Developing and validating a national set of standards for undergraduate medical education using the WFME framework: the experience of an accreditation system in Iran.

BACKGROUND: Defining standards is the first step toward quality assurance and improvement of educational programs. This study aimed at developing and validating a set of national standards for the Undergraduate Medical Education (UME) program through an accreditation system in Iran using the World Federation for Medical Education (WFME) framework. METHODS: The first draft of standards was prepared through consultative workshops with the participation of different UME program stakeholders. Subsequently, standards were sent to medical schools and UME directors were asked to complete a web-based survey. The content validity index at the item level (I-CVI) was computed using criteria including clarity, relevance, optimization and evaluability for each standard. Afterward, a full-day consultative workshop was held and a wide range of UME stakeholders across the country (n = 150) discussed the survey results and made corrections to standards. RESULTS: Analysis of survey results showed that relevance criteria had the best CVI as only 15 (13%) standards demonstrated CVI < 0.78. More than two-thirds (71%) and a half (55%) of standards showed CVI < 0.78 for optimization and evaluability criteria. The final set of UME national standards was structured in 9 areas, 24 sub-areas, 82 basic and 40 quality development standards, and 84 annotations. CONCLUSIONS: We developed and validated national standards as a framework to ensure the quality of UME training with input from UME stakeholders. We used WFME standards as a benchmark while addressing local requirements. The standards and participatory approach to developing standards may guide relevant institutions.

Bilateral Staged Total Hip Replacement and the Natural Progress of an Untreated Case of Developmental Dysplasia (Dislocation) of the Hip: A Clinical Case Report by the Surgeon and the Patient.

The natural history of an untreated case of a Developmental Dysplasia (Dislocation) of the Hip (DDH) associated with multiple congenital abnormalities is reported in a 55-years-old man. The patient's complaints and the varieties of the typical manifestations emerged in other parts of the body throughout the life are reviewed and discussed as comorbidities of a dysplastic condition. Two-stage bilateral total hip replacement (THR) operations were performed at the age of 55. In addition, to relieve the pain, the walking disabilities were overcome, hence gaining normal walking in swing and stances. The leg length discrepancy was corrected by anatomically positioned prostheses, examined by the knee bending test and characterized and evidenced by radiological features and indices.

Impact of various color LED flashlights and different lighting source to skin distances on the manual and the computer-aided detection of basal cell carcinoma borders.

BACKGROUND/AIMS: Quantitative analysis based on digital skin image has been proven to be helpful in dermatology. Moreover, the borders of the basal cell carcinoma (BCC) lesions have been challenging borders for the automatic detection methods. In this work, a computer-aided dermatoscopy system was proposed to enhance the clinical detection of BCC lesion borders. METHODS: Fifty cases of BCC were selected and 2000 pictures were taken. The lesion images data were obtained with eight colors of flashlights and in five different lighting source to skin distances (SSDs). Then, the image-processing techniques were used for automatic detection of lesion borders. Further, the dermatologists marked the lesions on the obtained photos. RESULTS: Considerable differences between the obtained values referring to the photographs that were taken at super blue and aqua green color lighting were observed for most of the BCC borders. It was observed that by changing the SSD, an optimum distance could be found where that the accuracy of the detection reaches to a maximum value. CONCLUSION: This study clearly indicates that by changing SSD and lighting color, manual and automatic detection of BCC lesions borders can be enhanced.

Radiolabeled nanoceria probes may reduce oxidative damages and risk of cancer: a hypothesis for radioisotope-based imaging procedures.

Low-dose ionizing radiations are commonly utilized in medical centers for diagnostic imaging procedures. Unfortunately, the absorption of ionizing radiation generates reactive chemical species that could damage cells. In diagnostic radioisotope-based imaging procedures, the radiological exposures by gamma emitter imaging probes such as radioactive technetium ((99m)Tc) could express low risk of cancer. Recently, many studies have documented cell protective, neuro-protective, anti-inflammatory and cardio-protective properties of cerium oxide nanoparticles (nanoceria) as a result of their antioxidant and free radical scavenger properties. Since there is no safe level of ionizing radiations, then we hypothesize that radiolabeled nanoceria might be an interesting probe to reduce cancer risk and other related oxidative stresses. We also provide a synthetic scheme of nanoceria functionalization with fluorine radiolabeled ligands as an exemplary approach. In conclusion, using nanoceria to combine radioisotope-based imaging probes with antioxidant activity might open new way to protect patient against radioactive emission of radioisotopes and ionizing radiations in several radioisotope-based imaging applications, in particular for patients who need frequent imaging procedures and children who are more susceptible to radiation.

A comprehensive model for trauma research design.

Concomitant research and education are invaluable for patient care and medical practice in trauma. Elucidation of a foundation for the integration of training and service that can be combined with research in trauma is crucial, and every trauma case should be studied for this purpose. In this study, we investigated the unique features of trauma research to formulate a generic comprehensive model that can be used at any point at which one may desire to develop a research plan. The framework of this model is designed to enable proper trauma research plain in combination with the best routine trauma care. Selection of the appropriate method of study, the corresponding basic questions raised, aims, and the relevant epidemiologic context are factors that are included in this review. Furthermore, suitable sources, proper time for data collection, reliable and valid measures, and criteria for the scaling and quantification of the findings are indicated. In addition, the levels, orders, operational stages, and steps to be taken in planning research projects are logically set based on the principles of cognitive task analysis, and correspond to the entire spectrum of trauma care situations. Lastly, a measure of utility value is assigned in terms of the expected extent of efficiency and presumed level of effectiveness.

The role of high-resolution imaging in the evaluation of nanosystems for bioactive encapsulation and targeted nanotherapy.

Nanotechnology has already started to significantly impact many industries and scientific fields including biotechnology, pharmaceutics, food technology and semiconductors. Nanotechnology-based tools and devices, including high-resolution imaging techniques, enable characterization and manipulation of materials at the nanolevel and further elucidate nanoscale phenomena and equip us with the ability to fabricate novel materials and structures. One of the most promising impacts of nanotechnology is in the area of nanotherapy. Employing nanosystems such as dendrimers, nanoliposomes, niosomes, nanotubes, emulsions and quantum dots, nanotherapy leads toward the concept of personalized medicine and the potential for early diagnoses coupled with efficient targeted therapy. The development of smart targeted nanocarriers that can deliver bioactives at a controlled rate directly to the designated cells and tissues will provide better efficacy and reduced side effects. Nanocarriers improve the solubility of bioactives and allow for the delivery of not only small-molecule drugs but also the delivery of nucleic acids and proteins. This review will focus on nanoscale bioactive delivery and targeting mechanisms and the role of high-resolution imaging techniques in the evaluation and development of nanocarriers.