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

[Pattern of antibiotic usage in Razi hospital in Ahvaz, Iran [2011-12]]

Indiscriminate use of antibiotics is one of the major health problems worldwide. Rapidly increasing incidence of antibiotic-resistant microbes warns healthcare authorities in the country to use drugs, reasonably. This study was carried out to assess the pattern of antibiotic usage in Razi teaching hospital in Ahvaz, southwest of Iran. This descriptive -analytical study was conducted on 17668 hospitalized patients in Razi teaching hospital Ahvaz, southwest of Iran during 2012. Proper or inappropriate antibiotic usage was judged based on existing national guidelines or guidelines referenced in textbooks. 3119 of patients were received antibiotics which 20.4% of patients were being treated unnecessarily. 2482 [79.6%] of patients had indications for antibiotic therapy. Out of 2482 patients with indications for antibiotic therapy, 51.9%, 18.1% and 6.5% of patients were received incorrect antibiotic regiment, inadequate dose and unsuitable duration of therapy, respectively. The highest rate of unnecessary, inappropriate, incorrect duration and dosage of antibiotics were observed in internal, scorpion wards and the lowest was in infectious diseases and obstetrics wards [P<0.05]. The pattern of antibiotic usage in Razi teaching hospital in Ahvaz was inappropriate. Unnecessary prescription, inappropriate antibiotic spectrum, inadequate dose and duration of antibiotics were inappropriate treatment strategy

[Implementation and designing of line-detection system based on electroencephalography [EEG]]

In Brain-based lie detection systems which have been recently introduced as substitutes or classic lie detection systems, the procedure for recognition of guilty and innocent subjects is done by inspection of brain signals which are acquired during the specific Polygraph test. With the aim of increasing the performance, this paper presents a powerful method for detection of Guilty persons in lie detection systems using brain signals. It was an experimental study. The employed method is based on the extraction of P300 components from brain signals. In this way, the test protocol was designed based on Odd-ball method, firstly. This test was done on 16 people and their brain signals were acquired. After preprocessing, p300 amplitude was extracted for each person from brain signals, and finally Guilty and Innocent persons were classified by comparing amplitude through Bootstrapped Amplitude Difference [BAD] method. The obtained results show that the proposed method has detected correctly 7 out of 8 guilty persons and 8 out of 8 innocent persons. Also, the validated results show the promise of the proposed approach in discrimination of guilty subjects from innocent subjects by the accuracy of 93.75%. Knowing the existence of precious information in brain signals and their relation with brain's cognitive activities and also considering the performance of the proposed method, there are enough reasons use the proposed approach for detection of guilty persons from innocent ones. Further, in comparison with previous methods, the impact of man ability to control brain signal parameters and creating incorrect feelings been reduced through the proposed method

[Pulmonary tuberculosis risk factors in hospitalized HIV positive patients in Ahvaz, Iran [2001-09]]

Human immunodeficiency virus [HIV] pandemic is increasing word-wide. Tuberculosis is the main cause of death and low quality of life in HIV infected patients. The prevalence of Tuberculosis in HIV infected patients varies in different areas according to socioeconomic, cultural and geographical situation. This study was done to asses the pulmonary Tuberculosis risk factors in hospitalized HIV positive patients in Ahvaz, Iran. In this data based study all medical files of admitted HIV positive patients in Razi hospital in Ahvaz in south west of Iran were reviewed during 2001-09. Demographic characteristics and HIV Tuberculosis related variables were analyzed using SPSS-16, Fisher's exact test and Odds Ratio. Out of 123 HIV cases 99 [80.5%] were injecting drug user [IDU], sixty eight [55.3%] had imprisoment history. Eighty one patients [65.8%] had Tuberculosis, in which 46 had co-morbidities such as infective endocarditis or viral hepatitis, 79 cases were IDU, 61 cases had imprisonment history and 24 cases had CD4 count below 200. There was a significant association between Tuberculosis and IDU, imprisonment and CD4 count [P<0.05]. This study showed that the rate of Tuberculosis in HIV positive patients is higher than the rate in previous studies performed in Iran. Also exposure to Tuberculosis cases in prison, IDU and low CD4+ T- lymphocyte count are the main risk factors for Tuberculosis acquisition

[ main risk factors of pulmonary tuberculosis acquisition in hospitalized patients in Razi hospital, Ahvaz-Iran [2001-07]]

Risk factors of tuberculosis vary in communities according to different socioeconomic conditions. Knowing these risk factors help to control the disease. This study was done to determine the main risk factors of pulmonary tuberculosis acquisition in hospitalized patients. In this data based, case-control study 173 tuberculosis patients [as cases] and 305 non tuberculosis patients [as controls] hospitalized in Razi hospital in Ahvaz, Iran during 2001-07 were gone under investigation. Risk factors included injecting drug addiction, smoking, HIV infection, diabetes mellitus, imprisonment and corticosteroid usage. Data were analyzed using SPSS-13, Chi-Square and Fisher exact tests. Odds ratio was determined for risk factors. Frequencies of the main risk factors in case and control groups were as: smoking; 54.3%, 14.8% [p=0.0001, OR: 6.5], HIV infection; 11.5%, 3% [p=0.0002, OR: 4.3], injecting drug addiction; 18%, 3.3% [p=0.0001, OR: 6.7], diabetes mellitus; 22.5%, 5.9% [p=0.0001, OR: 4.6] and imprisonment; 20.2%, 3.9% [p=0.0001, OR: 6.2], respectively. Corticosteroid use and renal failure were similar in cases and controls. This study showed that smoking, HIV infection, injecting drug addiction, diabetes mellitus and imprisonment were the main risk factors for tuberculosis acquisition in this region

Gelatin, ringer or modern hydroxyethyl starch solutions: which is better after coronary artery bypass graft?

Hemodynamic stability in patients after coronary artery bypass graft surgery [CABG] with the cardiopulmonary bypass pump [CPB], especially during transfer to ICU ward and the early hours of ICU admission is very important. Adequate fluid therapy and intravascular volume maintenance as a matter of principle is essential using various intravenous fluids, but there is always the question of what is the ideal intravenous fluid?. The aim of this study is to compare the effects of gelatin, hydroxyethyl starch [HES 6%, Voluven], and Ringer's solution to maintain hemodynamic status after cardiopulmonary bypass in patients undergoing coronary artery bypass surgery. In this randomized double blind clinical trial, 92 patients who were candidates for onpump CABG were studied. After discontinuation of CPB, all patients were transferred to the ICU and were put randomly into three groups. The first group received Ringer's solution, the second group gelatin 4%, and the third group HES 6% [Voluven]. Hemodynamic parameters like heart rate, mean arterial pressure, systolic blood pressure, diastolic blood pressure, central venous pressure, cardiac output and the presence of arrhythmias were documented. The volume that was needed for maintaining normal blood pressure and central venous pressure [CVP] in the range of 10 to 14 mmHg was less in the HES group than the other groups, but was similar in the gelatin 4% and Ringer's groups in the first 24-hours after surgery. Urinary output in the first four hours and 24 hours after surgery were significantly higher in the HES group than the other two groups, and mean creatinine levels were significantly lower in the HES group. HES 6% has better volume-expanding effects than gelatin 4% and Ringer's solution and its short-term effects on renal function are also better

[ effects of oral administration of solution containing minerals and organic substances in parturient dairy cows and the prevention of mineral deficiency and negative energy balance]

Negative energy balance and mineral deficiency are the most important metabolic disorders in fresh dairy cows. In order to evaluate the effect of the feeding of solution [LICVITE [registered sign]] containing minerals [calcium, phosphorus and magnesium] and organic substances [propylene glycol and niacin] in parturient dairy cows, 30 cows were examined in a dairy farm with 500 milking dairy cows. 500 ml of Licvite syrup was fed to 15 dairy cows one hour post partum, and once again 14 hours after calving [treatment group]. Fifteen parturient dairy cows, almost at the same physical situation as the treatment group, did not receive any substances after calving and were chosen as the control group. Jugular blood samples were taken from two groups as follow: 12- 15 days before parturition; 14 and 24 hours after calving; and, 10 days after parturition. Analysis of sera showed that the mean serum concentration of calcium in the treatment group at 24 hours after parturition, and mean serum concentration of phosphorous in all the measured times after parturition, were significantly higher than the control group [p<0.05]. After parturition it was noticed that there was a decreased level of BHBA and NEFA in the cows in the treatment group. The differences, however, were not statistically significant. The results of present study showed that oral administration of a solution containing mineral and organic substances, to dairy cows during the first day after parturition, had a very significant effect on the prevention of subclinical mineral deficiency and the negative energy balance

Determination of seroprevalence rate of Toxocara canis in 6-15 years aged rural and urban school children in Ahvaz, Iran

Toxocariasis is a worldwide zoonosis caused by the acaridae of dogs and rarely cats. Seroprevalance of toxocariasis vary with geographic regions. In this study, the sera of school children aged between 6 to 15 years were examined for the presence of anti T.canis antibodies. In this descriptive cross-sectional study the sera of 203 randomly selected school children aged between 6 to 15 years from urban and rural regions in Ahvaz, south western of Iran from 2007 to2008 was examined by means of ELISA with excretory-secretary antigen of infectious larva stage. CBC was performed for the presence of eosinophilia or hypereosinophilia. A short questionnaire was fulfilled to obtain data of age, sex, history of pica, contact with dogs and living area [urban or rural]. Of total 203 students 90 [44.3%]were female and 113 [55.7%] were male. 86 [42.9%] were rural and 114 [57.1%] were urban, 67 [33%] had contact with dogs,35 [17%] had history of recent cough,5 [2.5%] had pica, on had hypereosinophilia but 21 [10.3%] had eosinophlia, 4 [2%] had positive ELISA for T.canis IgG, of them one was male and three were female, two were urban and two were rural, non had history of contact with dogs, pica, chronic cough or asthma, and also non had hypereosinophilia but all had eosinophilia. Our study showed that toxocariasis is present in the school children of Ahvaz, but it is lower than was expected and also lower than similar tropical regions

[Self-control: an important educational need in diabetic patients9 mental health]

Diabetes is a kind of chronic conditions which needs a kind of adaptation during all time, thus some behavioral and psychosocial adoptive mechanism should be considered by the patient. Lack of self-control skills and information will lead to poor glysemic control among diabetics. Educational in this context has an important role in patient's well-being, the study aims to describe the concept of self-control as an important educational need in the diabetic patients' mental health. The qualitative content analysis method was employed in the study. Study population including health professionals [3 nurses and 4 physicians] and diabetic patients [n=12] were selected purposefully and were interviewed in-depth. Three main categories including three concepts were identified namely fight with self, internal versus external control, and dominance over self. The findings showed that such patients faced with various and often conflicting alternatives that resulted in experiencing internal breaking and conflict. It was founded that the patients' perception of their power span and whether they have control over disease was an underlying factor to deciding about the health related behaviors' alternatives. Such findings emphasized on importance of supporting the diabetic patients in the rout of being responsible about their physical and mental status. Preparing the patients to maintain and expand their control over self is important specifically through developing communication, decision making and self supervising skills

[Concept of the quality of the educational services in cardiac rehabilitation]

Achieving quality educational services is one of the current health system challenges; and nurses have a great role in this regard. Although quality educational services are a complex concept; so it is important to clarifying and exploring the related components. The study aimed to describe the components underlies to quality educational service in a cardiac rehabilitation program qualitatively and introduce some of the related problems. This is a qualitative study using qualitative content analysis method.Study population consisted of health practitioners working at health and research centers affiliated to Isfahan University of Medical Sciences, cardiac patients including inpatient and out patient service users and their assistants [family members]. Data were gathered through conducting unstructured interviews with a purposive sample of 25[consisted of 3 physicians, 6 nurses, 1 dietarian, 13 patients and 2 patient assistant]. The study was begun at 1386 and data analysis was completed at 1388. The rigor of the study was achieved applying Guba and Lincoln directions. The concept of quality educational services in cardiac rehabilitation is described using four underlying concepts namely fittingness, comprehensiveness, authenticity and orderliness that are the elements of quality educational services in the cardiac rehabilitation program. Based on the findings, paying attention to audiences' special needs and capabilities are important determinants in providing quality educational services in the cardiac rehabilitation program. Hereby the audiences could receive the trustful and responsive services. We suggest organizing the education and information giving routs. It would result in service comprehensiveness that could save the service taking opportunities. The existed problems were inadequate fittingness, poor coordination in the services and poor referral system that were resulted in poor response to some of the audiences needs. [Quality educational services] is a context based concept. Considering the cardiac rehabilitation, it was emphasized on providing need based services fitted to users' capabilities, attending to various bio-psycho-social aspects at both person and family levels and serving the services through predefined and coordinated pathways. It is necessary to nurses as one of the key members of cardiac rehabilitation team that consider such emerged elements in service management and direct care delivery to the cardiac patients and their families. Future researches on emerged concepts are worthy to suggest

Prevalence of cryptosporidium infection in immunocompromised patients, in south-west of Iran, 2009-10

Cryptosporidium is a protozoan parasite with worldwide distribution. The aim of this study was to estimate the prevalence of Cryptosporidium infection by antigen detection in faeces among immunocompromised patients referred to educational hospitals of Ahvaz City, South-West of Iran, 2009-1010. Fecal samples from 176 immunocompromised patients were collected and Cryptosporidium coproantigen test was performed using ELISA method [DRG kit, Germany]. A questionnaire was completed for each case and the results were analyzed using descriptive and Chi-square test, SPSS statistical software [15[th] version]. Our study indicated 5.1% Cryptosporidium infection prevalence in the immunocompromised participated population. Furthermore, 4.2%, 4%, 4.5% and 9.1% infection rates were identified in children suffered from hematopoietic malignancy, adult cancer patients, renal transplant recipients, and HIV[+] cases, respectively. There was not significant correlation between the infection and age and gender [P>0.05]. Infection was most frequent among HIV[+] patients. The present study confirmed the high prevalence of Crytosporidium antigen in fecal samples of immunocompromised patients in the region. As no chemotherapeutic agents have yet proven, especially in immunosuppressed patients, therefore our results highlight the importance of preventive intervention in these groups

Tuberculous spondylitis: risk factors and clinical/paraclinical aspects in the south west of Iran

Tuberculous spondylitis [TS] is both the most common and the most dangerous form of TB infection. Delay in diagnosis and management causes spinal cord compression and spinal deformity. The aim of this study was to identify the clinical and paraclinical aspects and also to describe its risk factors in Khuzestan, a province located in the south west of Iran. In this medical record-based retrospective study 69 cases of TS registered in Khuzestan Health Center from 1999 to 2008, were reviewed. For each TS case two extra pulmonary TB cases [without spinal involvement] were randomly selected as control. Related data in patients were analyzed in SPSS software [version 16, USA] using chi square and Fishers exact test. Differences with P<0.05 were considered significant. The mean age of patients was 43.7 +/- 18.3 years, and 60.8% were males. The mean time of delay: for patients' delay, doctors' delays and from diagnosis to initiation of treatment was 1.8 +/- 1.1, 6.8 +/- 4.3 and 1.3 +/- 1.2 months, respectively. In 56 cases [81.1%], TS was diagnosed on lumbosacral radiograph, in remaining cases by lumbosacral MRI. Twenty patients [30.4%] had a previous TB history, 30.4% had underlying medical disorders such as diabetes mellitus [30%], steroid use [45%], chronic renal failure [50%]. The most common clinical findings were: backache 98.5%, fever 26.1%, spinal tenderness 84.1%, paraparesis 26.1%, and kyphosis 28.9%. Laboratory results were: elevated sedimentation rate [ESR] 92.8% and positive CRP 86.9%. There were statistically significant differences in age, gender, CRF, imprisonment and previous TB infection between the two groups. TS is therefore a diagnosis that attending doctors need to consider early. Patients in endemic area of TB, presenting with back pain in association with constitutional symptoms and elevated ESR and or positive CRP should be investigated to exclude TS. Older age, male gender, chronic peritoneal dialysis, imprisonment and previous TB infection may be the main risk factors of TS

CT cavernosography: a new method for evaluating venous incompetence in impotent patients

Cavernosography is traditionally recognized as an imaging modality for evaluation of venous leakage in impotent men. We introduce CT cavernosography as a novel method for demonstrating leaking veins. Sixty-seven patients diagnosed as venous incompetence by Doppler study, and eight normal subjects were enrolled into the study. After intracavernosal injection of papaverine, normal saline was injected into the corpora cavernosa and the injection rate was gradually increased and the penis was observed to obtain the injection rate causing erection. Then contrast media was injected into the corpus cavernosum with obtained injection rate followed by CT scan of the penis and pelvis. In the first group, 63 patients [94%] had venous leakage by CT cavernosography. In this group, full erection was observed at the rate of 36 ml/min of saline injection in three patients and 24 ml/min in one patient. In 46 patients [73%], erection was induced with saline injection at the rates of 48-120 ml/min, and in 17 patients [27%] no full erection was demonstrated even at the injection rate of 120 ml/min. In the 2nd group we observed full erection after saline injection at the rates of 36 ml/min and 24 ml/min in five and three patients, respectively. Beside the capability of CT source images in precise visualization of all leaking veins without superimposition of bony structures, different techniques of two- or three- dimensional reformation enable us to demonstrate the anatomy of the penis and the leaking veins elegantly for further surgical planning

Therapeutic effect of sodium selenite and zinc sulphate as sup-plementary with meglumine antimoniate[glucantime] against cutaneous leishmaniasis in BALB/C Mice

Successful therapy of leishmaniasis depends on effective cellular immune response. We evaluated the effectiveness of sodium selenite and zinc sulphate as known immunomodulator materials, in combination with Glucantime in treatment of cutaneous leishmaniasis lesions resulting from Leishmania major in susceptible animal model. Thirty three female mice weighing 18-20 g at the age of 7-8 week infected with L. major were randomly divided into 3 groups: group1: treated by sodium selenite [0.35 mg/kg for 30 days], group2: treated by zinc sulphate [2 mg/kg for 30 days] and group3: treated by distilled water [0.01 ml/gr body weight for 30 days] as control. All groups received Glucantime as a standard anti- leishmanial agent [60 mg/kg, ip] for 14 days. To assess the results of treatment measurement of lesions size and parasitological tests were done weekly. The lesion sizes increased continuously in sodium selenite group .Although, in zinc group did not increase compared to baseline but with considering the time- group interaction there was no significant difference between zinc and control group during this study. There was no difference between lesion sizes and Leishmanial loads in the interventional and control groups, respectively. Sodium selenite and zinc sulphate at mentioned doses and duration of treatment did not show any treatment effect on cutaneous leishmaniasis caused by L. major in BALB/c mice. Increasing the dose of supplements and considering the follow up period after treatment can help more certain conclusion

[Seroprevalence of legionella pneumophila in patients with, community acquired pneumonia]

Legionella pneumophila [LP] is a major cause of pneumonia worldwide. In spite of suitable epidemiological conditions and probability of LP existence in the region, the incidence of LP infection has not been determined in Ahvaz. Determination the seroprevalence of LP in patients with Community Acquired Pneumonia [CAP]. In this prospective descriptive study, during one year period [2007-2008], 80 admitted patients were selected in Razi Hospital of Jundi Shapoor University of Medical Science in Ahvaz with CAP and was studied the serprevalence of LP among them. Sera were tested for L. pneumophila IgG and IgM by using Elisa kit [Vircell, Spain]. Data were analyzed by using SPSS, version 16 statistical package. Among 80 serum samples, 12 cases [15%] were positive for LP- IgG+ IgM. Age, gender and area of residency did not significantly affect the seroprevalence of L P. [P>0.05]. The prevalence of L P seropositivity was not significantly affected by co-morbidities except diabetes mellitus [P>0.05]. Smoking and receiving antibiotic was observed in 100% seropositive patients. Legionella Pneumophila is a prevalent infectious agent in Ahvaz and should be considered in patients with CAP especially in diabetic and smoker patients

[Evaluation of epidemiological, clinical and laboratory findings of admitted patients with meningitis in infectious diseases ward of Razi hospital, Ahvaz]

Familiarity with the epidemiological, clinical and laboratory features of bacterial meningitis [BM] is important for rapid diagnosis and initiation of antibacterial therapy. This study aimed at evaluating these patients based on their epidemiological, clinical and laboratory findings and comparing these variables with patients with aseptic meningitis [ASM]. Admitted patients aged 18 years or more who were hospitalized because of meningitis, were studied between 2003 and 2007. Cases were grouped as BM and ASM and compared for their epidemiological, clinical and cerebrospinal fluid [CSF] laboratory aspects. Among 312 patients with meningitis, 215 [68.9%] had BM [42 definite, 156 probable and 17 partially treated] and 97 [31.1.%] had ASM. The mean age of patients with BM was 44.7 +/- 26.7 years and for ASM was 37.3 +/- 15.5 years [P>0.05]. Twelve percent of cases had triad of fever, neck stiffness and low level of consciousness. The means for CSF-WBC, CSF- glucose and CSF-protein in BM compared with ASM patients were 4021.6 +/- 1035.2 and 163.2 +/- 116.4 cell/microl of CSF; 27.5 +/- 17.3 and 68.7 +/- 16.lmg/dl and 689.8 +/- 476.8 and 132.6 +/- 107.7mg/dl, respectively [P<0.05]. The prevalence of BM was higher than that of ASM. Tuberculous meningitis had a considerable frequency among ASM patients. Confirmed BM based on CSF culture was lower than other studies. The number of performed LP procedures was not in accordance with the total meningitis cases. Similarly, WBC and glucose in CSF were helpful in differential diagnosis of BM vs. ASM

[Comparative study on knowledge about tuberculosis in two cities with different tuberculosis epidemiological index in Khuzestan, 2004]

Tuberculosis [TB] is a global health problem. One of the most important and effective ways of TB control is health education. Health planning depends on public health needs. The aim of this study was to assess the general population's knowledge about tuberculosis. This study is a comparative descriptive study which was conducted in 2004 in Behbahan and Omidieh, two cities in Khuzestan province with different TB epidemiological index. Nine hundred and seventy five individuals referring to health centers of these cities were asked to answer questions about TB. Data were obtained from questionnaires with 92% reliability and 98%validity and were analyzed with SPSS software using t test with 95% confidence. Of total 975 individuals 546 [56%] were living in Behbahan and 429 [44%] in Omidieh. Mean knowledge score for signs and symptoms, transmission and control of tuberculosis in Behbahan and Omidieh were 26, 10, 13 and 14, 6, 9 respectively. There was a significant difference in tuberculosis knowledge between two cities [P<0.05]

[Pattern of empiric antibiotic prescription in patients referred to an emergency department of a medical university affiliated hospital in Tehran]

Resistance in microorganisms is a serious problem in infectious medicine which the most reason is inappropriate antibiotic prescription by physicians. As there was not any information about the pattern of empiric antibiotic prescription in Iran, this study designed for recognition of antibiotic prescription pattern in one of emergency departments in a hospital affiliated to Shahid Beheshti medical university. This cross sectional study was performed during the years 2006-7 in the emergency department of the above mentioned hospital on 200 patients whom at least received one antibiotic. Physicians, after taking history and physical examination, completed the information form according to the patients chart in emergency department. Our references on appropriateness of empiric prescribed antibiotics were a] textbook of "Mandell's Principles and Practice of Infectious diseases, 6[th] Edition; 2005", and b] protocols from the "Infection Control Committee" of the same hospital. Among 200 patients to whom at least one antibiotic was prescribed, for 108 cases [54%], prescribed antibiotic was without indication and among 92 cases which antibiotic was indicated, in 55 cases [59.8%] the prescribed antibiotic was appropriate, i.e., the prescribed antibiotic was appropriate by type, dose and interval. According to the results, it is prudent that the prescription of antibiotics without clear indication and wrong selection of empiric antibiotics in this hospital's emergency department were disproportionately high. Thus it seems that using solutions like periodic education programs for physicians and supervision for prescribed antibiotics are mandatory

[Nursing students' experiences and perceptions of effective instructor in clinical education]

Clinical education program was designed to promote nursing education which its processes are mainly aimed at students. Despite all of this, less attention has been paid to students' feedback in this process. This study focused on nursing students' personal experiences about instructors' roles in clinical education program and intended to clarify the concept of "effective instructor" in clinical education. Using purposeful sampling method, 12 nursing students of Isfahan University of Medical Sciences, who had passed at least one clinical education course, were selected and studied through phenomenological approach. Data was gathered through in-depth interview. Raw data was analyzed using Colaizzi method. The validity and reliability of the study was acquired through considering four elements of factual value, applicability, consistency and neutrality. The interview texts were analyzed and the codes were extracted. Then, the codes were categorized into eight major concepts of presence, instructor as evaluator, instructor as communicator, instructor as experience provider, instructor as motivator, instructor as supervisor, instructor as moderator, and instructor as supporter. Participants in this study emphasized the instructor's key role in forming an appropriate or safe working environment. They revealed that the instructor can play an effective and useful role in clinical learning by providing new information, supporting the students thoroughly, and supervising their performance. In addition to experiencing some levels of dependence, participants accentuated the necessity for establishing a safe environment in order to provide learning opportunities for students. They also confirmed effective role playing by the teacher as an appropriate input for nursing students' needs

[Molecular differentiation between bovine Mycobacterium bovis isolates and human Mycobacterium tuberculosis isolates in Iran through PCR-RFLP method and comparison with 5 standard strains]

Mycobacterium tuberculosis complex is consisted of homogenous organisms. They are slowly growing mycobacteria and their isolation and identification are difficult and time consuming. Differentiation of Mycobacterium bovis, causative mammalian tuberculosis, from other members of Mycobacterium tuberculosis complex is very important in epidemiology and control of disease in humans and animals. The aim of this study was to evaluate a molecular method to differentiate Mycobacteriom bovis from Mycobacterium tuberculosis. DNA human isolates of Mycobacterium tuberculosis [n=6] and Mycobacterium bovis isolates [50] were extracted and used as template in PCR. A 548bp fragment of oxyR pseudogene was amplified and digested with Alul endo nuclease. The nucleotide 285 could be adenine [M. bovis] or guanine [M. tuberculosis]. Such variation produces different restriction site for Alul. There were three incisive fragments in all Mycobacterium bovis and Mycobacterium bovis BCG strains and one incisive fragment in other members of Mycobacterium tuberculosis complex. PCR-RFLP method on 548bp fragment of oxyR gene is a rapid and accurate method to differentiate Mycobacterium bovis and Mycobacterium bovis BCG from other members of Mycobacterium tuberculosis complex