Shahram Yazdani

Space or no space for managing public hospitals; a qualitative study of hospital autonomy in Iran

Mehdi Jafari, Arash Rashidian, Farid Abolhasani, Kazem Mohammad, Shahram Yazdani, Patricia Parkerton, Masud Yunesian, Feizollah Akbari and Mohammad Arab* Department of Health Services Management, School of Health Services Management, Iran University of Medical Sciences, Tehran, Iran Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran Department of Epidemiology and Biostatistics, School of public health, Tehran University of Medical Sciences, Tehran, Iran Educational Development Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Health Services Management, School of Public Health, University of California Los Angeles, California, USA Center for Environmental Research; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland.

BackgroundOvertreatment (or unnecessary treatment) is when medical or dental services are provided with a higher volume or cost than is appropriate. This study aimed to investigate how a group of dentists in Switzerland, a wealthy country known to have high standards of healthcare including dentistry, evaluated the meaning of unnecessary treatments from an ethical perspective and, assessed the expected frequency of different possible behaviors among their peers.MethodsA vignette describing a situation that is susceptible for overtreatment of a patient was presented to a group of dentists. The vignette was followed by five options. A questionnaire including the vignette was posted to 2482 dentists in the German-speaking areas of Switzerland. The respondents were asked to rate each option according to their estimation about its prevalence and their judgment about the degree to which the behavior is ethically sound.Results732 completed questionnaires were returned. According to the responses, the most ethical and the most unethical options are considered to be the most and the least prevalent behaviors among dentists practicing in Switzerland, respectively.ConclusionsSuggesting unnecessary treatments to patients seems to be an ethically unacceptable conduct in the eyes of a sample of dentists in Switzerland. Although the respondents believed their colleagues were very likely to behave in an ethical way in response to a situation that is susceptible to overtreatment, they still seemed to be concerned about the prevalence of unethical behaviors in this regard.

Fall-Related Injuries in Community-Dwelling Older Adults in Qom Province, Iran, 2010-2012

Background: Falls and related injuries are common health problems in the elderly. Fractures, brain and internal organ injuries and death are the common consequences of the falls, which result in dependence, decreased self-efficacy, fear of falling, depression, restricted daily activities, hospitalization and admission to the nursing home and impose costs on the individual and the society. Objectives: The purpose of this study was to determine the types of fall-related injuries and the related risk factors in the elderly population of Qom province, Iran. Patients and Methods: This retrospective study was performed on 424 elderly people (65 years and over) referred to Shahid Beheshti Hospital, Qom, Iran, due to falls between 2010 and 2012. The ICD-10 codes of external causes of injury from w00 to w19 related to falls were selected from the health information system of the hospital and demographic variables of the patients and external causes of falls were extracted after accessing the files of the patients. Data were analyzed using SPSS version 18 (SPSS Inc., USA). The duration of hospital stay and its relationship with underlying variables were investigated using t test and ANOVA. The level of significance was considered P < 0.05. Results: Among 424 elderly people, 180 cases (42.45%) were male and the mean age of the patients was 78.65 ± 7.70 years. Fall on the same level from slipping, tripping, and stumbling was the most common external cause with 291 victims (68.60%), and hip fracture in 121 patients (29.00%), intertrochanteric fracture in 112 patients (26.90%), and traumatic brain injury in 51 patients (12.20%) were the most common causes of hospital stay. The mean hospital stay was 7.33 ± 3.63 days. Conclusions: Lower limb fracture and traumatic brain injury were the most common causes of hospitalization, which resulted in the longest hospital stay and highest hospitalization costs in the elderly.

Evidence-based Medicine versus the Conventional Approach to Journal Club Sessions: Which One Is More Successful in Teaching Critical Appraisal Skills?

This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (p<0.01), and the promotion of scores of the FT and CAST in the experimental group were more than that of the conventional group (p<0.0001). The current study indicated that an evidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.

A comparative study on the function and structure of medical development education office in world's top universities

PURPOSE: It is essential to adjust the responsibilities and function of medical education offices (MEOs) in regard to the current societal requirements. Therefore, it is a good idea to learn lessons from the experiences about the establishment and function of these offices around the world. The aim of the present study was to carry out a comparative study to investigate the function and structure of MEOs at some of the medical universities from America, Europe, and Asia. SUBJECTS AND METHODS: This is a comparative, descriptive study that was conducted in 2015. Eleven offices around the world (in America, Europe, and Asia) were selected for the study. Expert group discussion and literature review were used in order to select research sample. The data were gathered using self-constructed checklists. Content and face validity of the checklist was assessed by gathering feedback from experts. The Kappa coefficient was used to determine the inter-rater reliability. RESULTS: All the 11 offices in our study (100%) dealt with the issues of faculty development and research and scholarship activities. Only one out of the 11 offices (27%) dealt with the issues of society and patient education. Five out of the 11 offices (36%) dealt with the continuing medical education and continuing professional development. Consultation services are provided at seven of the 11 offices (64%). CONCLUSIONS: This study revealed both commonalities and differences in the function and structure of MEO among the 11 offices we examined. Based on this study, effective goals and strategies for MEO can be recommended.

Necessity of Blending Dental Education Into the Mainstream of Medical Education as a Specialty Area: Advocating for a Reform Idea Aiming to Promote the Health System Performance in Iran

With the knowledge we have today about the concept of health and its complexities and determinants, the separation between medical and dental education (DE) does not seem reasonable anymore. Dentistry has mainly developed based on a mechanical approach to treat the related problems. This makes the efforts for reorientation of dental care (DC) toward a preventive approach, relying upon dentists as the chief oral health (OH)-related workforce, inefficient. This is while effective strategies have been identified for prevention, as the key to simultaneously control the burden and costs of the ubiquitous oral diseases, at both individual and population levels without dentists. We think that approaching OH as an integral part of the general well-being requires fundamental changes in the structure of OH system including a substantial revision in the current situation of dentistry as an autonomous health profession with a separate education from the main body of the medicine. In this short article, we briefly discuss the necessity of blending DE into the mainstream of medical education and actual consideration of dentistry as a medical specialty area. After discussing the subject at two levels (health-care system and national levels), the next sections draw attention to some complementary issues.

Designing a Conceptual Pattern of Medical Lecturer Professional performance in E-Learning System Based on a Critical Review

1 PhD Student at School of Medical Education, Shahid Beheshti University of Medical Sciences and Health Services. Tehran, Iran. 2Department of Medical education, School of Medical Education, Shahid Beheshti University of Medical Sciences and Health Services. Tehran, Iran. 3Department of E-learning in Medical Education, Virtual School, Center of Excellence for E-learning in Medical Education, Tehran University of Medical Sciences,Tehran,Iran. 4Department of Medical Ethics, School of Medical Education, Shahid Beheshti University of Medical Sciences and Health Services. Tehran, Iran.

Learner’s role in medical education: Narrative review

Nowadays, learner’s role in medical education has deeply changed.This brief review has aimed to overview 5 main aspects of learner’s role in medical education. These domains are as follow: active versus passive role, group-learning and communication, knowledge construction facilitative role of teacher and learning styles. In conclusion, curriculum planning and teaching in medical education needs careful consideration to different aspects of learner’s role.

توسعه و طراحی راهنمای آموزشی خودمراقبتی براي بهبود علائم گرگرفتگی دوران یائسگی با تأكيد بر فعالیت جسمانی و رژیم غذایی در زنان 45-60 سال

Introduction: The study purpose was to develop a public education guideline for reducing menopausal symptoms and its complications based on proper diet and exercise in women between 45-60 years old. Methods: It was a combined study designed in two stages. The first stage was a systematic review. All of the articles which focused on the effects of diet and physical activity on reducing hot flash after menopause that published in Iran and abroad since 10 years ago were extracted and the results recorded. In the next stage, a panel of experts was held. Through a qualitative method, the specialists discussed the obtained results from the reviewed articles. The outcome presented in a booklet format. Results: 410 articles were obtained from external and internal sources, and by eliminating redundant and irrelevant articles, the results of 77 articles were analyzed; 40 of these articles were about diet and 37 articles were about physical activity. The summarized results showed that daily using of phytoestrogen supplements such as passion flower extract 60 drops, vitagnous extracts 40 drops, licorice extract powder 60 mg or ingestion of 60 g of baked soybean powder, along with moderate to high- intensity aerobic activities such as 30-45 minutes walking (3-5 days a week) were effective in reducing the hot flash’s symptom of women between 45-60 years old. Conclusion: Finding showed that regular physical activities and dietary regimen containing phytoestrogens such as passion flower, vitagnous and licorice extract, and soybeans are effective to relieve hot flash symptoms in menopause women.