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کاربرد نوع شرط:
- جایگاه : پژوهشی
- مجله: Interdisciplinary Journal of Virtual Learning in Medical Sciences
- نوع مقاله: Journal Article
- کلمات کلیدی: Students,feedback,university,Clinical education,Residents
- چکیده:
- چکیده انگلیسی: Evidence-based Medicine is a new approach for physicians to integrate their clinical experiences. It can provide the best evidence to apply such experiences to the right and precise diagnostic and treatment decisions. There have been a lot of studies concerning teaching methods in and efficiency of evidence-based medicine in recent years. As such, the present study, with an analytic view, aims to deal with diverse teaching methods and the levels of efficiency in evidence-based medicine. This research, with an analytical-theoretical view, is a library-based study, seeking data from articles in scientific data-bases. Primarily, 42 articles were reviewed. Out of them, 21 articles with more data on teaching methods and level of efficiency were included in the study. The review revealed that evidence-based medical education would usually start in the early years of medical education. Although lecturing was the dominant teaching method, other methods as integrated approaches, interaction, and group discussion were also common. In addition the studies on the level of efficacy were more concerned with assessing the students’ satisfaction and knowledge but not the application of evidence-based medicine. Therefore, in medical education more attention should be paid to interactive and integrated methods with an interdisciplinary approach. Evidence-based medical education should be presented step by step, based on the students’ educational needs in basic sciences and clinical levels. It is necessary to have more studies on the efficiency of evidence-based medicine in practice and students’ behavioral change.
- انتشار مقاله: 11-10-1398
- نویسندگان: Zahra Karimian,Javad Kojouri,Mohammad Mahdi Sagheb
- مشاهده
- جایگاه : پژوهشی
- مجله: Trends in Pharmaceutical Sciences
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی: Increased serum creatinine level and decreased glomerular filtration rate are the major features of vancomycin nephrotoxicity. Electrolyte disorders of this agent have not been considered in relevant clinical studies so far. The aim of the present study was to determine potassium and magnesium disorders in patients with hematologic and oncologic diseases under vancomycin treatment. A cross-sectional, observational study was performed during 9 months at three hematology-oncology wards of Namazi hospital in Shiraz. Patients > 18 years with no documented history of acute kidney injury or chronic kidney disease planned to receive vancomycin for at least 1 week were recruited. Urine samples for determining creatinine, potassium, and magnesium levels were collected at days 0, 3, 5, 7, 10, and 14 of treatment. Hypokalemia and hypomagnesemia was defined as serum potassium and magnesium level below 3 mEq/L and 1.2 mEq/L, respectively. Two-fifth (40.38%) of the study population developed hypokalemia during 2 to 3 days after initiating vancomycin. Hypomagnesemia was detected in 5.77% of vancomycin recipients with the time onset of 7.67 ± 3.21 days. The mean ± standard deviation of potassium supplement was significantly higher in patients with than those without hypokalemia (P = 0.006). No case of renal potassium and magnesium wasting was identified. Amphotericin b co-administration significantly associated with hypokalemia during vancomycin treatment (odds ratio = 0.164 [95% confidence interval = 0.041-0.647], P = 0.01). In contrast to hypomagnesemia, hypokalemia occurred commonly during the first days of vancomycin treatment. However, the real casual relationship, mechanism, and clinical outcome of these electrolyte disorders in vancomycin recipients remain unclear.
- انتشار مقاله: 31-04-1395
- نویسندگان: Iman Karimzadeh,Ghazaleh Haghighati,Mani Ramzi,Mohammad Mahdi Sagheb,Kamiar Zomorodian
- مشاهده
- جایگاه : پژوهشی
- مجله: Trends in Pharmaceutical Sciences
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی: Nephrotoxicity is generally considered as the most clinically significant and dose-limiting adverse reaction of amphotericin B. Currently, only the clinical effectiveness of salt loading and administering lipid formulations of amphotericin B have been clearly demonstrated to prevent its nephrotoxicity. In this review, we collected the published data related to dopamine receptor agonists in preventing amphotericin B nephrotoxicity. A literature search was conducted by the relevant keywords like ‘‘amphotericin B”, “nephrotoxicity’’, and ‘‘dopamine’’ in databases such as Scopus, Medline, Embase and ISI Web of Knowledge. Four relevant articles were considered. Results of all the 3 experimental studies demonstrated that co-administration of dopamine (0.5-10 μg/kg/min) as continuous intravenous infusion, SK&F R-105058 (10 mg/kg twice daily), a prodrug of fenoldopam, orally, or fenoldopam, a relatively selective dopamine receptor type 1 agonist, (0.5 or 1 μg/kg/min) as continuous intravenous infusion can at least significantly mitigate the decrease in creatinine clearance caused by amphotericin B. Furthermore, fenoldopam and SK&F R-105058 can also protect against or delay amphotericin B-induced tubular damages. In contrast, the only clinical trial published until now found that simultaneous continuous intravenous infusion of low dose dopamine (3 μg/kg/min) had no beneficial effects on the incidence, severity, as well as time onset of developing amphotericin B-induced nephrotoxicity in autologous bone marrow transplant and leukemia patients. Considering the lack of beneficial effects in different settings such as acute kidney injury of any cause, negative results of the only clinical trial, and risk of significant adverse reactions, continuous intravenous infusion of low dose dopamine (1-3 μg/kg/min) or selective dopamine receptor type 1 agonists (e.g., fenoldopam) currently appears to have no real clinical role in preventing or attenuating amphotericin B nephrotoxicity.
- انتشار مقاله: 18-04-1394
- نویسندگان: Iman Karimzadeh,Hossein Khalili,Mohammad Mahdi Sagheb
- مشاهده
- جایگاه : پژوهشی
- مجله: Journal of Advances in Medical Education and Professionalism
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی: Introduction: Teaching renal physiology for undergraduatemedical students in an understandable way using methods whichimprove their deep learning has always been a problem. In thisstudy, Early Clinical Exposure (ECE) was used in teaching renalphysiology for the second year medical students in Shiraz MedicalSchool. This article aims to introduce and develop this programand also measure the attitude of medical students toward ECE inlearning renal physiology.Methods: This is a mixed method study conducted on 120 secondyear undergraduate students. After performing the course, bothqualitative and quantitative methods were used for measuring theviewpoints of the students. In the qualitative part, 10 high rankmedical students were selected. These students participated inbrain storming sessions to express their opinion about the programbased on the strengths and weaknesses. For trustworthiness of thequalitative part, member check and peer check were done. In thequantitative part, a researcher-made questionnaire was used basedon the objectives of the program in a 4 point Likert scale. Thevalidity of questionnaire was determined by medical educationexperts and reliability was determined after a pilot study.Results: Based on the results of the quantitative part of the study,98 percent of the students stated that the ECE program wasgenerally a useful program. In the qualitative part, the students’comments were obtained. The benefits of the program weresummarized in 4 main themes. These themes are “understandingof renal physiology”, “Integration of basic and clinical knowledge”,“Improvement of attitude toward importance of physiology”, and“encouragement to study”. In response to the questions aboutnegetive aspects of this program in qualitative part, the two mainthemes were insufficient time and large grup size.Conclusion: Students reported that ECE was useful, but theystated that they needed to have more encounter with patientsand more hospital teaching. The results also reveal that this ECEprogram is an excellent approach to strengthen learning in adifficult subject like renal physiology. This approach is adjustableto other basic science topics and subjects as well.Keywords: Early clinical exposure; Integration; Learning
- انتشار مقاله: 11-07-1396
- نویسندگان: ARMAN DEHGHAN,MITRA AMINI,MOHAMMAD MAHDI SAGHEB,SEYED MOSTAFA SHIDMOOSAVI,PARISA NABEIEI
- مشاهده
- جایگاه : پژوهشی
- مجله: Journal of Advances in Medical Education and Professionalism
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی: Introduction: It has been found that the decision-making process in medicine is affected, to a large extent, by one’s experience, individual mentality, previous models, and common habitual approaches, in addition to scientific principles. Evidence-based medicine is an approach attempting to reinforce scientific, systematic and critical thinking in physicians and provide the ground for optimal decision making. In this connection, the purpose of the present study is to find out to what extent the education of evidence based medicine affects clinical decision making.Methods: The present quasi-experimental study was carried out on 110clinical residents, who started their education in September, 2012 and finally 62 residents filled out the questionnaires. The instrument used was a researchermade questionnaire containing items on four decision-making approaches. The questionnaire was used both as a pre-test and a post-test to assess the residents’ viewpoints on decision making approaches. The validity of the questionnaire was determined using medical education and clinical professionals’ viewpoints, and the reliability was calculated through Chronbach alpha; it was found to be 0.93. The results were analyzed by paired t-test using SPSS, version 14.Results: The results demonstrated that evidence-based medicine workshopsignificantly affected the residents’ decision-making approaches (p<0.001).The pre-test showed that principles-based, reference-based and routinemodel-based approaches were more preferred before the program (p<0.001). However, after the implementation of the program, the dominant approaches used by the residents in their decision making were evidence-based ones.Conclusion: To develop the evidence-based approach, it is necessary foreducational programs to continue steadily and goal-orientedly. In addition, the equipment infrastructure such as the Internet, access to data bases, scientific data, and clinical guides should develop more in the medical departments.Keywords: Clinical, Evidence-based medicine, Decision making, Resident
- انتشار مقاله: 07-07-1393
- نویسندگان: ZAHRA KARIMIAN,JAVAD KOJOURI,MOHAMMAD MAHDI SAGHEB,ALI MAHBOUDI,MAHBOOBEH SABER,MITRA AMINI,MOHAMMAD REZA DEHGHANI
- مشاهده
- جایگاه : پژوهشی
- مجله: Journal of Advances in Medical Education and Professionalism
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی: Introduction: The present study aimed to find an appropriate method toinform senior high school students to correctly select their academic field ofstudy and their intentions.Methods: This is a descriptive-analytic and cross-sectional study. A verifiedquestionnaire was given to a total of 2600 students selected by stratified random sampling method (ten different colleges and entrance year from the 1st to 4th are considered as the strata). The position of the present field of study (major) among the list of the fields in the entrance exam was asked. The students’ methods of familiarity with different fields of study in Shiraz University of Medical Sciences (SUMS), the reasons for their selection, the students’ motivation and insistence on studying in the same field and university were asked in the questionnaire. Data were analyzed using independent two samples t-test, Analysis of Variance (ANOVA) and Chi-Square test.Results: The most significant references for university field selection were high school teachers, the students' parents and the adjacency of university to one's living place. Also, the results revealed the good reputation of SUMS in the first year and its downward trend during the following years. 59.4% of the 1st year students were satisfied with their field of study and SUMS. 31.8% were satisfied with the university but not with their fields of study. 6.4% were dissatisfied with the university but not with their fields of study. 2% of the students were dissatisfied with both their fields of study and university. Dissatisfaction with SUMS and field of study increased little by little so that the results obtained among the students who had entered the university earlier (in the 4th year of their study) showed nearly 16.3% dissatisfaction with both the university and the study fields .Conclusion: The methods for introducing the university are recommended tobe revised.Keywords: Medical student, Intention, Satisfaction
- انتشار مقاله: 07-07-1393
- نویسندگان: ALI NOORAFSHAN,SAEEDEH POURAHMAD,MOHAMMAD MAHDI SAGHEB,ALI DEHGHANINAZHVANI,ALI DEHSHAHRI,MANIJEH ABDOLLAHI,ZEYNAB MOHEBBI,ZAHRA KESHTKARAN,AFSANEH AHMADI,SOMAYEH KAVOUSIPOUR,FARIBA FARAHMAND,HAMIDREZA KHORRAMI,ROBABEH SOLTANI,SAIED KARBALAY DOUST
- مشاهده
- جایگاه : پژوهشی
- مجله: Journal of Advances in Medical Education and Professionalism
- نوع مقاله: Journal Article
- کلمات کلیدی:
- چکیده:
- چکیده انگلیسی: Introduction: Consultation and guidance is a process of learning which is donethrough the relationship between two individuals. In this mutual relationship,the counselor, through his scientific and occupational skills and qualification,tries to help the students using the methods corresponding to their needs. Themain objective of this study was to provide a framework for the managementof the advisors’ plans in the university based on the analysis of different schools.Methods: This research is a cross-sectional and descriptive-analytic study.Data were collected both qualitatively (centralized groups at the presence ofadvisors in universities) and quantitatively (self-assessment of teachers andstudents’ evaluation). Sampling was done randomly from all students of ShirazUniversity of Medical Sciences. All the teachers who were advisor took part inthis study.Results: This study was conducted in eight schools of Shiraz University ofMedical Sciences simultaneously and 974 students and 125 teachers took partin it. At the time of data collection, 25.5 percent of the students declared thatthe advisors have provided allocated time to them and 45.4 percent believedthat the advisors helped the students to understand the importance of thecourses.Conclusion: The emergence of weaknesses and strengths of the academicadvising program and the guidance through teacher’s self assessment, notonly may be the sign of realization of programmed objectives, but also may bethe starting point for qualitative improvement of the situation. Moreover, inorder to improve the advisory services and guidance, it is necessary to regardconsultation as a scientific subject which needs training.Keywords: Advisor teacher, Consulting, Guidance, Education.
- انتشار مقاله: 09-10-1392
- نویسندگان: RITA REZAEE,PARISA NABEIEI,MOHAMMAD MAHDI SAGHEB
- مشاهده
- جایگاه : پژوهشی
- مجله: Iranian Journal of Medical Sciences
- نوع مقاله: Journal Article
- کلمات کلیدی: Acute kidney injury,Coronary Artery Bypass,Reperfusion injury,schemic preconditioning
- چکیده:
- چکیده انگلیسی: Background: Remote ischemic preconditioning (RIPC) protects other organs from subsequent lethal ischemic injury, but uncertainty remains. We investigated if RIPC could prevent acute kidney injury (AKI) in patients undergoing coronary artery bypass graft (CABG) surgery.Methods: This parallel-group, double-blind, randomized, controlled trial was done on adults undergoing elective or urgent on-pump CABG surgery from 2013 to 2017 in Shiraz, Iran. Patients were allocated to RIPC or control groups through permuted blocking. The patients in the RIPC group received three cycles of 5 min ischemia and 5 min reperfusion in the upper arm after induction of anesthesia. We placed an uninflated cuff on the arm for 30 min in the control group. The study primary endpoint was an incidence of AKI. Secondary endpoints included short-term clinical outcomes. We compared categorical and continuous variables using Pearson χ2 and unpaired t tests, respectively. P
- انتشار مقاله: 15-10-1396
- نویسندگان: Sina Bagheri,Shahrbanoo Shahbazi,Masih Shafa,Afshin Borhani-Haghighi,Mahsa Kiani,Mohammad Mahdi Sagheb
- مشاهده
- جایگاه : پژوهشی
- مجله: Iranian Journal of Medical Sciences
- نوع مقاله: Journal Article
- کلمات کلیدی: guideline,Amikacin,Drug Utilization Review
- چکیده:
- چکیده انگلیسی: Background: The inappropriate use of aminoglycosides has harmful effects such as the development of resistant pathogens and the incidence of nephrotoxicity and ototoxicity. Therefore, drug utilization evaluation of these drugs may improve their usage remarkably. The aim of this study was to assess the usage pattern of amikacin in an internal medicine ward.Methods: This cross-sectional study was conducted in the Internal Medicine Ward of Nemazee Teaching Hospital, Shiraz, Iran, in 2011. The guideline for amikacin use was approved by the institutional Pharmacy and Therapeutics Committee, and the study criteria were developed to assess several parameters involved in amikacin therapy such as appropriateness of drug use, dosage, duration of therapy, toxicity monitoring, and serum concentration assay. Serum concentration was assayed using a Cobas Mira AutoAnalyzer. Clinical and paraclinical parameters such as glomerular filtration rate, culture, microbial sensitivity, white blood cell count, and fever were collected.Results: Sixty-three patients were evaluated. Fifty-seven percent of the patients needed dose readjustment; however, it was not performed for 89% of them. Culture between48 and 72 hours after amikacin administration was not controlled for 79% of the patients. In 19% of the patients, optimum therapeutic effect was not achieved. The mean±SD of the trough and peak concentrations was 7.63±5.4 μg/mL and 15.67±7.79 μg/mL, respectively. Forty-five percent of the trough and 38% of the peak levels were within the therapeutic range. The overall adherence of amikacin usage to the guideline was only 48%.Conclusion: To achieve appropriate treatment and prevent toxic effects, we recommend that pharmacokinetic dosing methods, amikacin guideline, and serum monitoring be considered.
- انتشار مقاله: 25-01-1393
- نویسندگان: Soha Namazi,Mohammad Mahdi Sagheb,Mohammad Mahdi Hashempour,Arman Sadatsharifi
- مشاهده
- جایگاه : پژوهشی
- مجله: Iranian Journal of Immunology
- نوع مقاله: Journal Article
- کلمات کلیدی: Mycobacterium Tuberculosis,Hemodialyses,Tuberculin Test
- چکیده:
- چکیده انگلیسی: Background: The risk of developing tuberculosis is high among chronic hemodialysis patients. The tuberculin skin test (TST) has been in use for diagnosing latent TB, but few data are available on TST in hemodialysis patients.
Objective: This study was done to identify the TST reactivity and frequency of booster effect in serial TST among hemodialysis patients.
Methods: A total of 100 patients in three hemodialysis centers were prospectively tested. Patients with less than 10mm indurations were given addi-tional TST one and four weeks later to determine the frequency of booster effect.
Results: The cumulative prevalence of a positive TST was 7 % for the first test and 16 % for the third test. There was a weak, but significant correlation between TST positiv-ity, serum albumin level, urea reduction ratio and KT/V (p<0.05). There was no influ-ence of age, gender, hemodialysis duration and primary renal disease.
Conclusion: This study showed that the TST reactivity and booster effect among our hemodialysis pa-tients in Iran are lower than in other societies. Inadequate hemodialysis and poor nutri-tion may contribute to the lower tuberculin skin test reactivity in our hemodialysis pa-tients.- انتشار مقاله: 17-05-1395
- نویسندگان: Mohammad Mahdi Sagheb,Mandana Goodarzi,Jamshid Roozbeh
- مشاهده