Modalization and Transcendence of Health in the Coming Decade: Emphasizing the Human Cognitive System in the Stories of Prophets in the Holy Quran.

In this study, the progression and importance of health knowledge is explored, projecting its future path. We do this by comparing the stages of evolution of the human cognitive system from birth to old age (inner intellect) with the stages of intellectual modalization in divine messengers (external intellect), as depicted in the stories of the prophets in the Holy Quran. This comparison aims to articulate the course of evolution, which includes sensory perception, apprehension, imaginalization, intellection, and intuition. Future medicine will consider the influence of spiritual factors (soul) in the form of human cognition and intention, as well as material effects (genes and biology). The seven medical domains of the future will encompass the field of 'sprito-epigenetico psycho-neuro-endocrino-immuno-pharmacology'. This perspective emphasizes the need for a transcendent outlook in health and medicine. This study employed a library research method, including studies in medical journals from the last forty years.

Involvement of Coenzyme Q10 in Various Neurodegenerative and Psychiatric Diseases.

Coenzyme Q10 (CoQ10), commonly known as ubiquinone, is a vitamin-like component generated in mitochondrial inner membranes. This molecule is detected broadly in different parts of the human body in various quantities. This molecule can be absorbed by the digestive system from various nutritional sources as supplements. CoQ10 exists in three states: in a of reduced form (ubiquinol), in a semiquinone radical form, and in oxidized ubiquinone form in different organs of the body, playing a crucial role in electron transportation and contributing to energy metabolism and oxygen utilization, especially in the musculoskeletal and nervous systems. Since the early 1980s, research about CoQ10 has become the interest for two reasons. First, CoQ10 deficiency has been found to have a link with cardiovascular, neurologic, and cancer disorders. Second, this molecule has an antioxidant and free-radical scavenger nature. Since then, several investigations have indicated that the drug may benefit patients with cardiovascular, neuromuscular, and neurodegenerative illnesses. CoQ10 may protect the neurological system from degeneration and degradation due to its antioxidant and energy-regulating activity in mitochondria. This agent has shown its efficacy in preventing and treating neurological diseases such as migraine, Parkinson's disease, Alzheimer's disease, Huntington's disease, amyotrophic lateral sclerosis, and Friedreich's ataxia. This study reviews the literature to highlight this agent's potential therapeutic effects in the mentioned neurological disorders.

Comparison of the Effects of Citicoline and Piracetam on Hypoxic-ischemic Brain Damage in Neonatal Rabbits.

OBJECTIVES: Perinatal hypoxic-ischemic brain injuries have been a major cause of mortality and neurodevelopmental morbidities in newborns. Citicoline and Piracetam have been used as nootropic agents in a number of studies. In this investigation, we aimed to determine the effects of these agents solely and in combination in hypoxic-ischemic brain damage in rabbit neonates. MATERIALS & METHODS: Hypoxic-ischemic brain damage was induced by the occlusion of both uterine arteries of dams for eight minutes. The subjects were randomly divided into five groups as follows (n=6 per group): control group without hypoxia (C1), control group with hypoxic-ischemic damage (C2), the third group (P) received Piracetam (100 mg/kg), the fourth group (T) administered with Citicoline (250 mg/kg), and the fifth (PT) received both. The preventive effects of the two drugs on hypoxic-ischemic brain damage were microscopically investigated by the rates of damage to the hippocampus. RESULTS: Neuronal destruction rates in C1, C2, P, T, and PT were 4%, 45%, 37.5%, 12.5% (P=0.01 vs. C2), and 20% (P=0.03 vs. C2), respectively. The total means of hypoxic-ischemic damage, cell edema, neuronal degeneration, and eosinophilic degeneration were lower in the T group compared to C2 (P<0.05). CONCLUSION: According to our results and previous findings, Citicoline as a treatment for hypoxic-ischemic brain injuries could be beneficial, and it has priority over neuroprotective agents like Piracetam. Moreover, the combination of Citicoline and Piracetam showed no superior effect in contrast with Citicoline alone. However, experimental studies on larger populations and clinical trials are highly suggested.

Effects of the liaison nurse management on the infectious stroke complications: a randomized controlled trial.

BACKGROUND: Two of the most serious complications after stroke are pneumonia, and urinary tract infection. Liaison nurse, from hospital admission to discharge and then at home helps patients with complicated caring issues stroke. This study investigates the effect of liaison nurse management on the incidence of pneumonia and urinary tract infection in patients with stroke after discharge from the hospital. METHODS: This randomized controlled trial was conducted on 80 patients in a hospital in Iran. The intervention group was assessed and developed a caring program by the liaison nurse and the control group received routine care. Two weeks and two months after discharge, the patients were evaluated for the incidence of pneumonia and urinary tract infection. Collected data were analyzed using the Chi-square test. P < 0.05 was considered statistically significant. RESULTS: The two groups were homogenous in terms of mean age; gender frequently distribution and having urinary catheter. The incidence of pneumonia in intervention and control groups (11.6% vs. 19.2%, P = 0.35) had no statistically significant differences, but there was a significant difference in the incidence of urinary tract infection (0% vs. 24.6%, P < 0.001). CONCLUSIONS: With liaison nurse performance, there was a significant difference in the incidence of urinary tract infection, in two months after discharge from hospital, but the incidence of pneumonia had no statistically significant differences in two groups. Nurse's evaluation each patient individually according to needs, developing and monitoring the home-based care program, beyond overall education to these patients, could reduce some of complications of a stroke. TRIAL REGISTRATION: This study is retrospectively registered by Iranian Registry of Clinical Trials with decree code: IRCT20170605034330N3 on April 4, 2018.

Designing a "Near-Death Experience" Reality Testing System.

"Near-death experiences (NDEs)" are usually depicted with a vivid perception of departure from the physical body and being in a distinctive spatial and temporal area setting. There are challenges to whether consciousness during this phenomenon is cerebral or extracerebral? To investigate this subject further, the AWARE research projects were designed. It was a research milestone in this field. During the AWARE projects, images were put in the cardio pulmonary resuscitation (CPR) area. The person with experience of leaving the body was then asked about the nature of the images. In a recent project, a complementary system was designed that contains two main parts: a transmitter connected to the electroshock (as starter) and a receiver connected to the monitor. The laboratory experiment showed that the connection between the parts of the system was systematically and meticulously organized. This new system, such as the AWARE projects, is based on the perception of the visual and auditory elements, during the out-of-body experience component of the NDE but, unlike the AWAREs, it has three main differences in testing of visual elements: unfixed/dynamic images, "timed" movie's capacity, and the automatic activation. Also this system, records the ambient sounds.So, after the successful resuscitation, researchers will be asked about the ambient sounds specification. The new system records the ambient sounds. Consequently, it becomes feasible to study environmental and corporeal events in more detail, during the phenomenon.

Medical Students' Occupational Burnout and its Relationship with Professionalism.

INTRODUCTION: Occupational burnout is a prevalent syndrome among medical students as well as other health professionals. It may be an important factor contributing to professional conducts. The aim of this study was to determine the prevalence of burnout among medical students of Shiraz University of Medical Sciences at clinical level and its relationship with professionalism. METHODS: In this cross-sectional study, all medical clinical students who had spent a minimum of six months of the first year of clinical level and who were in their final year, in 2015-16 were examined (using the census method). Data were gathered using demographics, educational background, and the dimensions of professionalism questionnaires and Maslach Job Burnout Inventory. Data analysis was performed using descriptive statistics, ANOVA and Pearson correlation test by SPSS, version 14. A p-value of <0.05 was considered statistically significant. RESULTS: The total mean score of burnout was 61.37+20.44 (moderate). In this study, 54.3% of the students had low, 35.2% moderate and 10.4% high job burnout. There was a negative correlation between job burnout and professional ethics with Pearson correlation test (p <0/000, r=0.23). There was no significant relationship between the increase in academic years and burnout. CONCLUSION: Regarding the high prevalence of burnout and its adverse effects among medical students, developing a workplace assistance program and adequate facilities to help them is necessary. Also, due to the negative correlation between professionalism and burnout, continuous training of professional ethics should be taken into consideration by educational authorities.

Occupational stress among medical residents in educational hospitals.

BACKGROUND: Occupational stress and its related psychological strain is a concern among resident doctors that may affect patient care adversely. Residents face many stresses because of their high job demands in delivery of hospital care. They are often subject to work load and pressure due to direct involvement with patients, prolonged working hours, poor job opportunities and low support. Their multiple educational and clinical roles can also affect their performance and quality of personal or professional life. The aim of this study was to evaluate the occupational stress among residents of various medical specialties.We aimed to explore the reasons of occupational stress in residents' life and determine how we can enhance the stress-coping strategies and create more suitable conditions. METHODS: This cross-sectional analytical-descriptive study was conducted on all medical residents with various specialties in Shiraz University of Medical Sciences. Data was collected using Osipow occupational stress questionnaire and analyzed by SPSS software version 17. RESULTS: The response rate was 88.8%. The average stress score of all residents was 156.35 out of 250. The highest and lowest average stress scores belonged to gynecology and dermatology specialties, respectively. The highest average score of the stress factors was related to the workload with the score of 35.09 of 50 (moderate to severe stress). The total stress score had a significant relationship with age (P = 0.030) and sex (P = 0.009) as well as lack of time to get the needed healthy meals (P = 0.047), high work hours (P < 0.01), surgical specialties (P < 0.01) and on call shift (P < 0.01). CONCLUSION: Since most of the stressors were related to the workload, interventions such workload reduction, education about occupational stress and its management, promoting interpersonal relations and more supportive measures are recommended.

Medical students' experiences and perspective on unprofessional behavior in clinical practice.

INTRODUCTION: Recognition of professional and unprofessional behaviors is the most important and fundamental factor which affects the relationships between the doctors and patients. Therefore, in order to progress in their professional life, doctors are supposed to understand and follow these behaviors. METHODS: This is a cross-sectional, descriptive analytical study. All students in teaching hospital of Shiraz University of Medical Sciences were eligible to participate (374 individuals with census method). The data were collected using a questionnaire containing 29 questions about the concept of medical professionalism. Here, participation of medical students in unprofessional behaviors and the relevance of this participation with the perception of these behaviors were considered. Data were analyzed through SPSS version 15, using descriptive statistics, t-test and Pearson correlation test. RESULTS: According to the obtained data, despite the fact that all students (140 students in the junior and 234 in the senior years as interns) had passed the course of professionalism (95.7%), the perception of unprofessional behaviors between the two groups was significantly different (p<0.001) and the mean of the perception among junior students was higher than the interns. No significant difference was observed in participation in unprofessional behavior rates of the two groups (p=0.451).Moreover, the data did not reveal a strong relationship between participation in unprofessional behavior and what is taught in the curriculum (p=0.079). CONCLUSION: Medical students' perception of unprofessional behaviors as acceptable may increase their participation in these behaviors. Thus, medical policy makers should consider approaches beyond simply providing ethical and professional guidelines or policies, and students should be regularly evaluated for their activities; their professional behaviors should be evaluated in order to temper them, when appropriate.

Attitudes of Nurses and Hospitalized Patients about the Rights of Psychiatric Clients.

Objective: In recent years, protecting the rights of hospitalized psychiatric clients became a key issue in relationship-building and collaborative caretaking. Despite its importance, a few researches have been conducted on assessing the attitudes and expectations of clients and nurses about this issue. This study aimed to compare the nurses and psychiatric clients' attitudes towards rights of hospitalized clients. Method : In this cross sectional descriptive study, 60 nurses, and 100 clients, who were admitted to various wards of a psychiatric hospital in Shiraz, were included. Data were collected using 2 questionnaires that were designed for nurses (22 questions) and patients (29 questions) about the rights of patients. Data were analyzed by descriptive and inferential statistics. Results: The results revealed that most of nurses (55%) and clients (64%) agreed with active participation of the clients in healthcare decision-making. More than half of the clients agreed with the possibility of refusal/withdrawal of the proposed treatment or leaving the hospital despite medical advice. Only 38.3% of nurses agreed with those rules in some clauses (P-value < 0.001). Conclusion: To protect the rights of mentally ill clients, their family, and the society, we should identify weaknesses and shortcomings of the basic rights of this group and make suggestions for their improvement. A legal bill, which covers the rights of mentally ill clients, could be a turning point for improvement of the quality of care as well as increasing clients' satisfaction.

Learning professionalism through hidden curriculum: Iranian medical students' perspective.

Learning professionalism is a central topic in medical education. While many factors could affect the educational process of professionalism, hidden curriculum is considered one of the most important ones. As the working components of a hidden curriculum might be specific to the settings, this study explored its components in terms of professionalism and ethical conduct from the viewpoint of Iranian undergraduate medical trainees. Semi-structured and in-depth interviews were used to collect medical students' experiences and viewpoints, which were then analyzed through simple content analysis and the codes and categories were extracted. Finally, themes were derived as the central organizing concepts. Saturation occurred after 17 interviews. Seven main themes were extracted as the working components of hidden curriculum regarding professionalism in the setting: 'convenient patients', 'evaluate me', 'trust as the base of team interactions', 'perceiving encouragement', 'relationship satisfaction and authenticity', 'workload and students' well-being' and 'role modeling at the heart of professionalism'. Students' perception and experiences are a rich source of gaining a deeper understanding of the working hidden curriculum. In this study, two groups of human-related and environment-related elements were extracted. They were effective in the formation of the current 'ethical climate', which shaped the professional and ethical identity of medical trainees. Moreover, specific plans regarding the condition of the settings may provide opportunities for medical educators to enhance professionalism in their institutions.

Pediatric residents' and attending physicians' perspectives on the ethical challenges of end of life care in children.

One issue that has received less attention in present health care protocols is pediatric palliative care (PPC), which is an approach to care starting with the diagnosis of life-threatening diseases in children. It embraces physical, emotional and spiritual elements. Ethical issues are major concerns in today's pediatric health care guidelines and must be considered by residents and attending physicians in this field. The present study was conducted in Namazi Teaching Hospital, Shiraz, Iran. Forty-eight out of 92 pediatricians were enrolled in this research, including 8 attendings, 6 fellows, and 34 residents. The study questionnaire consisted of 66 items. It was built based on previous reliable and validated questionnaire; also the calculated Cranach's alpha was 0.815. Data were analyzed and presented by mean SD and percentage. While seventy-five percent of the participants reported involvement in pediatric palliative care, fifty-six percent did not acknowledge any information about the subject. More than half of the participants perceived the pediatric palliative care services in Namazi Hospital as somewhat or completely satisfactory. Furthermore, thirty-five percent of the applicants stated that they encounter an ethical problem with regard to PPC once a week. There are many challenges to providing decent palliative care for children, including symptom controlling, shifting to end of life care, background dissimilarities of patients, financial restrictions, and acceptance of death. Our applicants believed that offering psycho-spiritual support was the most important challenge in PPC. However, further investigations are needed to determine other requirements for providing a comprehensive guideline on PPC.

Current state of professional and core competency in pediatric residency program at Shiraz University of Medical Sciences: A local survey.

INTRODUCTION: Accreditation assesses performance, or capacity to perform, against predetermined standards. It typically combines external quality assurance, through a process of peers review, with elements of self-regulation through internal and self-directed assessment. This study is an attempt to identify the quality of pediatrics residency educational programs regarding predetermined standards. METHODS: This descriptive-analytical evaluation study of applied type was conducted during 2010 and 2011 in the pediatrics department of Shiraz Medical School, Iran. The assessment process occurred in several phases; at first an assessment model for a residency educational development and a series of educational criteria and indices were created based on WFME Standards. Multiple methods including a self-assessment questionnaire and several checklists were used to collect data, whereas systematic site visit, peer review and document reviewing were conducted with survey team. Due to limitation of the statistical society, all faculty members (n=34) and residents (n=41) of the pediatric department were asked to complete the survey. At last, descriptive and deductive statistics data analysis was performed using SPSS version 14. RESULTS: According to the records available in assessing program quality, it seems that the input criteria were desirable for the program based on the residents' viewpoints (86.6 %).There were proper physical facilities for them to meet the residency program goals.  The study indicated that the learning environment needed to be revised for the educational needs (Likert scale: 2.96±1.05). The peer evaluation team demonstrated achievement of mission fulfillment in the context of the objectives and indicators by meeting the desired themes.  In spite of some weaknesses in the process criteria, the criteria for output indicators were good according to the report (more than desired level of 75-80%). CONCLUSION: Accreditation is an important step towards strengthening the quality of educational programs. According to this study the current status of the pediatrics department of Shiraz University of Medical Sciences was desirable leading to a satisfactory level in general. However, additional educational development will be needed in order to achieve a widespread change and improvement.

Using video-taped examples of standardized patient to teach medical students taking informed consent.

INTRODUCTION: Medical student should be trained in medical ethics and one of the most essential issues in this field is taking informed consents. In this research, we compared the effect of effectiveness of teaching methods on students' ability intaking informed consent from patients. METHODS: This semi-experimental study was carried out on fifty eight subjects from the 4th-year students  of Shiraz University of Medical Sciences who attended in medical ethics coursebefore their 'clinical clerkship'training.Method of sampling was census and students were randomly allocated into two groups of control group(n=28) was trained in traditional lecture-based class and the case groupnamed as A1(n=22) were taught by video-taped examples of standardized patient.Then A1 group attended in traditional lecture-based classes named as A2. The groups were evaluated in terms the ability of recognition of ethical issuesthrough the scenario based ethical examination before and after each training. Scenarios were related to the topics ofinformed consent. Data were analyzed by SPSS 14 software using descriptive statistics and anovatest.P-Value less than 0.05 was considered as significant. RESULTS: The mean scores results of A2, A1and B groupwere found to be7.21 , 5.91 and 5.73 out of 8,respectively. Comparison between the groups demonstrated that the ability of taking informed consent was significantly higher in A2 group (p<0.001), followed by A1group (p<0.05),while was the leastin the B group (p=0.875). CONCLUSION: According to this research, lecture-based teaching is still of great value in teaching medical ethics, but when combined with standardized patient, the outcome will be much better.it should be considered that mixed methodsof teaching should be used together for better result.

Needs assessment and evaluation of a short course to improve faculties teaching skills at a former World Health Organization regional teacher training center.

INTRODUCTION: In the design of educational programs, much attention has been paid to teaching methods, needs assessment, an important part of the development of educational programs, generally is neglected. Another important aspect in educational program design is assessing effectiveness. The aims of this study were to design a formal needs assessment program to define the core contents of a faculty development program, and to determine whether participation in the faculty development program reinforced new teaching skills. METHODS: A teacher-training program was designed at Shiraz University of Medical Sciences to help medical instructors boost their teaching skills. Needs assessment was done with nominal group technique followed by a 5-point Likert scale questionnaire. The program, imparted in workshop format, covered effective teaching methods, feedback, assessing knowledge and time management. Instruction was in the form of lectures, group discussions, case simulations, video presentations and role-plays. The program was evaluated in several phases using data triangulation and multi-item assessments of overall program quality in three major dimensions: Kirkpatrick program evaluation model, evaluation of the educational environment and qualitative analysis with open-ended questions. All participants in the study belonged to the academic staff of Shiraz University of Medical Sciences (n=396). RESULTS: Seven main categories were derived from nominal group techniques and questionnaires. After the program, participants rated the quality of the program highly. They felt that the educational intervention was appropriate and had a positive impact on their knowledge of effective teaching methods, feedback, knowledge assessment and time management. Assessment of the effectiveness of the program showed that participants reported significant improvements in their teaching abilities. CONCLUSIONS: Our faculty development program  have a significant positive effect on medical university teaching staff members' competencies. Further research is needed to investigate whether the faculty development program actually results in improved teaching performance.

Clinical learning environment at Shiraz Medical School.

Clinical learning occurs in the context of a dynamic environment. Learning environment found to be one of the most important factors in determining the success of an effective teaching program. To investigate, from the attending and resident's perspective, factors that may affect student leaning in the educational hospital setting at Shiraz University of Medical Sciences (SUMS). This study combined qualitative and quantitative methods to determine factors affecting effective learning in clinical setting. Residents evaluated the perceived effectiveness of the university hospital learning environment. Fifty two faculty members and 132 residents participated in this study. Key determinants that contribute to an effective clinical teaching were autonomy, supervision, social support, workload, role clarity, learning opportunity, work diversity and physical facilities. In a good clinical setting, residents should be appreciated and given appropriate opportunities to study in order to meet their objectives. They require a supportive environment to consolidate their knowledge, skills and judgment.

Assessing the impact of faculty development fellowship in Shiraz University of Medical Sciences.

BACKGROUND: Changing concepts of education have led many medical schools to design educational programs to enhance teaching skills, as traditional approaches cannot fulfill the current students' needs. The educational development of medical faculty members has recently received impetus in Iran and the Eastern Mediterranean region. The aim of this study was to investigate whether participation in a faculty development program reinforced new teaching skills. METHODS: A teacher-training program was designed at Shiraz University of Medical Sciences to help medical instructors improve their teaching skills. The program, imparted in workshop format, covered effective teaching methods, feedback, knowledge assessment, and time management. Program sessions lasted four hours, four days each week for one month. Instruction was in the form of lectures, group discussions, case simulations, video presentations, and role-playing. All participants in the study (n = 219) belonged to the academic staff of Shiraz University of Medical Sciences. RESULTS: The participants highly rated the quality of the program. They felt that the educational intervention was appropriate and had a positive impact on their knowledge (P < 0.001). Assessment of the effectiveness of the program in strengthening the participants' teaching ability showed that students noticed significant improvements in the participants' teaching abilities (P < 0.05). CONCLUSION: Our faculty development program appears to have a significant positive effect on medical teachers' competencies, and we suggest that our educational intervention is effective in achieving its aims. Further research should investigate whether this faculty development program actually results in improved teaching performance.

Comparative efficacy of dexamethasone versus hydrocortisone in severe acute pediatric asthma.

This study aimed to compare the efficacy of dexamethasone and hydrocortisone in the treatment of acute paediatric asthma. Forty seven asthmatic children were randomised to receive either dexamethasone (0.6 mg/ml, maximum 16 mg) in a single dose or hydrocortisone (8-10 mg/kg/day) in 4 equal doses for 2 days. Our findings showed that the mean length of hospitalization in children receiving dexamethasone was significantly shorter than those receiving hydrocortisone.