Effectiveness of E-learning compared to classroom learning in the diagnostic approach to bioterrorism and chemical terrorism for emergency physicians

Background and purpose: Emergency physicians play an important role in the immediate diagnosis of bioterrorism activities. The present study was conducted with the purpose of comparing the effectiveness of e-learning and classroom learning in approach to bioterrorism and chemical terrorism for emergency physicians

Methods: This was a semi-empirical study, which was conducted via testing knowledge before and after the educational intervention in the field of bioterrorism and chemical terrorism on the emergency physicians in Tehran. The external validity of the questionnaire was confirmed by two academic experts in order to determine the ability to detect bioterrorist and chemical terrorist diseases. In this study, education was done in both virtual and classroom forms. The education regarded 6 bioterrorist diseases in group A [anthrax, plague, viral hemorrhagic fever, tularemia, smallpox], and 5 chemical terrorist diseases [nerve gas, mustard, lewisite, phosgene, chlorine]

Results: 160 doctors participated in this study. 96 people [60%] were men and 64 people [40%] were women. The average age of the participants was 36.2 +/- 5.5 years. In e-learning method, the pre-test scores average was [30.6%], while the post-test scores average was [81.6%] [p=0.001]. In classroom learning method, the pre-test scores average was [41.9%], while the post-test scores average was [72.9%], which the pre-test and post-test scores average differences in both cases are significant [p<0.001]. In e-learning method, the difference was [51%], and in the classroom method it was [31%], which these two represent a 20% difference between methods. From statistical point of view, this difference indicates that the e-learning method being more effective [p=0.02]

Conclusions: Based on the study results, it seems that in comparison to the classroom learning, e-learning method is more effective in helping emergency physicians to diagnose bioterrorism or chemical terrorism factors

[Progress of hospital information systems in Kerman teaching general hospitals in 2012]

Introduction: Health care facilities have intended to mechanize their information systems. The rate of mechanization of information systems is not similar within these organizations. The study aimed to assess the mechanization rate of hospital information system among four teaching- general hospitals in Kerman in 2012

Methods: This applied research was a descriptive cross-sectional study conducted in four teaching general hospitals. A Ministry of Health and Medical Education checklist on "Health Information System evaluation" was used for data gathering. Data was analyzed using SPSS 13 and Excel through descriptive statistics

Results: The Findings of this study revealed that the highest and the lowest mechanization progress rate of hospital information system were concerned to medical record information system and decision support with 91.66 per cent, and 15. 62 per cent, respectively

Conclusion: It is recommended that executives establish a committee to plan, organize, supervise and hold training courses and conduct periodic assessment of hospital information system in order to identify and amend weaknesses and also allocate adequate budget to hospital information system

Assessment of statistical relationship of ejection time and acceleration time with the severity of valvular aortic stenosis

Valvular aortic stenosis is a relatively common disease among valvular heart diseases and can be rheumatic, degenerative or congenital. Evaluation of the severity of the disease is sometimes challenging and problematic. Besides, the use of more parameters of non-invasive methods for the assessment of valvular disease and its severity seems attractive and helpful. Transthoracic echocardiography [TTE] is an appropriate modality for the evaluation of the aortic valve. In this study, TTE was performed for 80 patients with valvular aortic stenosis. The goals were to assess the statistical relationships between ejection time [ET] and acceleration time [AT] and their ratio [AT/ET] with the four traditional parameters of the echocardiographic severity of aortic valvular stenosis [aortic jet velocity, aortic valve area, mean pressure gradient and LVOT VTI/aortic VTI ratio]. There was a meaningful relationship between adjusted ET with the four above-mentioned parameters, d. ET [ET-adjusted ET according to heart rate and stroke volume] was inversely related with the aortic valve area [calculated with continuity equation]. AT/ET was significantly correlated with the four mentioned parameters. The regression equations were calculated. The cut-off value of AT/ET for the echocardiographic diagnosis of severe valvular stenosis was 0.36 [with 95% level of confidence]

Agreement determination between coronary calciumscoring and coronary stenosis significance on CT-angiography

The most important lesions in coronary artery disease [CAD] are coronary artery plaques, many of which are calcified. Multi-slice spiral CT [MSCT] scanners can concurrently perform coronary calcium scoring [Ca-Score] as a predictor of CAD and coronary CT-angiography [CCTA] as the determining factor in therapeutic decision-making. We aimed to determine the agreement of a Ca-Score more than 100 [based on Agatston technique] with coronary artery stenosis significance on CCTA. Using ECG-gated MSCT, 65 patients who were referred for CCTA were assessed both for their Ca-Score and a significant [>/= 50% diameter reduction] coronary stenosis, simultaneously. Their total Ca-Score were classified in three groups [a-O, b-less than 100, and c- >/= 100]. The severity of coronary stenosis was categorized to further three groups [1-lack of stenotic lesion, 2- presence of non-significant stenosis, and 3-presence of significant stenosis]. Of 65 patients referred for CCTA, 42 [64.61%] had no CAD, 8 [12.3%] had non-significant lesions' and 15 [23.09%] had significant stenoses. Forty-three [66.2%] out of 65 subjects had a zero. 14 [21.5%] had scores < 100, and 8 [12.3%] had >/= 100 Ca-Score. In the first group [Ca-score = 0], only one had significant stenosis; while 50% of the patients in the second group [Ca-score < 100] and 87.5% from the third group [Ca-score of >/= 100] had significant stenosis. Significant coronary stenosis has a moderate-to-good agreement with a Ca-Score of 100 or higher, compared to those with a Ca-Score of less than 100, and this was statistically significant [P < 0.0001]. In patients with a calcium score of 100 or more, performing CCTA may be advisable to assess the likelihood of significant CAD

[Knowledge of Kerman general practitioners about Tramadol in 2004]

Tramadol is an opioid analgesic indicated for the management of moderate and severe pains. Its side effects, in parts are due to the activation of micro receptors and in parts to increasing central catecholamine and serotonin levels. In the case of long administration, tramadol has a potential to cause dependency, tolerance and also drug abuse. After prohibition of injective diclofenac, considering Iranian's tendency for rapid sedation of pain symptoms, tramadol has been prescribed widely. The aim of this study is to determine general practitioners knowledge about this new drug.This cross-sectional study was arranged by collecting data through a self-administrated questionnaire consisted of 25 questions related to different aspects of drug knowledge. Sample consisted of 244 general practitioners in Kerman and data analysis was performed by SPSS. Out of 173 general practitioners, 49.1% worked in clinics, 34.9% in private offices and 16% in Emergency Units. Mean knowledge score was 30.72 +/- 0.35 out of the maximum of [50]. From all subjects 49.7% had poor knowledge [Z<-1], while 39.3% had moderate knowledge [-11]. The poorest information was in regard to drug classification and pharmacokinetics, while in dosage and side effects subjects' knowledge was better. No correlation was observed between mean score and variables of job experience, duration, place and sex of practitioners. Considering serious side effects and drug interactions of tramadol and also the low level of knowledge of general practitioners about this drug, educational programs and limitation of distribution seems to be necessary

[Knowledge of Kerman general practitioners about Tramadol in 2004]

Tramadol is an opioid analgesic indicated for the management of moderate and severe pains. Its side effects, in parts are due to the activation of micro receptors and in parts to increasing central catecholamine and serotonin levels. In the case of long administration, tramadol has a potential to cause dependency, tolerance and also drug abuse. After prohibition of injective diclofenac, considering Iranian's tendency for rapid sedation of pain symptoms, tramadol has been prescribed widely. The aim of this study is to determine general practitioners knowledge about this new drug. This cross-sectional study was arranged by collecting data through a self-administrated questionnaire consisted of 25 questions related to different aspects of drug knowledge. Sample consisted of 244 general practitioners in Kerman and data analysis was performed by SPSS. Out of 173 general practitioners, 49.1% worked in clinics, 34.9% in private offices and 16% in Emergency Units. Mean knowledge score was 30.72 +/- 0.35 out of the maximum of [50]. From all subjects 49.7% had poor knowledge [Z<-1], while 39.3% had moderate knowledge [-11]. The poorest information was in regard to drug classification and pharmacokinetics, while in dosage and side effects subjects' knowledge was better. No correlation was observed between mean score and variables of job experience, duration, place and sex of practitioners. Considering serious side effects and drug interactions of tramadol and also the low level of knowledge of general practitioners about this drug, educational programs and limitation of distribution seems to be necessary