Psychometric characteristics of clinical reasoning problems [CRPs] and its correlation with routine multiple choice question [MCQ] in cardiology department

Introduction: clinical reasoning is one of the most important skills in the process of training a medical student to become an efficient physician. Assessment of the reasoning skills in a medical school program is important to direct students' learning. One of the tests for measuring the clinical reasoning ability is Clinical Reasoning Problems [CRPs]. The major aim of this study is to measure psychometric properties of CRPs and define correlation between this test and routine MCQ in cardiology department of Shiraz medical school

Methods: this study was a descriptive study conducted on total cardiology residents of Shiraz Medical School. The study population consists of 40 residents in 2014. The routine CRPs and the MCQ tests was designed based on similar objectives and were carried out simultaneously. Reliability, item difficulty, item discrimination, and correlation between each item and the total score of CRPs were all measured by Excel and SPSS software for checking psycometeric CRPs test. Furthermore, we calculated the correlation between CRPs test and MCQ test. The mean differences of CRPs test score between residents' academic year [second, third and fourth year] were also evaluated by Analysis of variances test [One Way ANOVA] using SPSS software [version 20][alpha=0.05]

Results: the mean and standard deviation of score in CRPs was 10.19 +/- 3.39 out of 20; in MCQ, it was 13.15 +/- 3.81 out of 20. Item difficulty was in the range of 0.27-0.72; item discrimination was 0.30-0.75 with question No.3 being the exception [that was 0.24]. The correlation between each item and the total score of CRP was 0.26-0.87; the correlation between CRPs test and MCQ test was 0.68 [p<0.001]. The reliability of the CRPs was 0.72 as calculated by using Cronbach's alpha. The mean score of CRPs was different among residents based on their academic year and this difference was statistically significant [p<0.001]

Conclusion: the results of this present investigation revealed that CRPs could be reliable test for measuring clinical reasoning in residents. It can be included in cardiology residency assessment programs

Association of ABCB1 [C3435T] and ABCC1 [G2012T] polymorphisms with clinical response to atorvastatin in Iranian patients with primary hyperlipidemia

Background: Atorvastatin is prescribed for the primary and the secondary prevention of coronary artery diseases. A wide variation in inter-individual statin response suggests that genetic differences may contribute to this variation. This study investigated the association of ABCB1 [C3435T] and ABCC1 [G2012T] polymorphisms with clinical response to atorvastatin in Iranian primary hyperlipidemic patients

Methods: Individuals [n=179] with primary hypercholesterolemia were enrolled, and peripheral blood samples were collected. Genotyping of two polymorphisms were performed by amplification refractory mutation system PCR

Results: Following four weeks of treatment, a significant reduction of LDL-C was observed in variant groups [CT+TT] of ABCB1 [P=0.018] and wild-type group [GG] of ABCC1 genes [P=0.029]. Logistic regression analysis revealed a significant difference between male and female responses to 10 mg/day atorvastatin [P=0.004, odds ratio=0.2, CI 95%=0.06-0.6]

Conclusion: Our finding indicated that these polymorphisms may be attributed to LDL-C serum levels in the primary hypercholesterolemia patients receiving atorvastatin

Endovascular repair of the traumatic dissection of the subclavian-axillary artery: report of four cases

Traumatic injuries to the subclavian-axillary artery, although uncommon, are associated with high morbidity and mortality rates if not managed promptly. The emergence of endovascular techniques offers an alternative to the surgical management of these injuries. We herein present 4 cases of traumatic subclavian-axillary artery injury with limb ischemia successfully managed via the endovascular approach with non-covered self-expandable stents. We achieved excellent immediate results with limb salvage and without complications. At follow-up by duplex sonography, all the patients had good peripheral pulses and patent revascularized arteries

Medical students' academic emotions: the role of perceived learning environment

Introduction: Research shows that there is a relationship between students' perceptions of classroom and learning environment and their cognitive, affective, emotional and behavioral outcomes, so, in this study the relationship between medical students' perception of learning environment and academic emotions was examined

Methods: The research method used was descriptive-correlativeÒ Stratified sampling method was used to select 342 participants. They completed self-report questionnaires of Dundee Ready Educational Environment Measure [DREEM] and Achievement Emotions Questionnaire [AEQ]. All descriptive statistics, Pearson's correlations and simultaneous multiple regression were performed using SPSS 14 software

Results: Simultaneous multiple regression of the students'perceived learning environment on their academic achievement emotions showed that the perceived learning environment predicts the students' academic emotions

Conclusion: The results of this study revealed that caring for and supportive learning environment can increase the students'positive emotions and decrease their academic negative emotions [i.e. anxiety, shame, and hopelessness]. Implications of the results are discussed

Assessment of the interns' ability based on Dundee model in Shiraz university of medical sciences

Introduction: The importance of medical profession and the role of the physician in society is no secret to anyone. Skills and competencies in clinical practice are necessary for the medical profession. In fact, in patient care, doctors require practical skills in addition to scientific knowledge. This study examines the potentials of medical school students in three areas of doing the right thing, doing the right thing in an intermediate range, and doing the right thing by the right person

Methods: This study was done in a descriptive-analytical and sectional model. The population of this study was all interns of Shiraz University of Medical Sciences who were passing internship at Internal Medicine, Surgery, Pediatrics, Obstetrics and Emergency wards. About 100 persons were selected were selected by simple randomization. In order to collect data, a questionnaire with 12 questions was designed in two parts. The questionnaire was approved by 7 Faculty members of Clinical Medicine and Medical Education, and its reliability was approved by test-retest method on 20 medical students in the form of a pilot study and through Cronbach's alpha [82%]. Collected data were analyzed by SPSS software version 14 using descriptive statistical methods

Results: Results showed that within the inner circle, interns evaluated their skills in surgery, internal medicine, and gynecology wards, intermediate and at other wards as weak. Also within the center circle, interns evaluated adequate educational evidence-based training in the field of medicine, and sufficiency of educational training in the field of clinical decision making and clinical care as suitable

Conclusion: According to the results, it seems that medical interns' skills in performing most medical skills are moderate. So teaching students by new educational methods and workshop techniques, using experienced teachers will be effective. The use of clinical skills training centers and objective assessment methods for the students' skills, especially before entering the clinical departments, is very important

Role of organizational citizenship behavior in promoting knowledge sharing

Introduction: Organizational citizenship behavior has been linked to overall organizational effectiveness, thus these types of employee behaviors have important consequences in the workplace. One of the important consequences of these types of behaviors is knowledge sharing. Thus, the current study examined the role of organizational citizenship behavior in promoting knowledge sharing

Method: A descriptive correlation design was employed in this study. We collected the data from Kharazmi University employees in city of Tehran in 2014. The statistical population consisted of 484 Kharazmi University employees from which 210 persons were selected randomly [using simple random sampling] by the Krejcie and Morgan [1978] sample size determination table. Data were collected through organizational citizenship behavior questionnaire and knowledge sharing questionnaire. To examine the reliability of the questionnaires, Cronbach alpha coefficient was used. These coefficients were 0.80 for attitude toward knowledge sharing and 0.77 for intention to share knowledge. Also, for organizational citizenship behavior it ranged from 0.71 [courtesy] to 0.82 [altruism]. To determine the validity, content validity method was applied. All descriptive statistics, t-test, Pearson correlation and multiple regression were performed using SPSS 19

Results: The results of t-test indicated that the means of organizational citizenship behavior [mean=2.50] and all its dimensions [altruism: 2.60, conscientiousness: 2.52, sportsmanship: 2.41, courtesy: 2.49, civic virtue: 2.45] among employees were at the moderate level. The results showed that the correlation between organizational citizenship behavior and knowledge sharing was significant [r=0.50, P<0.001]. Other results showed that the correlations between knowledge sharing and organizational citizenship behavior dimensions - Altruism [r=0.35], Conscientiousness [r=0.19], Sportsmanship [r=0.46], Courtesy [r=0.39], Civic virtue [r=0.18] - were significant [p<0.001]. Finally, results of multiple regression analysis showed that organizational citizenship behavior dimensions - Sportsmanship [beta= 0.53] - could predict knowledge sharing

Conclusion: According to the findings, it can be concluded that with improvement in each of the research variables, other variables will improve. For example, as the result of improvement in organizational citizenship behavior, knowledge sharing will increase and the organization could use its competitive advantage

Outcome of penetrating cardiac injuries in southern Iran, Shiraz / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Cardiac injuries are one of the most challenging injuries in the field of trauma surgery. Their management often requires immediate surgical intervention, excellent surgical technique and the ability to provide excellent postoperative critical care to patients. The aim of this study was to evaluate the outcome and survival rate of patients with penetrating cardiac injury in southern Iran, Shiraz.</p><p><b>METHODS</b>From January 2001 to June 2007, medical records of all patients suffering from penetrating cardiac injuries were reviewed and their outcomes were investigated. The inclusion criterion was the presence of a confirmed penetrating cardiac injury intraoperatively or by autopsy. Patients with blunt cardiac injuries were excluded from the study.</p><p><b>RESULTS</b>The study consisted of 37 patients, including 1 gunshot wound (2.7%), 35 stab wounds (94.6%) and 1 (2.7%) shotgun wound. The overall survival rate was 76% (28 in 37) and that in stab wound patients was 80%. The collected data of 9 expired patients revealed 11% death on arrival, 67% hypotensive, and 22% normotensive considering physiologic presentation. Paired sample test showed significant correlation between mortality and electrocardiographic changes, amount of retained blood in pericardium, clinical stage and physiologic condition at presentation, as well as associated injury type (gunshot more than stab wound).</p><p><b>CONCLUSION</b>Our results show that injury mechanism and initial cardiac rhythm are significant predictors of outcomes in patients with penetrating cardiac injuries. Besides, gunshot injury and exsanguination are the most important predictive variables of mortality.</p>

Assessing the impact of faculty development fellowship in Shiraz University of medical sciences

Changing concepts of education have led many medical schools to design educational programs to enhance teaching skills, as traditional approaches cannot fulfill the current students' needs. The educational development of medical faculty members has recently received impetus in Iran and the Eastern Mediterranean region. The aim of this study was to investigate whether participation in a faculty development program reinforced new teaching skills. A teacher-training program was designed at Shiraz University of Medical Sciences to help medical instructors improve their teaching skills. The program, imparted in workshop format, covered effective teaching methods, feedback, knowledge assessment, and time management. Program sessions lasted four hours, four days each week for one month. Instruction was in the form of lectures, group discussions, case simulations, video presentations, and role-playing. All participants in the study [n = 219] belonged to the academic staff of Shiraz University of Medical Sciences. The participants highly rated the quality of the program. They felt that the educational intervention was appropriate and had a positive impact on their knowledge [P < 0.001]. Assessment of the effectiveness of the program in strengthening the participants' teaching ability showed that students noticed significant improvements in the participants' teaching abilities [P < 0.05]. Our faculty development program appears to have a significant positive effect on medical teachers' competencies, and we suggest that our educational intervention is effective in achieving its aims. Further research should investigate whether this faculty development program actually results in improved teaching performance

[ per-capita cost of training undergraduate medical students in Shiraz school of medicine, 2007]

Cost-benefit analysis is a scientific method which helps policy makers to select a project among other projects, with the same defined goal, making sure that the chosen project has the maximum benefit with a fixed cost or the minimum cost with a fixed level of benefit. Therefore, universities should consume the resources more carefully and efficiently. This survey was conducted to provide documents for evidence based decision making for policymakers. Having the cooperation of the admission office, the number of medical students was extracted and then with the assistance of university budgeting manager, total costs were extracted regarding education, research, cultural-recreational affairs and management emphasizing on medicine field. Finally, data was analyzed with Excel. Our findings showed that the per capita cost in education was 268.3 million rials, in research, it was 13.25 million rials, and as for cultural-recreational affairs and management, it was 7.4 and 14.45million rials respectively. The sum of per capita costs was 303.4 million rials The calculated cost is fivefold the amount which was allocated as a per capita cost. The total cost of the university was more than the amount allocated by the management and planning organization; this necessitates further revisions in allocating recourses to universities by management and planning organization

Use of 12-lead electrocardiography for prediction of left main coronary artery significant lesion

Significant Left Main Coronary Artery [LMCA] lesion [>/= 50% stenosis] is rare and most of these patients die of sudden death or cardiogenic shock. Therefbre, prediction of LMCA obstruction by electrocardiography [ECG] is important to identity these cases. Concerning the risk of LMCA lesions early diagnosis of these lesions with ECG causes earlier and better management. From December 2005 to December 2006, ECG findings of 51 patients with LMCA significant lesion [LMCA group] were compared with 492 patients will] normal coronary angiography [control group]. Nine patients of LMCA group and 18 controls had signs of anterior myocardial infarction [Ml]. ST elevation [>/= 1.0 mV] in two consecutive precordial leads or pathological Q wave, in ECG that was taken in 48 hours before performing coronary angiography. Chi-Square Test was used to compare ECG findings in these groups. Inverted U wave [Biphasic T wave in V1 to V4 was seen more [77.8%] in LMCA group with signs of anterior MI [than controls with signs of anterior MI 133.3%] [p < 0.046] and more in LMCA group without signs of anterior MI [19.0%] than in controls without signs of anterior MI [7.4%] [p<0.009]. ST elevation in aVR [>/= 0.5 mm] was useful for differentiating of LMCA group without signs of anterior MI [42.9%] from control group without signs of anterior MI [20.5%] [p<0.001] but not for differentiating these groups with signs of anterior MI. [p<0.121] ST depression in interior lards was not a predictor of LMCA obstruction due to p<0.221 and 0.471 for LMCA group without signs of anterior MI and LMCA group with signs of anterior MI, respectively. In patients with ECG features of anterior myocardial infarction, Inverted U wave [Biphasic T wave] in V1 to V4 is the only ECG finding in favor of LMCA obstruction, [sensitivity 77.8%] ST elevation in aVR. with low sensitivity [42.9%]. is a predictor of LMCA significant lesion in patients with chronic angina pectoris