receiving the new curriculum during 5 semesters ranked (6.34±1.81) the arrangement of the specialized courses higher (P=0.001, t=7.42) than the students in the traditional curriculum (4.29±2.15). The scores for the given preparation time for basic sciences examination in the 5th semester was not significantly different between the two groups (2.86±1.10 vs. 2.77±1.34, p=0.72, t=0.35). The students’ stress for this exam was not significantly different between groups (3. 49±1.15 vs. 3. 48±1.22, P=0.99, t=0.01). Conclusion: The findings showed that even minor modifications could affect the attitudes of the students of medicine. However, merely rearranging the courses may not be sufficient. Thereby, continuous modification of the curriculum according to new approaches such as integrated courses through organ-based model, considering other contributing factors in improving students' satisfaction, such as modifying the content, method and learning environment are strongly recommended

Study of relationship between organizational dimensions climate and acceptance of curriculum innovation (Case study of Isfahan University of Medical Sciences.)

Introduction: Most scholars of educational, organizational climate and curriculum are important Vnvavry is the source of educational innovation. According to deepen and expand the culture of educational innovation as one of the essential needs of educational institutions, major attention to training in this field be.The purpose of this research was to study of relationship between organizational dimensions climate and acceptance of curriculum innovation in Isfahan University of Medical Sciences. Methods: This study was applied one and the research method was descriptive – correlative (survey).Statistical population included all 687 faculty members at Isfahan University of Medical Sciences. 124faculty members at Isfahan University of Medical Sciences were chosen as statistical sample. Research instruments were two questionnaires. A questionnaire for organizational dimensions climate(rules, discipline, democracy, social and cultural factors organizational image, total goal) which designed by Gole(2008) that has 37 questions' questionnaire was for acceptance of curriculum innovation(innovation goals, innovation content, innovation learning – teaching ,innovation evaluation).The reliability of these questionnaires was examined by the view of experts and their validity was calculated by Cranach Alpha and estimated 96%.To analyze data in the level of inferential statistics, multi Regression, Levin and MANOVA were employed. Results: Findings showed that:1) There was positive and significant relation between organizational dimensions climate and acceptance of curriculum innovation.2)There was positive and significant relation between organizational dimensions climate and acceptance of curriculum innovation goals ,curriculum innovation content, curriculum innovation learning – teaching ,and curriculum innovationevaluation.3) There was a significant difference between averages of organizational dimensions climate in terms of university, college, tenure, academic trips grade of academic faculty members at faculty members at Isfahan University of Medical Sciences (p<0.05),4)There was not a significant difference between averages of organizational dimensions climate in terms of sex faculty members at university of Isfahan and faculty members at Isfahan University of Medical Sciences (p<0.05). Conclusion: The effect of organizational climate in educational policies and educational programs, and revised in accordance with the conditions that caused curriculum the new education is inevitable. Requiring faculty members to observe the educational innovations in the teaching process, integrated and convergent approaches in the content of such postings education today

Ambulatory Education Quality in Al-Zahra Hospital Clinics in Isfahan, Veiw of Clerkships students and Interns

Introduction: Ambulatory education has a great role in improving the abilities of medical students to encounter with common cases and according to Ministry regulations half of clinical education should be conducted in ambulatory seting.. This study is aimed at measuring quality of ambulatory education in Al-Zahra hospital, Isfahan, Iran. It can help to increase educational quality by recognition releif of current chalenges. Method: This study is a descriptive, cross sectional research. It was conducted by designing a questionnaire and completing it by 180 clerkship students and interns. The questionnire consist of six areas: attending physicians’ teaching quality, residents’ quality of teaching, physical environment and facilities, patients’ affair, intern presence in ambulatory setting and duration of ambulatory teaching. The validity of the questionnaire was confirmed by educational experts and its reliability was measured through a pilot study (α=0.92). Findings: The conclusions in group of interns were as following: The mean score of attending physicians’ teaching quality, residents’ quality of teaching, physical environment and facilities, patients’ affair, intern presence in ambulatory setting and duration of ambulatory teaching were: 55.2, 52, 54, 61.5, 62.7 out of 100, respectively. Coresponding of scores for was 42.3, 42.7, 45.2, 56.6, 36.1, respectively. By the way, in both groups, interns and clerkship students, the mean suitable number of patients refer to clinics with the best educational output was estimated about 10 persons per day. Discusion: In conclusion, to improve ambulatory education, attending physicians should come to clinics on time and stay for longer duration than past. In addition, physical environment and facilities of clinics should be modified according to number of stagers and interns

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

Predictors of Persistent Post-Surgical Pain after Total Knee Replacement: A Systematic Review and Meta-Analysis of Observational Studies

Introduction/Aim: Each year 67,000 Canadians undergo total knee arthroplasty (TKA) and approximately 20% develop persistent post-surgical pain (PPSP). A complaint associated with functional limitations, reduced quality of life, and increased care-seeking. We systematically reviewed observational studies to explore factors associated with PPSP after TKA. Methods: We searched Medline, EMBASE, Cochrane CENTRAL, AMED, PsycINFO, SCOPUS and SPORTDiscuss from inception to October 31, 2018. When possible, we pooled estimates of association for all independent variables reported by more than one study. Random effects models were used for all meta-analysis. We assessed certainty in evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: Twenty-five studies, involving 44,069 participants, were eligible for review. Mean age of enrolled patients was 68.56 ± 8.77 years and 76% were female. Eligible studies reported the association of 56 predictors with PPSP after TKA, which clustered into 6 groups: (1) patient characteristics, (2) clinical findings, (3) genetic factors, (4) surgical approach, (5) radiographic findings, and (6) peri-operative management. Low and very-low quality evidence showed that higher preoperative pain (OR = 3.82, 95%CI 1.27 to 11.47) and female sex (OR = 1.23, 95%CI 1.08 to 1.4) were significantly associate with PSPP after TKA. Neither older age (OR = 0.97, 95%CI 0.88 to 1.07), higher BMI (OR = 1.07, 95%CI 1.00 to 1.13), or mood disorders (OR = 1.14, 95%CI 1.0 to 1.3) were predictors of PPSP following TKA. Discussion/Conclusions: Addressing high peri-operative pain may be important in reducing PPSP after TKA