Does surgical procedure type impact postoperative pain and recovery in deep inferior epigastric artery perforator flap breast reconstruction?

Background@#The deep inferior epigastric artery perforator (DIEP) flap is the commonest flap used for breast reconstruction after mastectomy. It is performed as a unilateral (based on one [unipedicled] or two [bipedicled] vascular pedicles) or bilateral procedure following unilateral or bilateral mastectomies. No previous studies have comprehensively analyzed analgesia requirements and hospital stay of these three forms of surgical reconstruction. @*Methods@#A 7-year retrospective cohort study (2008–2015) of a single-surgeon’s DIEP-patients was conducted. Patient-reported pain scores, patient-controlled morphine requirements and recovery times were compared using non-parametric statistics and multivariable regression. @*Results@#The study included 135 participants: unilateral unipedicled (n=84), unilateral bipedicled (n=24) and bilateral unipedicled (n=27). Univariate comparison of the three DIEP types showed a significant difference in 12-hour postoperative morphine requirements (P=0.020); bipedicled unilateral patients used significantly less morphine than unipedicled (unilateral) patients at 12 (P=0.005), 24 (P=0.020), and 48 (P=0.046) hours. Multivariable regression comparing these two groups revealed that both reconstruction type and smoking status were significant predictors for 12-hour postoperative morphine usage (P=0.038 and P=0.049, respectively), but only smoking, remained significant at 24 (P=0.010) and 48 (P=0.010) hours. Bilateral reconstruction patients’ mean hospital stay was 2 days longer than either unilateral reconstruction (P<0.001). @*Conclusions@#Although all three forms of DIEP flap breast reconstruction had similar postoperative pain measures, a novel finding of our study was that bipedicled DIEP flap harvest might be associated with lower early postoperative morphine requirements. Bilateral and bipedicled procedures in appropriate patients might therefore be undertaken without significantly increased pain/morbidity compared to unilateral unipedicled reconstructions.

[Effectiveness of dialectical behavior therapy on quality of sleep and anxiety in patients with irritable bowel syndrome]

Introduction: Sleep problems and anxiety symptoms in patients with irritable bowel syndrome are considered. Dialectical behavior therapy in the past decade as one of the most effective treatments in the treatment of many disorders is presented, Therefore the aim of this study was to determine the effectiveness of dialectical behavior therapy for irritable bowel syndrome is a group of sleep quality and anxiety

Methods: The research method was experimental [pretest-posttest control group and random assignment] is. The sample of the study consisted of 30 patients with irritable bowel syndrome in 2014 among whom all patients were admitted to hospitals. After the interview, the Rome-III diagnostic criteria and completed and Beck Anxiety Inventory and Quality of sleep Petersburg questionnaire, using simple random sampling [n = 15 per group] were selected and were allocated to experimental and control groups. After completion of 8 sessions [one session a week for 90 minutes over two months], dialectical behavior therapy in the control group, in order to measure the dependent variable [Sleep quality and anxiety], Quality of sleep and anxiety as a post- test questionnaire was administered in both groups. The collected data were statistically analyzed using analysis of covariance obtained by SPSS.20 software

Results: According to a dialectical behavior therapy in reducing insomnia, anxiety, irritable bowel syndrome patients in the experimental group was significantly effective. So that after the intervention, mean scores decreased sleep quality and anxiety

Conclusion: Dialectical behavior therapy can improve sleep quality and reduce the level of anxiety in patients with irritable bowel syndrome. So this intervention is used as an effective method in improving the signs. Also, it can be the mental state of patients with irritable bowel syndrome improved with the implementation of the treatment

[ investigation relationship between dimensions of social capital with burnout nurses in Khorramabad academic hospitals]

In recent years a new structure called social capital has attracted particular attention. Studies on burnout suggests that social capital is an important factor influencing burnout ; The present study aimed to determine the relationship between burnout among nurses was conducted with the dimensions of social capital. The study population consisted of all women nurses working in academic hospitals of Khorramabad, among which 180 people [Through Cochran formula] were tested using a stratified random sampling method. Tools used in this study were Dimensions of social capital and Burnout Inventory. The data collected have been analyzed with descriptive statistics standard deviation and inferential statistics, the correlation coefficient and regression analysis. Multiple regression analysis showed that the aspects of social capital are able to predict 23% of the variance in occupational burnout. That these informal social relationships and diversity in socializing and friendship, but a significant share of the trust, generosity and spirit of volunteerism, leadership and civic contributions were no significant. Considering the relationship between social capital and burnout, it seems that social capital by reducing burnout among nurses is improved; it seems to be trying to enhance the dimensions of social capital among nurses is essential

[ correlation of blood glucose with salivary glucose level in diabetic patients]

Finding a relationship between the blood glucose level and its concentration in other body fluids such as the saliva can help in developing a conservative method for blood sugar assessment replacing venous sampling .The aim of this study was to evaluate the relationship of blood glucose level with salivary glucose in diabetic patients. This case-control study was conducted on 75 diabetic patients as the case and 75 healthy subjects as the control group. Blood and salivary glucose levels were measured in the two groups. Pearson's correlation coefficient was used to assess the correlation of blood glucose with salivary glucose in the two groups The mean [ +/- SD] blood glucose and salivary glucose level was 247 +/- 24.2mg/dl and 1.4 +/- 0.2mg/dl in the case group, respectively. These rates were 84.97 +/- 15.8 and 1.09 +/- 0.12mg/dl in the control group, respectively. Statistical analyses showed a high correlation between blood glucose level and salivary glucose in diabetic patients [r =0/9]; whereas this correlation was insignificant in the healthy control group [r = 0.18] This study showed a high correlation between blood glucose level and salivary glucose in diabetic patients

[Usability evaluation of an emergency information system: a heuristic evaluation]

Introduction: Owing to the critical importance of emergency department activities in saving lives, information systems of this department should be free of fault to prevent the incidence of errors. Usability evaluation methods are used to assess this quality measure. Heuristic evaluation is one of the methods which identifies usability problems with minimum amount of time, cost and resources. The objective of this research was to evaluate the usability of emergency department admission subsystem of health information systems in Mashhad University of Medical Sciences

Methods: Using Nielsen's 10 usability principles, three trained evaluators, independent of each other, evaluated the corresponding subsystem and determined the severity of identified problems. All the problems, identified by independent evaluators, were collected in a single list and the mean severity of each problem was calculated

Results: A total of 163 usability problems were identified. The lowest mismatch with usability principles was related to "error prevention" [3 %] and the highest was related to "consistency and standards" [27 %]. The average severity of problems varied from 2.3 [minor problem] concerning "system's visibility" to 2.9 [major problem] concerning "help users recognize, diagnose, and recover from errors"

Conclusion: Heuristic Evaluation can be used to identify a high number of usability problems related to health information applications in health care systems. If remain unsolved, these problems may waste users' and patients' time, increase errors, reduce data quality, and in general, threaten patient's safety

[Determining of the factors affecting mortality in burn patients using a decision tree data mining algorithm]

Introduction: Using data mining to develop prediction models from large amounts of data in medicine has become increasingly popular during the recent years. In this study, we intend to use a decision tree data mining algorithm in order to identify factors influencing mortality in burn patients

Methods: The present retrospective descriptive study is based on burning patients' records. Overall, the medical records of 4804 patients were scrutinized. The collected data were analyzed using statistical software [SPSS version 16], data mining software [Clementine version 12], and CHAID algorithm

Results: The resulting model for predicting survival and mortality of burning patients included the percentage of Total Burn Surface Area [TBSA %], degree of burn, length of stay, gender, and age of patients. Other variables including blood cultures, wound cultures, urine cultures, and the months of patient hospitalization had no effect on improving the efficiency of the model

Conclusion: The proposed model is valid and reliable due to its accuracy [approximately 95%]. In fact, the results of this study, some of which are consistent with the results of other studies, can propose a comprehensive, accurate, and reliable local model for predicting mortality and survival of burning patients based on the mentioned variables. Thus, this local model can be used as an important criterion for evaluating the effective treatment of burn patients

[ study of educational needs of medical records staff of hospitals in Khuzestan province [2011]]

In recent years, There has been a change from paper to electronic medical records with more attention to the contents of health data resulting in the development of new opportunities and concurrently new educational needs for medical records professionals. The aim of the present study was to assess the educational needs of medical records staff. The population of this descriptive study consisted of all the medical records staff in 52 hospitals of Khuzestan province. Job and education relatedness were considered as the inclusion criteria for participation in the study. Data, having been gathered by a questionnaire, were analyzed through descriptive statistics. It was generally found that literacy in the areas of computer and information technology were considered as the most significant educational needs by the staff [70.4%] while literacy in the areas of safety and occupational health were regarded as the least significant needs [50%]. Regarding needs differences of the staff with different academic degrees, the highest needs of the holders of associate, bachelor, and master degrees were the skills in the implementation of health statistical activities [78%], use of computer and information technology [74%], and the implementation of health statistical activities in medical records [72%], respectively. It can be concluded that, along with the development of computerized health information systems, the enhancement of computer and information technology literacy of medical records staff are the needs to be met by authorities

[Assessment of serum vit E levels in patients with recurrent aphtous stomatitis]

Recurrent aphthous stomatitis [RAS] is a common oral mucosal disorder characterized by recurrent and painful oral aphtous ulcers. Although the exact cause of RAS is not known, but local trauma, nutritional deficiencies, hormonal changes, genetics, and immunologic factors have been suggested to contribute to its pathogenesis. The aim of this study was to assess the serum level of vitamin E in patients with RAU and normal subjects. This case-control study was conducted on19 patients with RAU and 17 healthy controls with same age and sex. Serum level of vitamin E was measured in both groups by liquid chromatography technique. Data were analyzed by Mann-u-Whitney test. The mean serum level of vitamin E was 14.89 +/- 2.3 micro g/ml in RAU patients and 22. 53 +/- 3.7 micro g/ml in normal group. This level was significantly lower in patients with RAU than in healthy control subjects [p<0.05]. The present study demonstrated that serum level of vitamin E significantly decreased in patients with aphtous ulceration

[Comparison of salivary alkaline phosphatase in periodontitis patients and healthy subjects]

Periodontitis is a chronic multi factorial infectious disease, characterized by the irreversible destruction of collagen fibers and other matrix constituents of the gingival tissues, periodontal ligament and resorption of alveolar bone around the teeth with the formation of periodontal pocket. Host response to periodontal disease include the production of different enzymes that are released by stromal, epithelial or inflammatory cells associated with cell injury and cell death. The aim of this study was comparison of Salivary alkaline phosphatase enzyme in mild and moderate to severe periodontitis patients and healthy subjects with normal periodontium. In this experimental study, unstimulated saliva of 20 patients with mild periodontitis, 20 patients with moderate to severe periodontitis, and 20 subjects with healthy periodontium were collected. The mean levels of alkaline phosphatase salivary enzymes were measured by kinetic system, finally, data were analyzed by ANOVA and TUKEY tests. Mean level of Alkaline phosphatase salivary enzyme in healthy gingival group was 9.25 +/- 4.3, in mild periodontitis group was 21.3 +/- 7.6 and in moderate to severe periodontitis group was 33. 75 +/- 11. 9 and there was significant differences between three groups [P<0.05]. The results of this study showed that the mean level of Alkaline phosphatase salivary enzymes in periodontally patients was greater than healthy subjects and these enzymes can be good markers for determining amount of destruction of periodontal tissues

Study on medical records departments function of hospitals related to ahvaz jundishapur university of medical sciences

Evaluation of medical records departments in hospitals of Iran shows that these departments have not achieved desirable standards and high quality services. The major aim of this survey is to evaluate the performance of the Medical Records Departments of hospitals of Ahvaz for awareness of their status. This is an applied research, conducted in descriptive cross-sectional. Research population includes medical records departments of hospitals Imam Khomeini, Golestan, Razi, Aboozar, Shafa, Taleghani, Salamat and Sina. In this study the required data has been collected by the use of a questionnaire and four types of check-lists in each of Admission, Filing, Coding and statistics units. To analyze of data, each four checklists of units was assigned 100 score and then the performance average of each unit was calculated and compared. The best performance was for statistics units [71.97%] and lowest it was for coding units [56.79%]. Functional status standards were partially observed. Auditing results show that the functional status in medical records departments of university hospitals in Ahvaz lack standard instructions that should be followed on all the functional processes and require appropriate attention by trustees of these hospitals

[Comparison of adherence of Candida Albicans on amalgam, light cure composite and glass ionomer: an In vitro study]

Statement of Problem: Candidiasis is the most common fungal infection in the human oral cavity. 85% of this infection is caused by Candida albicans. Although there is considerable information about the adhesion of Candida albicans to the epithelial cells and prosthetic materials, there are very few studies in regard to the adhesion of Candida albicans to various restorative dental materials

Purpose: This study aimed to compare the adhesion of Candida albicans to three restorative materials, amalgam, light cure composite and glass ionomer

Materials and Method: In this experimental study, 54 specimens of amalgam, light cure composite and glass ionomer [18 specimens from each group] were transferred to tubes containing suspensions of Candida albicans [1× 10[6] cell/ml]. After 40, 80 and 120 minutes, the specimens of restorative materials were suspended in tubes containing 1ml of saline solution and then 100 microlitre of this suspension were plated in Sabouraud Dextrouse Agar. After 48 hours of incubation, the number of candida colonies was counted. Finally, the data were analyzed using kruskal wallis and Mann-Whitney tests

Results: In the composites and amalgams specimens, the adhesion of Candida albicans increased with time and this differences was statistically significant [p < 0.05]. In glass ionomer specimens, no statistically significant difference was observed in different periods of time. The highest value of adhesion was related to composite at 120 minutes and the lowest was observed on a amalgam specimens at 40 minutes

Conclusion: The results of this study show that glass ionomer is an appropriate choice as a dental restorative material especially in patients who are susceptible to candidiasis infections

[Prevalence and associated factors of hepatitis c in self-introduced substance abusers]

Considering the importance and high prevalence of hepatitis C among substance abusers, especially injection drug users, this study aimed to determine the prevalence and risk factors of Hepatitis C in self-introduced substance abusers in Farabi Addiction Hospital in Kermanshah in 2007. A total of 263 drug addicts' medical files were assessed during the study. Data [individual characteristics and results of serological tests] were gathered through the files. Data were analyzed by measuring frequency of correlation between the variables [Chi square test and logistic regression]. The mean age was 31.82 +/- 9.18 years; mean duration of drug abuse was 121.7 +/- 29.1 months for prisoners. From 263 individuals in the study, 22.1% were infected with HCV. The most common ways of substance use were injection [33.1%], and fumigation [32.3%]. There was no history of imprisonment in 74.9% of individuals; and 52.9% had no history of drug injection. There was a history of physical or mental disorder in 25.5% of individuals. The Chi square statistical test showed significant relationship between HCV infection and substance abuse, and the way of consumption; and the t-test showed significant relationship with average daily consumption frequency. The highest relative risk ratio was for positive history of physical or mental illness [OR=8.33], and positive history of imprisonment [OR=5.94]. Having multiple sexual partners increased the risk of being infected with the HCV [OR=2.92]. The risk of HCV infection was independently increased with having a history of imprisonment, having multiple sexual partners, presence of physical or mental illnesses, and consumption methods in substance abusers

[Comparison of dimensional changes and water absorption of three acrylic resins used for provisional fixed restorations]

Statement of problem: Autoploymerized acrylic resins are used for construction of fixed provisional restorations. The linear polymerization shrinkage and water absorption are the critical factors in the desired properties of such restorations

Purpose: The aim of the present study was to compare the dimensional changes and water absorption of three fixed provisional acrylic resins,Trim II, Tempron, and Acroprars TRII

Materials and Method: In this experimental study, 90 acrylic samples [20 mm × 12 mm × 3 mm] were made by a metal mold [30 samples in each group]. Then, each group was randomly divided into two equal groups. Dimensional changes of the samples were measured immediately after polymerization and seven days post curing. The data were analyzed by one way ANOVA and T-test

Results: Acropars TRII resin exhibited the highest dimensional changes and water absorption. The lowest mean values were recorded for Tempron samples. One week after polymerization, no statistical difference was found between the dimensional changes of Trim II and Acropars TRII. Linear dimensional changes of all the used acrylic resins were less than 2%

Conclusion: It seems that water absorption of acrylic resins can compensate the polymerization shrinkage. This effect was more significant for samples made by Acropars TRII than the other tow groups. Clinically, linear dimensional changes of the three acrylic resins were acceptable

assessment of periodontal parameters, salivary total protein and albumin contents in patients taking Warfarin

In thrombosis and ambolism therapy, one of the therapeutive options is the use of anticoagulents. Patients who fake anticoagulants are susceptible to bleeding and cannot brush or floss their teeth. They are prone to periodontitis. Periodontal diseases are associated with periodontal cell destruction and consequently their cell contents would be found in the salvia. The assessment of albumin and total protein contents and determination of its correlation with periodontal parameters in patients who take warfarin are the goals of the present study. In this case-control study, the subjects were classified into 2 groups of patients who took warfarin [case group]. In both groups, periodontal parameters such as plaque index [PI], gingival index [GI], pocket depth [PD], bleeding on probing [BOP] and clinical attachment loss [CAL], and total protein and albumin were assessed. T-test and Pearson test were used to analyze the data. Although salivary albumin was significantly higher in the case group in comparison with the control one, total salivary protein contents were not observed differently between the two groups. Compared with the control group periodontal clinical parameters were high in the case group and obvious significant differences were seen [p<0.05]. Appropriate oral and gingival hygiene instruction is necessary due to the high periodontal clinical parameters in patients who take warfarin

Desmin expression by a gastrointestinal stromal tumor in a dog

This report describes the histological and immunohistochemical features of a small intestinal tumor that resembled a human gastrointestinal stromal tumor [GISTs] in a seven-year-old male cross-breed dog. This was unique because of the expression of desmin by the tumor. Grossly, the white-gray tumor measured 8.0x4.0x6.5 cm and was 760 gram in weight. It was cystic and enveloped the jejunum. Histopathologically, long spindle-shaped cells were arranged densely in the interwoven pattern. The tumor cells had a low rate of mitosis, were pleomorphic, and were positive for vimentin, alpha-smooth muscle actin, desmin, S100 and C-KIT and negative for CD34 on immunohistochemistry. The expression of desmin in the cytoplasm of this tumor cells is a rare event in these types of tumors

[Comparison of the effects of adcortyl ointment [triamcinolone in orabase] and triamcinolone mouthwash on oral lichen planus]

Oral lichen planus [OLP] is a common chronic immunologic mucocutaneous disorder with various types. Erosive and bullous types are painful and require treatment. In treatment of Lichen planus, various topical and systemic corticosteroids are used. The purpose of this study was to compare the effects of Adcortyl [Triamcinolone in orabase] and triamciniolone mouthwash in the treatment of oral lichen planus. This experimental study was conducted on 60 patients in two equal groups affected by erosive or atrophic lichen planus. Type and size of the lesions were gathered by mm[2] and the severity of pain by VAS. The first group was treated with%0.2 triamciniolone mouthwash and the second group by Adcortyl [triamcinolone in orabase]. The patients were evaluated after one month. The size of lesions and severity of pain were recorded and compared before and after treatment. The data were analyzed using T- test. This study showed a significant reduction in the size and severity of pain of the lesions after treatment using%0.2 triamcinolone mouthwash and Adcortyl in each group, but the difference between the two groups was not significant. Adcortyl and triamcinolone mouthwash were useful in healing and reduction of pain from lesion. The properties of triamcinolone mouth wash including internal production of triamcinolone ampoule, easy formulation and availability, convenient use, contact with the distal surfaces of the oral cavity, and preventing new eruptions introduces it as a useful drug to control the symptoms of OLP

[Comparison of unstimulated saliva secretion between heavy smokers and nonsmokers subjects]

Saliva plays an important role in oral homeostasis. Quantitative and qualitative variation in salivary secretion can cause dental caries and periodontal disease. The decrease of saliva may be caused by disease and drugs such as Sjogren Syndrome and Antidepressant drugs. Compare the quantitative variation of unstimulated salivary rate in smoker and non smoker males. This study was case- control. 220 people were evaluated in two groups. Group A were 110 subject male smokers, and group B were 110 subject male non smokers. The subjects had 20-55 years old. The evaluation was based on questionnaire. Heavy smokers have been considered as a target group after completing the questionnaire according to systemic disease and HAD test. After gathering necessary characteristics, they were selected as a case group. Non smoker subjects were selected as a control group. Then in a silent place without any disturbing agent such as stress or tiredness, the salivary rate of subjects was collected by spitting method. Data were analyzed by t - test. The mean age of the smoker subjects were 34.3 and the mean age of nonsmoker subjects were 34.7. The saliva average was 1.2 ml in 3 minutes in case group and 1.7 ml in 3 minutes in the control group. This study showed that; the amount of saliva in smoker subjects was less than nonsmoker subjects, and this difference was statistically significant [P< 0/05]. According to this study, smoking can cause reduction in unstimulated salivary secretion. Therefore, correct oral and dental hygiene instructions should be emphasized for these patients

[Comparative evaluation of dimensional stability of alginate impression by two methods and four disinfectants]

Disinfection of dental impression is necessary to prevent infection transmission. On the other hand, the dimensional stability of dental impression materials are very important. The aim of the present study was to compare the dimensional stability changes by two methods of disinfections [immersion and spray] by four disinfectant solutions. In this experimental study, ninety alginate impressions were taken from laboratory stainless steel model and located in three groups. The control groups which were not disinfected was stored 15 minutes in humid environment and poured with Elite model [type III] gypsum. The immersion group was immersed in 2% Microten, 2% Deconex,%2 Glutaraldehyde and%5.25 sodium hypochlorite for 15 minutes and then poured. The spray group was sprayed for 10 seconds and poured after 15 minutes. Distance between anterior cones was called "a" parameter, distance between anterior and posterior cone called "b" parameter and height of anterior cone called "c' parameter. Cast dimension was measured by Coordinate Measuring Machine. The data were analyzed by ANOVA and t test. Disinfectant materials [2% Deconex,%2 Glutaraldehyde,%5.25 sodium hypochlorite] caused significant dimensional changes in immersion method after 15 minutes [P<0.05], but did not cause significant dimensional changes in spray methods.%2 Microten caused significant dimensional changes in both immersion and spray methods [P<0.05]. The best method and material for disinfecting the alginate impression were spray method and%2 Glutaraldehyde and the worst were immersion method and%5.25 sodium hypochlorite

[Comparison of iron and ferritin serum levels among patients with aphtous stomatitis and normal individuals]

Aphtous stomatitis is one of the most common ulcerative oral diseases. Aphtous stomatitis has several etiologic factors including immunologic, microbial, nutritional factors as well as allergies to the food. The aim of this study was the measurement and compare of the levels of serum iron, ferritin and TIBC among patients with aphtous stomatitis and healthy subjects. In this case-control study 60 person were selected in two equal groups. The first group consisted of 30 persons with recurrent major aphtous stomatitis and no concurrent systemic disease was allocated as case group. The second group consisted of 30 person with no aphtous stomatitis and no systemic disease was allocated as control group. Blood samples for measurement of iron, TIBC and ferritin serum levels were collected. Data were analyzed with T-test. There was no significant difference in the iron serum levels in both groups[71/1 mg/dl in the case group and 77/96 mg/dl in the control group] but the mean serum ferritin level in case group was significantly lower than control subjects [46/99 IU in the case group and 90/1 IU in the control group]. But the mean of TIBC in the case group was significantly higher than the control subjects [358/73 mg/dl in the case group and 329/33 mg/dl in the control group]. Nutritional deficiency especially serum iron and ferritin can be an etiological [factors] for development of aphtous stomatitis

[Effects of peer education, education by physician and giving pamphlets on HIV knowledge in high school students: a comparative study]

Youths are the most at risk group for HIV/AIDS in the world and education of the preventive measurements is the most effective way for decreasing the incidence of HIV/AIDS among them. Due to ever-increasing cases of HIV and the importance of education, we compared the effects of three educational methods [peer education, education by physician and giving pamphlets] on knowledge of female high school students' of Kerman shah on HIV/AIDS. One thousand and five hundred female third grade students were recruited from 21 high schools using stratified random sampling method. An average of 73 students were selected from each school and participated in a pre-test exam using a questionnaire. Of 1500 students, 498 and 502 students were taught by general practitioners and peers, respectively. Pamphlets were presented to 500 other students. Twenty days after the educational intervention, the participants were contributed in a post-test exam using the very questionnaire. Data were analyzed using descriptive and inferential statistics via SPSS version 11.5. The students' mean age was 16.78 [SD = 0.7]. The mean scores of pretests and post-tests in all 3 groups were significantly different [P < 0.001]. The mean score for the group taught by general practitioners [10.7 +/- 3.6] was higher than the scores of other two group scores [8.8 +/- 3.4 and 7.3 +/- 3.9, respectively for peer education and pamphlet groups] after the interventions. Bonferroni statistical test showed the significant difference [P < 0.001]. Education presented by general practitioners seems to be more effective than the other two ways in increasing students' knowledge about HIV/AIDS