[ attitude of residents, interns and clerkship students towards teaching role of residents]

Appropriate and effective education for medical students is critically important in promoting and maintaining society's health and the role of residents is undeniable in medical students' education. The aim of this study was to determine the attitude of clerkship students, Interns and residents towards the teaching role of residents in Sari Medical School in 2007. In this descriptive cross-sectional study, the statistical population included all clerkship students, interns, and residents [n=250] in all wards having residents in medical school of Mazandaran University of Medical Sciences in 2007. Using census sampling method, 192 persons were investigated. The data gathering tool was a questionnaire including 4 demographic and 20 attitude items. The data was analyzed by SPSS software using descriptive statistics, Chi[2], and AN OVA. Among respondents, 47%, 39% and 13% were clerkship students, interns, and residents, respectively. The participants' attitudes were dissimilar in different clinical departments. The most positive attitude belonged to psychiatry department [70% with positive attitude] and after that in pediatrics, gynecology, internal medicine, and surgery departments, 50% or less had a positive attitude. The attitude of residents was much more positive than that of clerkship students and interns. So that, 23% of clerkship students, 38% of interns, and 58% of residents had a positive attitude and none of the residents had a negative attitude toward their own education. The attitude of participants towards the teaching role of residents was dissimilar in different wards and the attitude of residents was much dissimilar to that of clerkship students and interns. It is necessary to pay more attention to the teaching role of residents

viewpoints of general physicians toward continuing medical education programs implementation status and the participants motivation

Acquainting the viewpoints of Continuing Medical Education [CME] programs' participants concerning different aspects of these programs is of special importance. The aim of this study was to determine the status of CME programs' implementation from general physicians' viewpoints and their motivation for participating in these programs. In this descriptive cross-sectional study, 150 general physicians were randomly selected among CME programs' participants in Mazandaran University of Medical Sciences from October 2004 to March 2005. The data gathering tool was a self-administered questionnaire including a list of items regarding CME programs' features, their optimum status and the participants' motivations. The analysis and comparisons were made using chi2 by SPSS software. The main motivation for participating in CME programs was achieving points in 60% of respondents and in 28% of them, was restoring the previous knowledge and acquiring new information. Fifty six and a half percent believed that it was better to hold the programs in successive days, and the mean of the number of favorable days was 2.3 +/- 0.93 days. Sixty four percent identified the last three days of the week as the most suitable days for holding these programs. Eighty nine percent of them, described general physicians' needs assessment as a suitable means for selecting the topics, and 58% stated a combination of correspondence and attendance methods as an appropriate educational method. The programs' levels were evaluated poor by 14%, average by 66%, and satisfactory by 20%. Internal medicine was identified as the most important need by 60% and 56.5% requested Cardio-pulmonary Resuscitation workshop. Most general physicians participated in CME programs with non-scientific motivations and the programs' level in some cases was not according to their expectations. Planning CME programs based on general physicians' needs and situations may lead to enhancing their motivations and promoting these programs

Relationship between use of hydroxyurea and cholelithiasis in patients with major and intermediate beta-thalassemia

Cholelithiasis is a common problem among patients with homozygous major and intermediate beta-thalassemia due to chronic hemolysis, ineffective erythropoesis and other factors that causes variety of side effects. Hydroxyurea [HU] decreases hemolysis by increasing HbF production in homozygous beta-thalassemia patients. Up to now, there have not been evidences about relationship between use of Hydroxyurea and cholelithiasis in the patients. The aim of this study was to determine the relationship between use of HU and incidence of cholelithiasis in patients with major and intermediate beta-thalassemia referred to thalassemia research center of Mazandaran University of medical sciences at Boo-Ali Sina hospital of Sari, IRAN. This historical cohort study was performed in 2006. Study population was major and intermediate beta-thalassemia patients referred to Boo-Ali Sina Hospital of Sari, IRAN. The patients were divided to two groups: case and control groups. The case group [36 patients] was consisted of major or intermediate beta -thalassemia patients using hydroxyurea at least for one year, and the control group were: non-hydroxyurea user patients or beginning to use the drug less than 3 months. The groups were matched on order to age, gender and severity of the disease. Severity of the disease was determined according to grading, clinical and laboratory characteristics of the patients. Data about demographic information, severity of the disease and results of hepatobiliary ultrasound were recorded in a questionnaire. The data was analyzed using SPSS [11] software and t-test, Chi-square test and fisher exact test. Thirty-six [20 women [55.6%]] patients in case group and 36 [19 women [52.8%]] patients in control group were studied. The mean duration of use of hydroxyurea was 67.9 +/- 25.5 months with maximum 108 months [9 year]. The mean dosage of the drug was 14.9 +/- 5.9 mg/kg with maximum dosage 34 mg/kg. Thirteen [48.1%] patients in control group [12 cholelithiasis, 1 sludge] and 6 [19.4%] patients in case group [5 cholelithiasis, 1 sludge] had abnormal hepatobiliary sonography. The difference between two groups was significant statistically [P<0.02]. Among the different variables, a significant relationship was detected between gender of the patients and effect of HU on cholelithiasis. This study showed that the incidence of cholelithiasis in major and intermediate beta-thalassemia patients using hydroxyurea was less than non-hydroxyurea user patients did. As a result, it seems that there was a preventive effect of hydroxyurea in incidence of cholelithiasis in major and intermediate beta-thalassemia patients

Survey on relation between major thalassemia and desferiexamine with renal tubular damage

Thalassemia is a hereditary quantitative hemoglubinopathy which is common in mediteranian area including IRAN. Homos zygotic beta thalassemia patients suffer from severe anemia and complication of the disease in many organs. Studies have shown different results about renal complication and disease. Thus, in this study we investigated renal function of thalassemia Major [TM] patients in comparison with control group. This was a historical cohort Study. The population who TM patients was were admitted to Boalisina hospital, Sari, and control group were brothers and sisters of the patients who were matched in gender and age. Serum and urine markers of renal function were measured and demographic and therapeutic data were gathered from medical records. Analysis of the data was performed using SPSS 11 with statistical test [t, chi square]. The Total of 84 [42 patients and, 42 controls] patients were studied. The Mean age of the patients was 21.3 +/- 5.2 years. Dose of Deferral was 70 +/- 19 mg/kg. The results showed no significant statistical differences in levels of beta2 microglobulin, 24 urine protein, Excretion Fraction of Na and K between case and control group. There was significant differences in levels of serum BUN, creatinin, Potassium and urine potassium and creatinin between case and control group. Gender, level of Hb and serum Ferritin significantly affected the differences between two groups. In this study, evidences of renal tubular damage were not detected in TM patients. There was increase in levels of Bun, serum potassium, uric Acid, specially with severe anemia, high dose desferal and Iron over load

[Psychological aspects in young adults with beta-thalassemia major, control group]

Beta-thalassemia major [TM], a chronic, genetically determined hematological disorder, has received little investigation on the psychological aspects of the disease and the psychosocial adjustment of patients with this anemia. In the present study, the aim was to explore the nature of psychopathology according to age, sex, school performance, severity and complications of the disease in TM patients compared with demographically matched healthy persons. A controlled anterograde cohort study was conducted at the Thalassemia Unit of Boo-Ali Hospital from June 2003 to November 2005 in Sari, Iran. Psychological aspects were evaluated by the Persian version of symptoms checklist-90-revised questionnaire. Information on relevant demographic characteristics, school performance, severity and complications of the disease was collected by one of the investigators who had created the questionnaire. 125 persons with TM completed the questionnaires and were compared with 125 controls and 250 totally. The mean age of the participants was 18.51 +/- 2.0 years and with a range of 15-25 years. 132 [52.8%] were female with equal family status, social and economic status. Patients group reported a significantly lower level of marital status [P<0.01], education level [P<0.0001], school performance [P<0.0001]. TM patients were found to have significantly more psychiatric disorders than the control subjects with GSI: 1.16 +/- 0.47 vs. 1.01 +/- 0.6; [P<0.03], PSD: 54.99 +/- 12.59 vs. 46.42 +/- 18.76 [P<0.0001], and PSDI 2.02 +/- 1.02 vs 2.45 +/- 2.22 [P<0.05]. We recorded significant changes in the mean scores of somatization [P<0.0001], interpersonal sensitivity [P<0.0001], depression [P<0.003], anxiety [P<0.05] and psychoticism [P<0.03] in the TM patients as compared to the control subjects. These findings show that beta-thalassemia major patients are at risk for psychiatric symptomatology and need appropriate psychiatric consultation

[Screening of developmental problem, day care centers, Sari, 2006]

There has not been enough attention towards the domains of development in pediatrics,so there are many deficiencies in monitoring the achievement of developmental milestones in our country. One of the important ways for the improvement of this problem is to use screening method. PEDS questionnaire is one of the screening tools for development. The aim of this study was to investigate about parents' evaluation of developmental status for their children. This was a cross-sectional descriptive study. The population included infants and children under the age of 6 in day care centers of Sari. Sampling method was clustering. The tool for data collection was PEDS questionnaire [Parents' Evaluation of Developmental Status] which consisted of 38 questions about demographic data and medical history of children as well as parents' concern about different developmental domains along with "Yes", "No" and "little" answers. The data were analysed using SPSS11 software. Chi square and Wilcoxon were used. P<0.05 was considered significant. Out of 829 questionnaires, 736 were returned [88.7%]. The Sample age was 4.23 +/- 1.32 gl. Fifty percent of participants were male. By average, in each developmental domains, 3.2% of parents had major concern and 9.5% had partial concern. The most common domains of concern were communication with others [6.4%], behavior [6.1%], speaking [4.3%], preschool and school education [3.1%], children's understanding [2.5%], the self care [2.1%], the use of fingers [1.4%], the use of legs and arms [1.1%]. Parents' concern had a significant relationship with parent's education, residence and history of illness in children [P<0.05]. Out of 23.4% of the infants and children who had later returned to the diagnosis center, 80% had behavioral disorder, 87.6% had speech disorder and 16.6% had hearing impairment. A considerable percentage of parents was concerned about developmental domains of their children, but follow up at referral centers was low. Parents' concern led to the diagnosis of an illness for a child in most cases

[Frequency of gasteroesophageal reflux in infants < 2y with refractory asthma, Razi hospital Ghaemshahr, 2003-2005]

Wheezing is a common respiratory problem which is related to hypersensitivity of airways, GERD [Gasteroesophageal Reflux Disease] is one of the underlying factors of respiratory diseases and wheezing in infants [different rates]. For the patients with refractory wheezing, detection and treatment of underlying disorders is very important. So, in this study, frequency of Gasteroesophageal reflux was detected in infants<2y with refractory wheezing. This is a cross-sectional descriptive study on the patients referred to pediatric clinic during 2003-2005. Infants with refractory wheezing under 2 [Based on HX, PE] were introduced gradually, and patients with the evidence of foreign body aspiration, congenital heart disease, thracheoesophageal fistula and neurological impairement were excluded. Fleuroscopic barium study for detecting GERD was performed for the patients. Data were analyzed using SPSS11 software. During 2 years, 50 patients were studied. Age of the patients was 10.26 +/- 5.48 m and 54% of them were male. The most common complaints were wheezing and retraction. Also, 78% of the patients were under dronchodilator treatment, among them 30.8% responded to the drug. In fleuroscopic study using barium, 60% of the patients demonstrated GERD. Numbers of respiratory attack and admissions significantly were related to GERD. GERD is one the underlying factors of recurrent respiratory symptoms and refractory wheezing in infant below 2 years of age. So, evaluations for the detection of GERD should be performed in this patients

[Evaluation of faculty members' and students' attitude towards ambulatory teaching quality]

Ambulatory medicine is one of the most important parts of medical education. Due to its profound relation with professional future of physicians, ambulatory medicine is especially under attention and many studies have been performed to survey its quality and to design some ways to promote it. There is obvious deficiency in our evidence about ambulatory medicine. The aim of this study was to survey the quality of teaching of the ambulatory medicine from the viewpoint of the faculty members and students of medical faculty of Mazandaran. This was a descriptive and cross-sectional study. The study's population consisted of students, residents and clinical faculty members who were included by simple sampling. Data collection was performed by a questionnaire with 22 questions about demographic and educational variables as well as respondents' opinions about environmental conditions, independent activities, instructors' supervision, and social training in the ambulatory clinics. The validity of the questionnaire was controlled by content validity with expertise consultation, and its reliability was controlled by test-retest[r=0.85]. Data were analyzed using spss13 software. Response rate was 79%, the mean age of 36 faculties was 43.6 +/- 8.7 years and 32% of them were female. The mean age of 146 students was 25 +/- 3.6 years and 61% were female. The attitude of the majority of the students [88.3%] towards the quality of ambulatory teaching was negative, but majority of faculties [66.7%] had positive attitudes. There was no significant difference among teaching departments. Attitude of junior trainees was even worse. Attitude of faculty members and students was similar towards inappropriate physical environment of ambulatory clinics, but it was significantly different from independent activities of trainees in clinics [p=0.000]; relational drugs prescription [p=0.000]; management [p=0.004], and supervision of faculty members [p=0.000]. The overall attitudes towards the current condition of ambulatory teaching [especially trainees] were negative because of the impossibility of independent activities for trainees, low supervision of faculties, absence of teaching for rational drug prescription, differential diagnosis and management

[Comparison between the results of academic staff self assessment and those made by the students, faculty of medicine, Mazandaran university of medical sciences, 2006]

Educational evaluation is a structured process for determination of quality and effectiveness and an educational program. Of the most common and studied methods used for evaluation of academic staff is evaluation by students, however, "self-assessment" of the academic staff has not been widely used and there are few studies about it. So the purpose of this study was to assess the correlation between the results of the academic staff "self assessment" and assessment by the students. This study was an analysis of correlation. Study population was clinical faculty members of Mazandaran University of Medical Sciences, recruited by simple sampling method. Tool of data collection was a questionnaire consisted of demographic and educational variables and questions about evaluation of theoretical and clinical teaching of member of staff. Validity and reliability of the questionnaire were approved. Each faculty member was assessed by students and themselves and correlation between them was analysed using SPSS 13. Totally 35 member of staff participated in self assessment, with a mean age of 43.7 +/- 7.46 years, 73% male. 95.6% of the staff and only 80.6% of the students have positive attitude toward assessment of the staff by students [p<0.001]. Not only there was a weak correlation between the results of staff "self assessment" and their assessment by students [r=0.020, r=0/125] but also there was a significant difference between them [p<0.001]. Difference between these measures was higher in minor teaching departments. There was a weak correlation between measures of members of staff "self assessment" and their assessment by students, so educational intervention, for improvement of competency for "self assessment" should be designed and implemented