Comparison of plantar peak pressure and time to peak pressure during normal walking between females with genu recurvatum and healthy controls

Background and Aim: The aim of this study was to compare plantar peak pressure and time to peak pressure during normal walking between women with genu recurvatum [GR] and healthy subjects

Material and Methods: 10 women with genu recurvatum and 11 healthy women participated in this study

The knee angle was measured by goniometer. Plantar pressure was measured using emed platform during barefoot walking

After dividing plantar area into 10 masks, peak pressure values and time to peak pressure were calculated. Repeated measure and MANOVA were used for statistical analysis. P<0.05 was considered significant

Results: Subjects with GR had significantly lower peak pressure values at the lateral heel [p=0.02], medial heel [p=0.04] and midfoot [p=0.02] masks of the right foot; and also at the lateral midfoot [p=0.02] and 3[rd] 4[th] and 5[th] toes [p=0.04] masks of the left foot, compared to the healthy women

Also, we found higher values for time to peak pressure at the masks of the lateral heel [p=0.0001], medial heel [p=0.0001] and midfoot [p=0.01] of the right foot and at the masks of medial [0=0.03] and lateral heel [p=0.03] of the left foot in the subjects with GR, compared to healthy women

Conclusion: GR abnormality can change peak plantar pressure during walking by changing the alignment of ground reaction force

These changes may affect the function of the lower limb muscles and alter the gait pattern. So, assessment of plantar pressure distribution is recommended for planning and evaluation of the effectiveness of rehabilitation programs in the patients with GR

comparative study between the conventional MCQ scores and MCQ with the CBA scores at the standardized clinical knowledge exam for clinical medical students

Background and purpose: Partial knowledge is one of the main factors to be considered when dealing with the improvement of the administration of Multiple Choice Questions [MCQ] in testing. Various strategies have been proposed for this factor in the traditional testing environment. Therefore, this study proposed a Confidence Based Assessment [CBA] as a pertinent solution and aims at comparing the effect of the CBA Scoring system with that of the conventional scoring systems [with and without negative score estimation as penalty] on the students' scores and estimating their partial knowledge on clinical studies

Methods: This comparative study was conducted using a standardized clinical knowledge exam for 117 clinical students. After two-step training, both the conventional MCQ and CBA examination was given in a single session simultaneously. The exam included 100 questions and the volunteers were requested to complete a questionnaire regarding their attitude and satisfaction on their first experience of the CBA after exam. A new confidence based marking system was selected for the scoring, which was a hybrid of the UCL and MUK2010 systems. The MCQ-Assistant, SPSS and Microsoft office Excel software were used for scoring and data analysis

Results: The mean age of the volunteers was 27.3 +/- 5.47, of whom 43.6% were men and 69.2% were senior medical students. Exam reliability was 0.977. The fit line of the MCQ scores without penalty estimation was R[2]=0.9816 and Intercept=18.125 or approximately.2 deviation in the low scores. The MCQ scoring with penalty had a fit line approximately parallel to the 45-degree line but on or above it and the CBA scoring fit line was nearer to the 45-degree line, parallel to it and a little below it. These two sets of scores had a significant p value0.037. The response percentage to the CBA is higher [p value=0.0001]. The discrimination power of the MCQ and the CBA for the upper and lower 1/3 of the students was not significantly different [p value=0.34]. The students' satisfaction score was high and acceptable to the CBA system and expressed a positive perspective on this system for their examinations

Conclusions: The CBA method can increase the competencies of the MCQ exams. It was found to have a greater fairness assessment, was an effective examination, an authentic testing method, with precise estimation and higher constructs validity than the conventional MCQ exam. The CBA simulate the reflection for deeper learning among the students

Quality dimensions of educational morning report sessions

Morning report sessions had long-standing history in medical education. Morning report management is an important aspect of professional medical education. To evaluate the contents of the morning report sessions, including management, staff training, deep learning, attention to learners at different level of education, record keeping, feedback, and final summarizing, direct observation of 73 sessions was conducted in five teaching hospitals in a medical university in Tehran. The following scores were obtained: morning report management [91%], training faculty members [9%], residents' training [4%], direct learning by patient management instead of memorizing study material [88%], paying attention to the different educational levels of learners [28%], record keeping [36%], systematic feedback [48%], and a final summarizing session [26%]. Out of eight, five dimensions related to teaching in the morning report sessions need improvisation, specifically on the training of faculty members and residents, paying attention to different educational levels of learners, brief summary of all sessions, and record keeping

[Fall-related injuries in older people in Kashan]

Falls in the elderly cause a variety of injuries and may lead to dependency, lower self-efficacy, depression, limitation in daily activities, hospitalization, admission to a nursing home and cost to the individual and community. The present study was conducted to determine the types of injuries from falls in the elderly. In this cross-sectional study, all patients aged 60 years and older who were hospitalized due to fall in Shahid Beheshti Hospital in 2011 were investigated. External cause codes w00-w19 based on International Statistical Classification of Diseases and Related Health Problems [ICD-10] related to fall were selected from the hospital health information system, and the patient records, demographic variables, external causes of injury and type of injury were extracted. Data were analyzed using SPSS software. Relationship between duration of hospitalization and background variables were evaluated using chi-square test, t-test, ANOVA or nonparametric equivalents. A significance level of 0.05 was considered. A total of 251 patients aged 60 years and older were studied that 127 of them [50.6%] were women. The mean age of the patients was 76.82 +/- 7.3 years. Fall on the ground was the most common type of injury [78%] and upper limb fractures [44.1%], lower limb fractures [28.9%] and head injuries [15.9%] were the most common types of injuries. The total number of hospitalization days was 1425 and mean of hospitalization was 5.68 +/- 4.5 days. The most frequent injuries are fractures of the upper limb, lower limbs and head injuries that caused the greatest length of stay and cost of hospitalization in the elderly

Risk factors incidence of surgical wound infection following abdominal hysterectomy

Surgical wound infection is the most common complication following surgery. This study was done to determine the incidence risk factors of surgical wound infection following abdominal hysterectomy. This descriptive study was done on 400 patients who underwent abdominal hysterectomy in Babol, North of Iran, during 2008-10. Age, underlying disease, BMI, use of immunosuppressive drugs hospitalization period prior to surgery, shaving and bath time, prophylactic antibiotic, duration of surgery, diagnosis and pathology were recorded for each patient. Evidence of surgical location of infection including surgical discharge, erythema and dehiscence of surgical wound with and without fever during 10 days after surgery were recorded. Surgical wound infection was seen in 26 patients [6.5%] following abdominal hysterectomy. Regression analysis determined, use of immune-suppressive [95% CI: 1.71-480.30, P=0.020, OR:28.70] and emergency operation [95% CI: 1.42-14.39, P=0.011, OR: 4.52], diabetes [95% CI: 1.23-11.26, P=0.020, OR:3.72] were risk factors for surgical wound infection. Immuno-suppressive agents, emergency operation and diabetes increased surgical wound infection in post- abdominal hysterectomy

[Evaluation of upper limb intravenous block: ketamine with lidocaine versus lidocaine]

The most important side effect of venous [Bier] block is systemic toxicity induced by local anesthetics. This is occurred by accidental tourniquet release after drugs' injection. Effects of sensory and motor block of lidocaine increase by use of subanesthetic dose of ketamine with lidocaine simultaneously and its toxicity reduces. To evaluate the sensory and motor block via venous block in patients under upper extremity, surgeries induced by lidocaine compared to lidocaine and ketamine. Forty ASA physical status I-II patients, undergoing elective surgery of the hand or the forearm, were studied in Shahid Rajaee University Hospital. Patients divided in two groups randomly [n= 20]. The affected extremity was exsanguinated by elevating it and wrapping it with an esmarsh bandage. The proximal double- cuffed tourniquet was inflated on the arm of affected extremity and local anesthetics administered [each patient in control group received with 40 ml of lidocaine 0.5% and each patient in intervention group received 40 ml of lidocaine 0.25% plus ketamine 0.1% [40 mg]]. Sensory blocking was assessed by using a blunt pin every 1 minute after local anesthetic injection. Motor block also assessed based on patient's ability to move the operative hand fingers. Data were analyzed using t- test. The mean time of sensory and motor blocks were 4.25 +/- 0.63 and 7.65 +/- 0.24 minutes in control group and 4.35 +/- 0.62 and 8.35 +/- 0.67 minutes in intervention group resoectively. Time of motor block was significantly longer in lidocaine and ketamine group compared to lidocaine group [p= 0/003]. Using lidocaine combined with ketamine is safe method for the intravenous regional anesthesia especially in surgeries on hand or forearm. In this method lidocaine doses for blocking is lessen and reach to nontoxic level

Effect of acute smoking on diastolic function

Smoking is a known risk factor of atherosclerosis, endothelial dysfunction, athermanous plaque rupture, unstable coronary syndrome and sudden cardiac death. The present study comprised 40 randomly selected healthy male hospital staff without a history of hypertension or cardiac or pulmonary disease. Participants were divided into two groups. The first group included 20 professional smokers [at least 5 pack/year till the time of study] and the second group consisted of 20 nonprofessional smokers defined as 0.5 pack/ year or less till the time of study. Participants were instructed not to smoke for 6 hours before the study. Patients underwent echocardiography before smoking. The participants were then asked to smoke a whole cigarette. After smoking, echocardiography was repeated within 7 to 15 minutes. Echocardiographic indices of diastolic function [E wave, A wave, Ea, E/A ratio and deceleration time] were measured before and after smoking. There was no statistically significant difference in the baseline measures in both groups before smoking and also there was no significant difference between measures in the two groups after smoking. The analysis of the pooled data from two groups showed that, smoking resulted in significant increase of heart rate [P<0.001]. A wave, E wave, Ea, E/A ratio and deceleration time changed significantly after smoking [P<0.001, P=0.027, P=0.011, P<0.001 and P<0.001 respectively]. Smoking of only a cigarette in both professional and nonprofessional smokers resulted in the same significant diastolic dysfunction

[Qualitative assessment of dimensions and degree of autonomy granting to university hospitals]

The aim of this study was to determine the key organizational dimensions that influence the autonomy of university hospitals and the level of granted autonomy in each dimension. Six hospitals were randomly selected from those affiliated with three medical universities of Tehran, Iran and Shahid Beheshti. In this qualitative study, we interviewed 27 hospital managers [response rate of 82%]. The semi-structured interview guide was developed based on the results of four initial in-depth interviews and the organizational reform model of the World Bank. We used the framework method for the analysis of qualitative data. Nine themes were identified as the key factors influencing hospital autonomy: decision right in strategic management, decision right in human resources management, decision right in financial management, decision right in physical resources management, product market exposure, procurement market exposure, financial residual claim, governance arrangements and accountability mechanisms, and social functions of the hospitals. Limited decision rights in strategic, human resources, and physical resources management were granted to hospitals. Hospitals were not the financial residual claimant, but were exposed to competitive product market. Autonomy was limited regarding the procurement market. Governance systems were hierarchical and accountability mechanisms were supervisor-supervisee oriented. Some of the social functions of the hospitals were defined, but the expenses of these functions were not totally reimbursed by the government and the insurance industry. The autonomy granted to the hospitals is unbalanced and paradoxical. More decision rights should be granted for management of strategic, human resources and physical resources as well as hospitals entry to the procurement market. Hospitals need to be the financial residual claimant. The hierarchical administrative systems should be transformed to cooperative ones. Instead of supervisor-supervisee oriented control measures, Ministry of Health and Medical Education needs more regulatory mechanisms for controlling hospitals' performance and social functions

Intracranial rhabdomyosarcoma presented as chronic subdural hematoma: a case report

Intracranial rhabdomyosarcoma is a very rare disorder. Subdural rhabdomyosarcoma has not been reported yet. It can be misdiagnosed with chronic subdural hematoma in CT images. Herein, we presented a 2.5-year-old boy with intractable chronic subdural hematoma who were treated with burr hole insertion, needle aspiration and shunting for about 2 years with partial resolution of his symptoms after each procedure. The final pathologic evaluation after extensive bilateral craniotomy revealed rhabdomyosarcoma. The role of CT and MRI in early diagnosis and management of this rare situation is discussed

new approach to information technology instruction for medical students

Active learning, combined with computer-assisted instruction, can enhance medical students' performance and learning. This article is an attempt to introduce a new web-based approach to information technology instruction for medical students. Eight topics were selected to be instructed in Web-based workshops. PHPBB Forum was used for web-based collaborative learning. One oral lecture session was held to make the students familiar with the Forum and their duties. For each topic, groups of 6-9 students had to search the Web, based on a search strategy to find answers for the questions. The students could discuss their findings in their group Forum under the supervision of a tutor. Direct [face-to-face] and indirect [Web-based] interactions among students was considerably increased. The students showed greater interest in participating in class activities. Students' attitude toward Web-based learning was improved. Adding collaborative learning to computer-assisted instruction, along with constant supervision by the tutor, can enhance students' learning, since they can have free discussion and express their opinions

Students' viewpoints on the educational methods used in Shaheed Sadoughi University of Medical Sciences

Background: an education of desirable quality is the one which ends in an effective learning. Students interest on the educational method used may enhance their learning

Purpose: to determine Students' viewpoints on the educational methods offered in medical universities

Methods: this cross sectional study investigates the student's viewpoints on the educational methods used in the medical university teaching. The cases were selected by randomized sampling and a questionnaire was completed by the subjects

Results: of all subjects, 63% who were 24 years or older considered group discussion as the best educational method. 53.1% of the students valued group discussion as a prior educational method and 51% of the students deemed it an effective method while 13.4% preferred lectures and 75.3% marked "the professors skill and enthusiasm for teaching" a effective factor in the education process

Conclusion: more interactive methods such lecture with question and answerers is rather a simple change but may improve the students' satisfaction

mission-based gifted and talented program

Background: only in recent years has the concept of "Multiple intelligences" been acknowledged

Purpose: to develop a mission-based program to train gifted medical students on skills and sciences needed for sustainable development

Methods: a two-armed program was developed for training medical students. The first arm of the program train students for management purposes. The second branch of the program educates medical students to enable them to contribute to scholar development in areas of health and medicine

Results: the Managerial pathway has been implemented since July 2003. More than 400 students from Shaheed Beheshti and elsewhere registered in the program as main members or guest members of the program. The level up exam was given on February 2004 with 13 students qualifying for C level

Conclusion: it may be to early to draw any conclusion in terms of fulfilment of the outcomes of the program but the dedication of the members to the program has been beyond imagination