Comparing Short Clinical Evaluation Exercise and Direct Observation of Procedural Skills With the Traditional Evaluation Approach on the Clinical Skills of Forensic Medicine Residents

Background: The development of clinical teaching necessitates the use of novel and appropriate clinical evaluation methods. In the meantime, the use of new evaluation approaches that enhance learning at the same time has been recommended. This study aimed to compare the effect of the two new evaluation methods of direct observation of procedural skills (DOPS) and short clinical evaluation exercise (Mini-CEX) with the conventional evaluation method on clinical skills of forensic medicine residents.Methods: This is a randomized trial performed among forensic medicine residents. Using Cochran's formula, the minimum sample size was calculated to be 25 individuals per group. All the residents were randomly divided into either the experimental or the control groups. After training and evaluation, the experimental group was tested using the DOPS and Mini-CEX methods three times during the course, and the control group was evaluated using the conventional method. The basis for the evaluation of the procedures (physical examination and autopsy) in both groups was the valid and reliable checklists prepared by the researchers. The results were analyzed using descriptive and inferential statistics (e.g., the Chi-square and independent t-test).Results: There was no significant difference between the two groups in terms of demographic variables such as age, sex, and grade point average (GPA) (P>0.06). The means of total scores were significantly higher in the experimental group (using the Mini-CEX and DOPS methods) than the control group (conventional method) (P<0.0002).Conclusion: The use of new evaluation methods of DOPS and Mini-CEX improved the clinical skills of forensic medicine residents. Therefore, it is recommended that resident training centers use these two methods of assessment, together with other methods, to evaluate clinical procedures and boost forensic residents' learning

The Need to Revise Guidelines for the Management of Drug Abuse Treatment Centers (Methadone Maintenance Treatment)

Abstrac

Filicide by Electrocution

Background: Filicide is the term to describe the homicide of the child performed by one of the parents or both. Many different methods and devices may be used for these types of murders, for example, asphyxia, planned car accidents, stabbing by knife, battering, electricity, and so on. Most deaths due to electrocution are categorized as accidental in domestic and industrial environments. Murder by electrocution is reported very rarely. This case presents the murder of the child by his father in the way which is not usually applied in either filicide or homicide.Case Presentation: The body of a dead eight-year-old boy was brought to the Legal Medicine Organization center for autopsy with the history of separated parents and father with bipolar disorder. The coroner noticed the boy`s toes wired directly to an electric socket at the scene of the crime so the deceased was referred for further evaluation.Conclusion: Although filicide by electrocution is a rare method, especially for familicide according to literature, it should be considered in such murders.

Investigating Awareness Level and Attitudes Toward Induced Abortion in Patients Admitted to Medical Centers in Tehran, Iran

Background: Abortion is recognized as a social and cultural problem across societies, posing risks to people’s health. This study aims to explore various facets of induced abortion in patients admitted to medical centers in Tehran. Method: This descriptive-cross-sectional study surveyed referred patients at Mahdieh, Taleghani, and Shohada-e-Tajrish Hospitals in Tehran, Iran.  Information was collected using a researcher-made questionnaire. Data were analyzed employing the chi-square test, t-test, and Pearson's correlation coefficient, considering a P-value <0.05 as significant.  Results: Among the 1,200 examined patients, 75% were in favor of induced abortion but within legal bounds (95%, CI=58-90). Furthermore, 65% of the participants demonstrated adequate knowledge about induced abortion and its associated side effects (95%, CI=55-75), yet they advocated it due to financial and welfare problems. Meanwhile, there was a statistically significant correlation between awareness scores and age, education, and gestational age (P-value<0.04).   Conclusion: The awareness and attitude toward abortion vary among individuals. However, enforcing different severe restrictions and stringent abortion laws may lead to destructive consequences. 

Investigating the Awareness and Attitude of Medical Personnel of two referal Hospitals about Diseases Leading to the Dissolution of Marriage

Background: A criterion for the right termination of marriage is a disadvantage of the spouse, which burdens the other party. To solve this problem, defects are considered for couples in jurisprudence and law, and if they are incurable, the marriage contract is terminated. In this study, we examined the awareness and attitude of medical personnel about this issue. Methods: In this descriptive-analytical study, which was done in the first half of 2021, the personnel of Shohada Tajrish and Shahid Modares hospitals were evaluated using a researcher-made data collection form. The effects of demographic factors (age, sex, marriage, and education) were also investigated. Sampling was done by census method and employed according to the inclusion criteria. Cochran's formula was used to calculate the minimum sample size. Fisher and Pearson’s statistical tests in SPSS21 software were used for data analysis. Results: The knowledge and awareness of the participants in all age groups under the study was similar (P>0.2). All participants were aware of insanity as an obstacle to marriage and were unaware of other diseases leading to marriage termination. After learning that 10 to 11 diseases caused the annulment of marriage, they added all the incurable diseases to this list, and they had a negative attitude towards these restrictions. Conclusion: Most medical personnel had little awareness about the number of marriage annulment cases. There was a negative attitude toward discrimination between men and women in the number of these diseases

Methanol Poisoning and Its Treatment

Background: Methanol is a toxic alcohol found in illegal liquor, and its poisoning may cause death if not treated timely and properly. In 2018, methanol toxicity in Iran increased dramatically. Regarding the high prevalence of methanol toxicity, its high mortality rate, and the cost of treatment as well as the importance of timely diagnosis in the treatment of this condition, we decided to review methanol toxicity, its signs, symptoms, diagnosis, and treatment.Evidence Acquisition: We searched for articles on reliable databases such as Embase and Medline from January 2018 to May 2018 using the following keywords: “methanol,” “toxic alcohol,” and “ethanol toxicity treatment.”Results: This review discusses how to diagnose methanol toxicity by using clinical signs and symptoms and laboratory examinations; it also suggests new treatments. Meanwhile, we provide alternatives for diagnosis in case of shortages of tests in the emergency department.Conclusion: Diagnosis of ethanol toxicity due to non-specific signs and symptoms, late patient’s referral, and lack of proper history-taking can be very difficult and delay the onset of treatment. There is also no clear scientific evidence as to whether ethanol or fomepizole should be used as the first choice of therapy for methanol toxicity because there is no direct comparison between these two antidotes regarding their effectiveness and safety. The appropriate antidote is chosen depending on the availability, cost, accessibility of hemodialysis, and the physician’s experience. If the therapist does not have enough experience, it is easier to use fomepizole

Investigating the effect of selecting delivery method on medical malpractice incidence in the specialized field of obstetrics and gynaecology in complaints referred to medical forensic expert commission during 2011-2012

Background and aims: Complaints of obstetrics and gynecology specialist are on the top of complaint from doctors and these have been increasing with increased population and births. In this regard, parallel to industrialization of life, tendency to cesarean against vaginal delivery has been increased in patients. All the cases of complaint increased from 1995 until 2010. In multiple studies and evaluation of complications of cesarean and vaginal delivery conducted in legal authorities like forensics due to patient and her relatives complains can have an effective role on selecting delivery method in specialists by creating virtue of working. Limited information is available on this study. We aimed to investigate the effect of selecting delivery method on medical malpractice incidence in the specialized field of obstetrics and gynecology. Methods: This is a descriptive-analytic study, and 913 cases of 2011 to 2012 who referred to Tehran forensics organization have been assessed and computer software SPSS was applied for data analysis. Our study was approved by the Ethical Committee of Forensic Medicine. Results: Of the total referred cases, 12.8 were in the field of obstetrics and gynecology in which 691 cases were obstetric and 222 cases related to gynecological. In 44.5 of cases, medical malpractice was confirmed and 2.3 of them were due to caesarian surgery. The rate of maternal injuries was more prevalent than babies and children, and most of complains were related to inexperience surgeons. Conclusion: As in our study, 2.3 of complaints were associated with cesarean patients and the rate of approved malpractice in cesarean was almost double the vaginal delivery. Furthermore, the rate of complains associated with mother in cesarean delivery has been twice the vaginal birth. The type of medical malpractice associated with type and method of delivery. In this study cesarean surgery delivery is pioneer. Discussion: Considering the patient and fetus situation and patients’ education selecting the type and method of delivery has an important role in prevention of patients’ complaint to surgeons from forensic view and creation of more awareness among obstetrics and gynecology specialists about medical mistakes and special training that should be given to those joining with these specialties

Hyper Acute Quadriplegia with Chronic Lead Toxicity; a Case Report

Industrial lead toxicity is more common among miners. This type of toxicity occurs in two forms: acute and chronic. Chronic toxicity is associated with different levels of brain dysfunction, motor impairment, cognitive dysfunction, and neuropsychiatric problems, including depression, anxiety, irritability, and emotional disorders. However, quadriplegia induced by chronic toxicity is very rare.  Here we report a 37-year-old male patient with a history of desert hunting, where he used to roll lead bullets in his mouth, who was admitted with sensory impairment, muscle weakness, and quadriplegia and final diagnosis of lead toxicity

Medical Malpractices in Tehran Public Hospitals Referred to the Forensic Medicine Commission of Tehran Province in 2018: An Analytical Review

Background: The current status of medical malpractice in Tehran medical centers is unclear, while understanding the situation may help the authorities carefully plan, continuously monitor and, consequently, be sensitive to eliminate the weaknesses. Hence, the present study aimed at investigating the existing problems. Methods: In the present Descriptive and cross-sectional study, all patients complaining of the medical staff of public hospitals affiliated to three medical sciences universities (i e, Tehran, Iran, Shahid Beheshti, and Baqiyatallah) were evaluated in terms of demographic characteristics, physicians gender, the type of hospital, the type of specialty, the type of staff, and reason for complaint (disability, death) using a data collection form, and the results were analyzed in SPSS version 18 using the Chi-square and Fisher tests. P-value <0.01 was considered the level of significance. Results: Most of the filed complaints were against hospitals affiliated to Tehran and Shahid Beheshti universities of medical sciences, and 66% against private centers. Most cases won in the court were against general practitioners, dentists, general surgeons, and hospital technicians. The number of malpractices proven for teaching hospitals was significantly lower than that of non-teaching ones. Given the prevalence of plastic surgery in Iranian society, the number of complaints filed from female patients was two-thirds of male ones; almost 50% aged 21-40 years. For some reason, more than three-fourths of wrongful death complaints were for female patients. Conclusion: Complaints of medical malpractice in hospitals are an integral part of physicians and nursing staff work, as the saying goes: an unwritten dictation has no errors

Complications of Rhinoplasty in Patients: An Epidemiological Study

Background: In addition to odor perception, the nose also plays an important role in breathing and speech. In Iran, 70% of plastic surgeries is performed on the nose. Methods: In the present study, all patients underwent rhinoplasty during 5 years from April 2012 to March 2017 and were evaluated using a census method. A researcher-made questionnaire including the following variables were used: age, gender, level of education, season of performing the operation, length of hospitalization, occupational status, type of surgery, surgical procedure, and type of repair surgery. The obtained data were analyzed by SPSS. Results: A total of 106 individuals, with the mean age of 27.37 years were enrolled into the study. Most of the rhinoplasty surgeries were performed in summer and the lowest frequency was in spring. Most clients had a diploma, and in terms of occupational status, most subjects were students.Conclusion: There was a significant relationship between gender, educational level, and type of surgery