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کاربرد نوع شرط:
- جایگاه : پژوهشی
- مجله: Journal of Advances in Medical Education and Professionalism
- نوع مقاله: Journal Article
- کلمات کلیدی: Medical students,Education,Medical assessment
- چکیده:
- چکیده انگلیسی: Introduction: Clinical reasoning as a critical and high level of clinical competency should be acquired during medical education, and medical educators should attempt to assess this ability in medical students. Nowadays, there are several ways to evaluate medical students’ clinical reasoning ability in different countries worldwide. There are some well-known clinical reasoning tests such as Key Feature (KF), Clinical Reasoning Problem (CRP), Script Concordance Test (SCT), and Comprehensive Integrative Puzzle (CIP). Each of these tests has its advantages and disadvantages. In this study, we evaluated the reliability of combination of clinical reasoning tests SCT, KF, CIP, and CRP in one national exam and the correlation between the subtest scores of these tests together with the total score of the exam.
Methods: A total of 339 high ranked medical students from 60 medical schools in Iran participated in a national exam named “Medical Olympiad”. The ninth Medical Olympiad was held in Shahid Beheshti University of Medical Sciences, Tehran, Iran, under the direct supervision of the Ministry of Health and Medical Education in summer 2017. The expert group designed a combination of four types of clinical reasoning tests to assess both analytical and non-analytical clinical reasoning. Mean scores of SCT, CRP, KF, and CIP were measured using descriptive statistics. Reliability was calculated for each test and the combination of tests using Cronbach’s alpha. Spearman’s correlation coefficient was used to evaluate the correlation between the score of each subtest and the total score. SPSS version 21 was used for data analysis and the level of significance was considered <0.05.
Results: The reliability of the combination of tests was 0.815. The reliability of KF was 0.81 and 0.76, 0.80, and 0.92 for SCT, CRP, and CIP, respectively. The mean total score was 169.921±41.54 from 240. All correlations between each clinical reasoning test and total score were significant (P<0.001). The highest correlation (0.887) was seen between CIP score and total score.
Conclusion: The study showed that combining different clinical reasoning tests can be a reliable way of measuring this ability.- انتشار مقاله: 14-02-1398
- نویسندگان: ANAHITA SADEGHI,ALI ALI ASGARI,NEZARALI MOULAEI,VAHID MOHAMMADKARIMI,SOMAYEH DELAVARI,MITRA AMINI,SETAREH NASIRI,ROGHAYEH AKBARI,MOJGAN SANJARI,IRAJ SEDIGHI,PARISA KHOSHNEVISASL,MANOUCHEHR KHOSHBATEN,SAEED SAFARI,LEILY MOHAJERZADEH,PARISA NABEIEI,BERNARD CHARLIN
- مشاهده
- جایگاه : پژوهشی
- مجله: Annals of Colorectal Research
- نوع مقاله: Journal Article
- کلمات کلیدی: Constipation,enterocolitis,fecal soiling,Hirschsprung Disease,incontinence pull through surgery
- چکیده:
- چکیده انگلیسی: Background:
A large number of patients who underwent pull-through surgery due to Hirschsprung's disease (HD) were not followed up properly and they suffered from many complications such as fecal soiling, constipation, and etc. Although some of these complications may relief over time, it is rational to consider an evaluative protocol to identify anatomical or pathological complications in these patients. Objective:
The aim of the present study is to evaluate and introduce these catastrophic complications.
Method:
In this historical cohort study, 193 patients with HD who had undergone pull- through surgery between 2006 to 2013 were considered. All files and questionnaires were used to collect patients' information and patients were physically examined individually. The mean duration of the follow-up was 96.4±17.2 months ranging from 60 to 144 months The follow-up performed for all patients via the outpatient clinics or by telephone. All statistical information was analyzed by SPSS software version 17.
Results:
Results:
At first presentation, intestinal obstruction was more frequent than constipation. The most common involved segment was in rectosigmoid. The most common early postoperative complication was stricture in anal canal and the most common late complications were constipation and focal soiling.
Conclusion:
Although surgical advancements, a large number of patients underwent surgical procedures due to HD experience long term complications. Surgical treatment of HD generally present with high-quality outcome and the majority of children survive in satisfactory situation for long time but occasionally pediatric surgeons meet head-on catastrophic complication in these patients that require extended team work to be resolved- انتشار مقاله: 27-07-1399
- نویسندگان: Leily Mohajerzadeh,Ashkan Soltani,Amir Mohammad Zakeri,Ahmad Khaleghnejad Tabari,Mohsen Rouzrokh,Javad Ghoroubi,Mehdi Sarafi,Naghi Dara,Farnoosh Rahimi,Sayeh Hatefi
- مشاهده
- جایگاه : پژوهشی
- مجله: Annals of Colorectal Research
- نوع مقاله: Journal Article
- کلمات کلیدی: Esophagus substitution,Corrosive esophageal injury,Surgical outcomes
- چکیده:
- چکیده انگلیسی: Background: The corrosive esophageal injury would result in mucosal damage related to type, exposure time, and volume of ingested substance ranging from mild burn to severe necrosis. It is usually seen in childhood. Stricture and dysphagia are common. Swallowing problems are due to prolonged stricture and would require surgery. However postoperative problems should also be considered. The purpose of this study was to determine the results of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube.
Methods: In this observational descriptive-comparative study, 50 consecutive patients attending to Mofid children hospital since 2006 to 2016 were enrolled and the results of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube among them were determined and compared according to other variables.
Results: The results in this study demonstrated that 68% required surgery that 82.3% had repeat surgery. Out of them 22 were performed with Gastric Pull up method that was successful in majority of subjects. Esophageal stricture (74%), vomiting (46%), and dysphagia (40%) were most common preoperative problems and dysphagia (46%), stricture (36%), and vomiting (26%) were most common postoperative problems. There were 4 mortality cases.
Conclusion: Totally, according to the obtained results, it may be concluded that esophagus substitution in the management of corrosive esophageal injury is effective that Gastric Pull up method is best option.- انتشار مقاله: 27-09-1398
- نویسندگان: Arash Khashayar,Ahmad Khaleghnejad Tabari,Leily Mohajerzadeh,Javad Ghoroubi,Mahdieh Samami
- مشاهده
- جایگاه : پژوهشی
- مجله: Annals of Colorectal Research
- نوع مقاله: Journal Article
- کلمات کلیدی: laparotomy,Abdominal Abscess,Follow-up studies,Hospitals, Community,Laparoscopy
- چکیده:
- چکیده انگلیسی: Background: Laparoscopy is not an accepted procedure for complicated appendicitis in children for most pediatric surgeons. This procedure is associated with a higher incidence of postoperative abdominal abscess reported in some studies.
Objectives: In this study, we investigated the security, efficacy and complications of laparoscopy in children with complicated appendicitis in Mofid Children's Hospital.
Patients and Methods: From April 2010 to January 2013, we performed laparoscopic appendectomy (LA) in all cases of non-complicated and complicated appendicitis (including perforated appendicitis and localized or generalized peritonitis based on the operation findings and pathological reports). Primary outcomes were incidence of complications, intra-abdominal abscess and wound infection. Secondary outcomes were length of operation, length of hospital stay, resumption of diet, incidence of bowel obstruction, duration of antibiotic use and readmission. Laparoscopy appendectomy was performed with two working ports.
Results: LA was performed in 123 children aged 2 to 14 years (mean of eight years) over a 3-year period, of whom only 34 cases had complicated appendicitis (either localized or generalized peritonitis). There was one conversion to open appendectomy (OA) in a patient with appendicular abscess with a mass, which excluded from our analysis. There were 6 patients with generalized peritonitis and 26 patients with localized abscess, and two patients with appendicular mass. The Average duration of symptoms was four days (ranged 3-6 days). The mean length of operation was 52 minutes (ranged 40-80 minutes). The average length of hospital stay was 4.4 days (ranged 4-7 days). They were able to restart oral intake from 16 to 48 hours postoperatively. Two patients (5%) had postoperative complications; one patient with intra-abdominal abscess who underwent reoperation and the second patient with umbilical wound infection was resolved with antibiotherapy. The average follow-up was 14 months (ranged from 4-36 months).
Conclusions: We recommend laparoscopic approach for all children presenting complicated appendicitis as the initial procedure of choice.
- انتشار مقاله: 13-09-1392
- نویسندگان: Leily Mohajerzadeh,Mohsen Rouzrokh,Ahmad Khaleghnejad Tabari,Alireza Mirshemirani,Khashayar Atqiaee Atqiaee,Naghi Dara
- مشاهده