Combination of different clinical reasoning tests in a national exam.

INTRODUCTION: Clinical reasoning as a critical and high level of clinical competency should be acquired during medical education, and medical educators should attempt to assess this ability in medical students. Nowadays, there are several ways to evaluate medical students' clinical reasoning ability in different countries worldwide. There are some well-known clinical reasoning tests such as Key Feature (KF), Clinical Reasoning Problem (CRP), Script Concordance Test (SCT), and Comprehensive Integrative Puzzle (CIP). Each of these tests has its advantages and disadvantages. In this study, we evaluated the reliability of combination of clinical reasoning tests SCT, KF, CIP, and CRP in one national exam and the correlation between the subtest scores of these tests together with the total score of the exam. METHODS: In this cross sectional study, a total number of 339 high ranked medical students from 60 medical schools in Iran participated in a national exam named "Medical Olympiad". The ninth Medical Olympiad was held in Shahid Beheshti University of Medical Sciences, Tehran, Iran, under the direct supervision of the Ministry of Health and Medical Education in summer 2017. The expert group designed a combination of four types of clinical reasoning tests to assess both analytical and non-analytical clinical reasoning. Mean scores of SCT, CRP, KF, and CIP were measured using descriptive statistics. Reliability was calculated for each test and the combination of tests using Cronbach's alpha. Spearman's correlation coefficient was used to evaluate the correlation between the score of each subtest and the total score. SPSS version 21 was used for data analysis and the level of significance was considered <0.05. RESULTS: The reliability of the combination of tests was 0.815. The reliability of KF was 0.81 and 0.76, 0.80, and 0.92 for SCT, CRP, and CIP, respectively. The mean total score was 169.921±41.54 from 240. All correlations between each clinical reasoning test and total score were significant (P<0.001). The highest correlation (0.887) was seen between CIP score and total score. CONCLUSION: The study showed that combining different clinical reasoning tests can be a reliable way of measuring this ability.

The effect of audiovisual distraction on the tolerability of flexible bronchoscopy: a randomized trial.

OBJECTIVE: It is important to minimize patient discomfort during invasive diagnostic and therapeutic procedures such as bronchoscopy. The aim of this study was to investigate the effect of audiovisual distraction on the tolerability of flexible bronchoscopy (FB). MATERIALS AND METHODS: We conducted a prospective, randomized, controlled trial on patients undergoing FB at a hospital in Zahedan, Iran, in 2015. The patients were equally and randomly divided into a control group and an experimental group. Patients in the control group received standard care during FB While patients in the experimental group selected familiar folk music that was played during the procedure along with the screening of images of nature. The duration of the FB was recorded and cough, dyspnea, choking, nausea and pain were evaluated using a visual analogue scale before and after the procedure. Statistical analysis was carried out using paired and independent t-tests, χ2 -tests and analysis of covariance. RESULTS: Sixty patients met the inclusion criteria and were randomized. The duration of the FB procedure was significantly shorter in the experimental group compared with the control group (mean ± standard deviation 7.87 ± 2.12 min and 10.27 ± 1.72 min, respectively; P < 0.05). Dyspnea, cough and pain were significantly less severe in the experimental group compared with the control group (P < 0.05), but choking and nausea were not significantly different between the two groups (P > 0.1). CONCLUSIONS: Our findings showed that audiovisual distraction had a positive effect on the tolerability of FB. This method has important potential as a simple and practical approach in reducing discomfort during invasive diagnostic and treatment procedures.

Prevalence of coeliac disease in patients with non-alcoholic fatty liver disease.

BACKGROUND AND STUDY AIMS: Coeliac disease (CD) may be associated with several liver disorders including primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. Furthermore preliminary data suggest a causative role of CD in steatosis and steatohepatitis. The aim of present study was to determine the prevalence of CD in a series of patients with non-alcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS: In a cross sectional study (2008-2010), 403 consecutive NAFLD patients (127 female and 276 male) referred to GI clinics of the Zahedan University of Medical Sciences were included. IgA anti-tissue transglutaminase (Anti-tTG) was used for screening of coeliac disease. In the patients with a positive serologic test, duodenal biopsies were taken to confirm the diagnosis. RESULTS: The mean±SD of the age and BMI of patients were 37.4±12.4years and 28.3±4.15kg/m(2) respectively. BMIs lower than 25kg/m(2) were found in 58 subjects (14.5%). Furthermore diabetes mellitus and hyperlipidaemia were diagnosed in 48 (11.9%) and 84 (20.8%) individuals respectively. Positive Anti-tTGs were found in 14/403 (3.4%) and 13/403 (3.2%, 95% CI 1.5-4.9) had coeliac disease according to the modified Marsh classification; 8 had type I, 3 type II, 1 type IIIA and 1 type IIIB lesions. CONCLUSION: According to our data, prevalence of CD in the subjects with NAFLD is higher than the rates reported in the general population. Therefore screening for CD in selected cases of NAFLD may be appropriate.

High prevalence of vitamin D deficiency in Zahedan, southeast Iran.

BACKGROUND: Several studies show a high prevalence of vitamin D deficiency in Asia. Data regarding the prevalence of vitamin D deficiency in southeast Iran are inadequate. OBJECTIVES: The purpose of this study was to determine the prevalence of vitamin D deficiency in Zahedan, a sunny area in southeast Iran. SUBJECTS AND METHODS: This population-based cross-sectional study was performed on 993 apparently healthy subjects. Serum levels of 25-hydroxy vitamin D (25-OH vit D), parathyroid hormone, calcium, phosphate, and alkaline phosphatase activity were measured. RESULTS: Inadequate vitamin D status was diagnosed in 94.7% of the subjects (25-OH vit D <30 ng/ml). The frequencies of deficiency (<20 ng/ml), insufficiency (20-30 ng/ml), sufficiency (30-150 ng/ml), and toxicity (>150 ng/ml) were 85.2, 9.5, 5.3, and 0.0%, respectively. CONCLUSION: The results indicate that vitamin D deficiency is common in the population of Zahedan. Based on our results, fortification of milk and the use of supplements is suggested in this region.