ABSTRACT
Introduction: Continuing Medical Education [CME] has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners
Methods: Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general
Results: The participants' experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers' use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME
Conclusion: Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME
Subject(s)
Humans , Male , Female , Middle Aged , Adult , General Practitioners , Surveys and QuestionnairesABSTRACT
Introduction: In medical education, particularly in residency courses, most of the training occurs in real clinical environments. Workplace-based learning profoundly affects students' knowledge, attitudes, and practice; therefore, it should be properly planned. Due to the extensiveness of the clinical environment and its importance in training residents, investigating how residents learn in these environments and detecting factors that influence effectiveness will help curriculum designers to promote residents' learning by improving their learning environment. Therefore, our qualitative content analysis study, aimed to examine the experiences and perspectives of internal and surgical residents and their attending physicians about learning in clinical settings
Methods: This qualitative content analysis study was conducted through purposeful sampling. Semi-structured interviews were conducted with 15 internal and surgical residents and 15 of their attending physicians at educational hospitals of Tehran University of Medical Sciences
Results: The main categories explored in this study were hidden curriculum, learning resources, and learning conditions. In the context of clinical environment and under its individual culture, residents learn professionalism and learn to improve their communication skills with patients and colleagues. Because of clinical obligations such as priority of treating the patients for education or workload of the attending physicians, residents acquire most of their practical knowledge from colleagues, fellows, or follow-up patients in different learning conditions [such as: educational rounds, morning reports and outpatient clinics] They see some of their attending physicians as role models
Conclusion: Changing cultural and contextual factors is of prime importance to promote a learning-oriented environment in a clinical setting. The present findings will help curriculum planners and attending physicians to improve residents' learning by means of appropriate workplace planning and by considering the components involved in clinical learning
Subject(s)
Humans , Male , Female , Middle Aged , Adult , Hospitals, Teaching , Surveys and Questionnaires , Students, Medical , Education, Medical , Evaluation Studies as Topic , CurriculumABSTRACT
Background: It is unclear whether knowing of current HIV status is associated with change injecting behaviors among people who inject drugs [PWID] in Iran. The objective of the prese study was to determine whether awareness of HIV positive status is associated with a reductn in injecting risk behaviors, after matching for socio-demographic characteristics
Methods: Five hundred male PWID were recruited in 2014 from two drop-in centers [DICs] Kermanshah west of Iran
Trained interviewers collected data on socio-demograp characteristics, HIV testing and drug-related risk behaviors over the last month prior to intervi using a structured questionnaire
Our primary exposure of interest was awareness of HIV sts used to group participants into three categories: positive, negative, unaware. We u coarsened exact matching to make the three groups statistically equivalent based on age, pi of residence, education and income, and then compared them regarding the proportior borrowing, lending and reuse of syringes
Results: Matched sample [n=320] had a mean age +/- standard deviation [SD] of 33.5 +/-7J Overall, 25% [95% Cl: 14%, 32%] of participants reported [borrowing a syringe] in the month and 15% [95% Cl: 7%, 22%] of them reported [lending a used syringe] to others ii past month. In comparison to PWID who were unaware of their HIV status, those knew were HIV positive [OR 1.68, CI95%1.32-2.81] or negative [OR 1.54; 95% Cl: 1.28, 2.71] both more likely to report borrowing syringes in past month
Conclusions: PWID WHO know they are positive for H//V are more likely to borrow are person's syringe, to report reuse of their own used syringes and less likely to report lending syringes to others. Strategies to scale up HIV testing and counseling for PWID, whicl increase awareness of HIV status, may decrease injecting related the risk behaviors
ABSTRACT
Background: Hospitals in Iran are not prepared for disasters; the aim of this study was to determine the effect of training functional and nonstructural hospital safety to nurses and their intervention on hospital preparedness in psychiatric Razi Hospital and Day Hospital in Tehran based on Hospital Safety Index [HSI]
Materials and Methods: This semi-experimental study included nurse managers of Razi and Day hospitals as study sample. Research tool was checklist of hospital safety. Validity and reliability of the checklist was determined 93%. At first the checklist was filled out, then preparedness plan including a 1-day workshop about disaster management, functional and nonstructural safety and a table tab maneuvers held. Then, after two months, nonstructural and functional safety of the hospitals was re-evaluated by HSI checklist. Data were analyzed by using Excel file of the tool
Results: Findings showed that scores in most items of nonstructural and functional safety in HSI checklist significantly increased in two hospitals after workshop and nursing performance. Before intervention, these scores were 0.40 and 0.56 for Razi and Day hospitals, respectively which increased to 0.57, 0.86 after training
Conclusion: Results showed that teaching nonstructural and functional safety to nurses and using these principles by nurses can promote hospital safety and preparedness. Comparison between hospitals showed that allocating more budget and executive power to the nurses can increase further the hospital preparedness. Given the key role of nurses in disaster preparedness, it is recommended to teach and apply functional and nonstructural safety of hospitals to nursing managers
ABSTRACT
Background: Some disaster-stricken people in Iran are still experiencing challenges of resuming normal life several months after the incident. However, there is not sufficient and in-depth understanding of the factors affecting the complex process of post disaster recovery in Iran and rural areas in particular. This study aimed to explore the status of social capital in the process of returning to normal life after an earthquake
Materials and Methods: This study was conducted with the qualitative content analysis method. A total of 20 persons from the earthquake-stricken areas and 7 people with relevant scientific background and expertise were selected via purposeful sampling. Data were collected through semi-structured interviews, focus group discussions, and field notes from August 2013 to January 2014. Data collection continued to achieve data saturation. Data analysis was based on qualitative content analysis
Results: The ignorance of social capital was one of the most significant concepts explored in the process of "back to the normal life" after earthquake. This concept was divided into 4 subcategories of 1] top-down paternalistic approach, 2] undermining of trust, 3] undermining of social networks and self-centering, 4] inefficiency of the social institutions, and 5] social cohesion and social division
Conclusion: This study showed that many reason for ignoring social capital in the process of "back to the normal life" after earthquake should be considered in the recovery management. Policy-makers are suggested to consider a comprehensive plan for using and enhancing the social capital in the process of returning to normal life after earthquakes. This plan can provide an opportunity for rehabilitation after disasters
ABSTRACT
Objective: This study aimed to analyze the concept of occupational therapy handling in the children with cerebral palsy from the perspective of occupational therapy instructors and clinicians in Iran
Materials and Methods: In this qualitative study, using hybrid model to clarify the concept of handling through three phases. For the theoretical phase, attributes of handling were recognized through a review of the literature [until February 2014], and six in-depth semi - structured interviews, two observations and one panel of experts were conducted for the fieldwork to develop attributes from the data and to verify those identified from the literature review. In the third phase attributes and final analysis of handling were extracted from the first and second phase
Results: The results were classified in five main categories that were identified as: [1] care of child, [2] management of treatment, [3] manual techniques, [4] education of activities of daily living [ADL], and [5] lifting and carrying. Core attributes of handling include [control, safety, transfer and positioning]
Conclusion: It seems that the results of this study may help in clarifying the concept of handling in children with CP. In addition, by identifying the process, barriers and facilitative factors, and the concept of handling, occupational therapy instructors and therapists will be able to design and run their educational activities based on scientific findings which can provide them with the necessary conditions for education, learning and proper execution of handling in occupational therapy
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Stroke is an unexpected major life incident that effect on physical functioning and can lead to changes in lifestyle and inability to manage self care, work or leisure. To explore the everyday life situation as experienced by stroke survivors, and their family caregivers, this study was conducted 3-6 month after stroke. Twelve stroke survivors and thirteen family caregivers were interviewed and a qualitative content analysis was conducted to analyze data. The results were categorized into two central themes that were identified as; [1] Being challenged by changes in everyday life situation including; the struggle with physical dysfunctions, inappropriate daily plan for leisure activities, changes in mood, being faced with economical problems and being worried about changing roles [2] striving to cope with new conditions including; trying to preserve self-worth, seeking to support from spirituality, learning and re-learning and regaining independency. Physical dysfunction was the major concern for both the survivors and their family caregivers in their everyday life situation. This problem led to, and forced them, to be dependent on others. Training is needed to teach stroke survivors and their families strategies of how to cope with and overcome ongoing challenges of everyday life after stroke and to re-organize their lives and improve skills of the survivors to deal with the new situation at home. A daily plan for spending their time and leisure activities would ease this work. More investigation will be needed to clarify the process of life after stroke to cover this gap
ABSTRACT
Children with cerebral palsy need permanent care and attention in various stages of growth and development. The parents experience problems in taking care of these children and making them independent. This study was conducted to explore these experiences. This qualitative study was conducted in 2011-2012 using content analysis. Purposeful sampling was used to recruit 19 parents of children with cerebral palsy referred to rehabilitation centers in Tehran. The data were gathered using in-depth and semi-structured interviews and were analyzed inductively. Data analysis results revealed three original categories including "life with hardness" "being in ambiguity" and "need to be supported" and several subcategories including "physical strain" "psycho-emotional strain" financial burden" "restriction in social activities" "facing with anonymous" "lack of having an advisor" "need to get help from professionals and specialists" "need to have emotional- spiritual support" and "need to have help in caring the child". Parents in permanent care of children with cerebral palsy face with new and various situations consistently and experience difficulty and bewilderment because of insufficient family and social support. Further studies are needed to explore the support process of caregiver parents of these children
ABSTRACT
Disasters caused 3 million deaths and involved 800 million people in the world during the last 20 years. Disasters cost over 500 billion dollars economically. Iran is one of the 10 most disaster-prone countries in the world based on United Nations table. There is a high incidence of natural disasters due to special geographic conditions, locating in earthquake faults, and flood-prone areas of Tehran. Since, hospitals as the most important healthcare systems should be prepared before disasters; this study was done in order to study the affiliated hospitals preparedness to University of Welfare and Rehabilitation Sciences [Razi and Rofideh hospitals] for unexpected disasters. In this descriptive-analytical study, data was collected by using self administrated questionnaire in order to assess preparedness dimensions of both hospitals [Rofideh and Razi] dealing with unexpected disasters in 2010. The questionnaire had two parts: the first part was about hospital public specifications and the second part was related to study about the hospital preparedness in unexpected disasters. Descriptive statistics were used to analyze data. According to findings, the preparedness of Rofideh hospital was very low [12/142] and Razi hospital was average [84/142] in unexpected disasters. However, these results showed inadequate preparedness for disasters. It seems necessary to design and perform an organized preparedness plan for disasters due to disaster-prone of Tehran province, the importance of hospitals' role in control of unexpected disasters and the necessity of planning and practical measurements such as teaching, human resources, equipment, structure, cooperation, financial budget, map dividing and code group. So, paying attention to the results and suggested strategies would be useful in order to design a preparedness plan for disasters
ABSTRACT
Fatigue is a premature symptom in patients suffering from chronic obstructive pulmonary disease. This study aimed to determine effect of the home-based pulmonary rehabilitation on fatigue among patients with COPD. In this clinical trial, 36 patients were recruited among from 100 patients with COPD according to inclusion criteria in Masih Daneshvari hospital in 2010. Participants were allocated into two control and intervention groups using random block sampling. In the intervention group, the pulmonary rehabilitation program was implemented during three educational sessions in three consecutive days. Fatigue was measured using the Fatigue Severity Scale [FSS] before and seven weeks after discharge. Data were analyzed using descriptive and inferential statistical tests [Independent and paired t-test, chi-square and covariance analysis]. At baseline, the mean scores of fatigue were 47.11 and 47.50 in the experimental and control groups, respectively [P=0.902]. After the intervention, the mean scores of fatigue reached 21.94 and 54.64 in the experimental and control groups, respectively [P<0.001]. According to results of the study, home-based pulmonary rehabilitation nursing could decrease fatigue in patients with COPD
Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/rehabilitation , RehabilitationABSTRACT
Stroke survivors develop their own strategies to combat disabilities, developing strategies to maintain or reestablish a sense of continuity after the disruptive life event that stroke represents, using strategies to foster hope during the process of adjusting to life after stroke and drawing on spiritual practices. The aim of this study is to identify the used and recommended strategies of life after stroke among Iranian people. A grounded theory approach was recruited using semi-structured interviews with 10 stroke survivors, 12 family caregivers and 6 formal care givers. Five main concepts emerged describing as the used and recommended strategies of the participants including, improving functional performance, re-learning life skills and educational support, accessing to rehabilitative services, socio-economical support and well-suited coping strategies. Participants valued better knowledge and skills regarding the adaptive strategies for stroke survivors and their family care givers are essential in accomplishing with activities of daily living and doing social roles for improving life after stroke. Also developing the socio- economic supports is crucial for assuring a more supportive approach to achieve rehabilitation services and design better educational program for them