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Abstract Background Pre-hospital emergency technicians are crucial in managing patients with acute psychiatric symptoms. They must quickly assess the condition, make a primary diagnosis, and refer the patient to the appropriate treatment center. Insufficient skills in these situations can cause serious harm. Educating technicians on dealing with these patients may enhance their knowledge and skills; however, we do not know the extent and longevity of this improvement and which areas are affected. This study investigates the impact of training on pre-hospital emergency technicians’ knowledge and skills. Methods This quasi-experimental study involved pre-hospital emergency technicians in Robat Karim and Nasim Shahr counties from December 2022 to January 2022. The technicians received workshops on interacting with psychiatric patients. The training topics included the basic principles of coping with a psychiatric patient. They also covered a step-by-step approach to dealing with an aggressive patient, dealing with a patient threatening suicide, managing agitation, managing a patient suffering from panic attacks, and finally dealing with a delirious patient. A pre-test assessed their baseline knowledge and skills, followed by a post-test after training and another test three months later. The test results were analyzed. Results This study involved forty male participants ranging in age from 25 to 44 and with work experience ranging from five to twenty years. As a result of training in dealing with acute psychiatric patients, technicians developed significant skills and knowledge immediately after training, and these improvements remained significant three months after training. Nevertheless, the correct answers decreased during the three-month follow-up compared to the pre-test. Education was less effective at managing panic, delirium, and agitation. Conclusion In conclusion, technicians’ knowledge and skills can be effectively enhanced through training; however, the impact diminishes with time. Theories and practical methods, periodic repetition, and real-world internships are the best ways to maximize training effectiveness.

Background: Vulvovaginal atrophy (VVA) is a common condition and a silent epidemic affectingmany postmenopausal women who suffer from it in silence. This study aimed to evaluate the effect ofCitrus aurantium vaginal cream on vaginal atrophy in postmenopausal women.Methods: This single-group pretest-posttest quasi-experimental study was conducted on 30postmenopausal women who were referred to the Gynecology Clinic of Imam Khomeini Hospital in thecity of Noor, Iran, from June to November 2020. Citrus aurantium vaginal cream was administered towomen diagnosed with vaginal atrophy (based on subjective symptoms of atrophy, descriptive evaluationof the vagina, vaginal pH measurement, and degree of vaginal maturation determined by vaginal smear)every night in the first two weeks and every other night for the second two weeks. Data were collectedusing the scale of subjective symptoms of vaginal atrophy; descriptive evaluation checklist of vaginalmucosa; laboratory results registration form (vaginal maturation index, vaginal maturation value, andvaginal pH) before the intervention and two and four weeks after the intervention. Data were analyzedusing SPSS software (version 24) through the analysis of variance with repeated measurements, andLSD post-hoc test. A P value less than 0.05 (P

Background: Adherence to social distancing recommendations provided by health authorities plays an important role in the prevention and control of COVID-19 transmission, regarding the lack of effective drug therapies. Therefore, this study aimed to identify the relationship between socio-demographic factors and adherence to social distancing recommendations during COVID-19 pandemic in Gonabad, Iran. Methods: In this cross-sectional study, 587 subjects aged 15 and older were selected using the convenience sampling method from urban and rural areas in Gonabad, Iran, from July to September 2020. Data were collected online using a socio-demographic characteristics form, the adherence to social distancing recommendations scale, and a coronavirus disease awareness survey. Subsequently, the obtained data were analyzed in SPSS software (version 16) using hierarchical linear regression. The statistical significance was considered as p

Background and purpose: Volvovaginal atrophy is a common and progressive complication in menopausal women, affecting their daily life activities, sexual health, and quality of life. Hormone therapy is associated with some problems and many women prefer herbal medicine to reduce the symptoms. This systematic review aimed to explore the effect of medicinal plants on treatment of vaginal atrophy in postmenopausal women Materials and methods: Electronic databases, including Scopus, Pubmed, Web of Science, Science Direct, SID, Magiran and Google Scholar search engine were searched by two researchers independently. The following keywords were used in English and Persian: Herbal Medicine, Medicinal Plants, vagina, Atrophy, Postmenopausal Period, Clinical Trial, and relevant articles published until December 2020 were selected. The CONSORT 2010 checklist was used to assess the quality of studies and those with score 18 or higher entered this systematic review. Results: Out of 747 articles, 12 clinical trials were investigated in current review. These articles studied seven medicinal plants (chamomile, licorice, fennel, Pueraria mirifica, flaxseed, black cohosh, and red clover). Herbal products can have beneficial effects on reducing the symptoms of vaginal atrophy in postmenopausal women. Conclusion: Medicinal plants containing phytoestrogens can be considered as a treatment of choice for improving vaginal atrophy and a suitable alternative to chemical drugs following further studies that prove their efficacy.

مقدمه: با توجه به اهمیت سلامت روانی پس از زايمان، این مطالعه با هدف بررسی تأثیر نوشتن افکار و احساسات بر اختلال استرس پس از سانحه و افسردگی پس از زایمان به روش مرور نظام‌مند انجام شد. روش‌ها: در این مطالعه‌ی مروری نظام‌مند پایگاه‌های فارسی و پایگاه‌های انگلیسی مورد جستجو قرار گرفتند. واژگان کلیدی بر اساس Medical subject heading (MeSH) و شامل «افسردگی پس از زایمان»، «نوشتن احساسات» و «اختلال استرس پس از سانحه» و نیز «Postpartum depression»، «Writing»، «Postpartum period» و «Post-Traumatic stress disorder» بودند که جستجوی ترکیبی واژگان کلیدی با استفاده از عملگرهای «and»، «or» و «not» بدون محدودیت زمانی تا شهریور ماه ۱۳۹۹ انجام شد. ارزیابی کیفیت مقالات وارد شده به مطالعه با استفاده از آخرین ویرایش چک لیست CONSORT 2017 انجام شد. یافته‌ها: در جستجوی اولیه از پایگاه‌های اطلاعاتی در مجموع 275 مقاله یافت شد که 110 مقاله به دلیل تکراری بودن مقالات و 142 مقاله به علت عدم داشتن شرایط ورود، از مطالعه خارج شدند. پس از بررسی متن کامل 23 مقاله، در نهایت 6 مقاله وارد مطالعه شدند. یافته‌های پژوهش نشان داد که مداخلات نوشتن احساسات با کاهش مؤثر افسردگی، استرس و علایم اختلال استرس پس از سانحه همراه است. نتیجه‌گیری: نوشتن احساسات یک انتخاب مناسب برای زنان است که باعث کاهش علایم استرس پس از سانحه می‌شود و کارایی آن برای افسردگی، قابل توجه بوده است. بنابراین، پیشنهاد می‌شود که در آینده، مطالعات کارآزمایی‌های بالینی بیشتری باید اثربخشی مداخلات نوشتاری طولانی‌تر، مکرر و هدفمندتر را بررسی کند.

Introduction Isfahan functional disorders (ISFUN) cohort study aims to describe the interplay of genetic and environmental factors in shaping the characteristics of functional somatic syndromes (FSS). This study is primarily intended to investigate the epidemiology, risk factors, course and prognosis of FSSs in a sample of adult Iranian population. The other aim is to develop a new delimitation of FSSs based on an integrated multidisciplinary approach comprising of phenotypic and multiomics data.Methods and analysis ISFUN is a population-based prospective cohort study designed to follow a population of randomly selected seemingly healthy adults (18–65 years) through annual visits during a 4-year observation period. Structured questionnaires are used for data collection and clinical assessment of the participants. Questionnaire-based diagnosis of FSSs are validated in a medical interview. Human DNA genotyping, microbial amplicon sequencing and urine analysis is under progress for genomics, microbiota and metabolomics profiling, respectively. Enrolment began in September 2017, and study completion is expected in 2022. A total number of 1943 participants were initially recruited.Ethics and dissemination Ethical approval for data collection was granted by the National Research Ethics Committee of the Iranian Ministry of Health and Medical Education and the Research Ethics Committee of Isfahan University of Medical Sciences (IR.MUI.REC.1395.1.149). Following the description of the study procedure, we obtained written informed consent from all study participants. Study findings will be disseminated through peer-reviewed publications and presentations at scientific meetings.

Background and purpose: Shoulder dystocia is an obstetrics emergency which could be prevented by identifying its predictors and taking effective measures. The aim of this study was to determine the relationship between maternal factors and interventions for shoulder dystocia. Materials and methods: In this descriptive correlational study, we studied 6520 delivery files in a hospital in Sabzevar, Iran 2017-2018. All vaginal deliveries at 37-42 weeks with cephalic presentation were investigated and data of deliveries with shoulder dystocia (n=212) and without this condition (n=6308) were extracted using a researcher-made checklist. Mann-Whitney, Chi-square and logistic regression were applied for data analysis. Results: Findings showed significant differences between the two groups in mean age (P

Objective: Major birth defects are inborn structural or functional anomalies with long-term disability and adverse impacts on individuals, families, health-care systems, and societies. Approximately 20% of birth defects are due to chromosomal and genetic conditions. Inspired by the fact that neonatal deaths are caused by birth defects in about 20 and 10% of cases in Iran and worldwide respectively, we conducted the present study to unravel the role of chromosome abnormalities, including microdeletion/microduplication(s), in multiple congenital abnormalities in a number of Iranian patients. Materials and Methods: In this descriptive cross-sectional study, 50 sporadic patients with Multiple Congenital Anomalies (MCA) were selected. The techniques employed included conventional karyotyping, fluorescence in situ hybridization (FISH), multiplex ligation-dependent probe amplification (MLPA), and array comparative genomic hybridisation (array-CGH), according to the clinical diagnosis for each patient. Results: Chromosomal abnormalities and microdeletion/microduplication(s) were observed in eight out of fifty patients (16%). The abnormalities proved to result from the imbalances in chromosomes 1, 3, 12, and 18 in four of the patients. However, the other four patients were diagnosed to suffer from the known microdeletions of 22q11.21, 16p13.3, 5q35.3, and 7q11.23. Conclusion: In the present study, we report a patient with 46,XY, der(18)[12]/46,XY, der(18), +mar[8] dn presented with MCA associated with hypogammaglobulinemia. Given the patient’s seemingly rare and highly complex chromosomal abnormality and the lack of any concise mechanism presented in the literature to justify the case, we hereby propose a novel mechanism for the formation of both derivative and ring chromosome 18. In addition, we introduce a new 12q abnormality and a novel association of an Xp22.33 duplication with 1q43q44 deletion syndrome. The phenotype analysis of the patients with chromosome abnormality would be beneficial for further phenotype-genotype correlation studies.

Introduction: In several countries, students’ open day is a permanent part of formal university programs. The purpose of this program which is run annually is to provide an opportunity for K12 students to meet university teachers and students and discuss about atmosphere (mainly educational atmosphere) of that university. This article is a report of the first education and research open day of Isfahan University of Medical Sciences which was held for high school students. Methods: In this study, performed in academic years of 2007-2008 in Isfahan, 120 students of 12 high schools having highest admission rate in university entrance exams were invited. The program included lectures about critical thinking, clinical and basic research, a video clip on university students' prevalent problems associated with research, a video show of noble winners of 2002, a panel to introduce research perspective of different disciplines in university to the students, and finally visit of exhibition of university students' research outputs. Moreover, each participant received a package containing booklets of university overview as well as its majors. Then a questionnaire for determination of students' research and education needs and interests as well as their opinions about the open day was delivered to them. Frequency measures were used for descriptive analysis. Inferential analysis was performed using chi2 and T test. Results: 68 students from 6 high schools (56.6% of invitees) participated in students’ open day and 58 students (85%) filled the questionnaire. According to questionnaires, 37 participants (67%) selected medicine as their first choice. Among major selection motivating factors, only there was a significance differences between two sexes considering the aspect of making money (P=0.031). Thirty two students (55%) were satisfied with their information about university major selection. The first choice of 60% of participants (35 students) was Isfahan University of Medical Sciences and 88% of attendees (46 students) were satisfied with taking part in this program. Conclusion: Holding such a program implies feasibility and necessity of performing similar programs to make students more familiar with universities' research and education capacities and facilities. The results also show that there is a need to give more information about major selection to high school students and also to increase their research abilities through well designed courses and workshops during high school and early university years.

Background: Stem cells are undifferentiated cells that can turn into any number of differentiated and specific cell types. For years, stem cell assisted therapy has been accepted as a standard treatment method for the management of some diseases. Scientists hope that this method can be expanded and used for the treatment of other diseases. One of the main concerns in the field of stem cell therapy research is the safety of these cells. This article assessed the safety of using mesenchymal fibroblasts, keratinocytes, melanocytes and skeletal myoblasts in clinical trials. Methods: A systematic search of reliable electronic databases was performed in order to find all articles related to safety of the mentioned cells. After studying all the articles critically, the preliminary results were reviewed and criticized by experts through Delphi method. Ultimately, the final draft was reviewed and approved by all the members of the Regional Research Ethics Committee. Findings: Overall, 62 articles were retrieved and studied. Conclusion: Since we did not find any reports of serious complications for fibroblast, keratinocyte and melanocyte cells, especially about their in-vivo uncontrolled proliferation, it is possible to give ethical approval for research in these fields (considering all ethical codes and principles). However, according to serious complications reported for skeletal myoblast cells transplantation, giving ethical approval for using this cell type in human research requires strict commitment to precise methods (such as inclusion criteria, patient follow-up methods, and prophylactic treatments). The ethical approval should be issued by the research ethics committee of the corresponding university after accurate reviews. Finally, repeating previous research which has resulted in arrhythmia and tissue injury is unethical and thus not recommended.

Background: One of the reasons of uncertainty in choosing a specific clinical specialty is wrong decision-making. This study was conducted to train professional decision-making skills to medical students at internship and externship course levels in the form of a workshop. We also reviewed the impacts of the workshop on reducing indecisiveness in selecting a clinical specialty. Methods: This was a quasi-experimental study on 43 medical students at internship and externship course levels at Isfahan University of Medical Sciences, Isfahan, Iran. Before holding the workshop, students completed the hesitation and indecision scales. The participants were taught about decision-making skills for 15 hours. Immediately after the course and a month later, the students completed the same questionnaires again. The information and scores related to the pre-test, post-test, and one-month follow-up were analyzed using t-tests in SPSS. Findings: There was a significant difference in scores of hesitation scale at pre-test, post-test, and follow-up (P = 0.033). However, there was no significant difference in the scores of indecision scale (P = 0.151). There was no significant correlation between scores of students and different educational levels, sex, and marital status (P > 0.05). Therefore, training on professional decision-making skills reduced hesitation in selecting clinical specialty among medical students. However, it had no significant impact on their indecision. Conclusion: The professional decision-making skills training course reduced uncertainty in selecting clinical specialty among medical students. They were thus satisfied with participation in the course. They were also willing to attend complementary programs on selecting clinical specialty. Therefore, such an educational course is recommended to be held for all students who like to continue specialized studies in medicine during their medical course, especially in the first year of university.

The first national medical science Olympiad suggested by Isfahan University of Medical Sciences was hold in 2009 in Isfahan. The venture had the mission to identify and flourish potentials in Iranian medical science students - the health system's capital. The ministry of health in collaboration with the affiliated universities hosted 364 medical science students. Students formed teams of three members and competed excitingly in a friendly atmosphere in solving problems which could help promote our health system or basic medical sciences. To reach better coordination, meetings with authorities of ministry of health and academic members of universities were held. 35 academic members from 13 universities formed committees to set questions/ problems to be discussed and solved. Questions were of Key features, scenario, script concordance, matching, and open ended types. Individual and group tests on three domains (clinical reasoning, basic science reasoning, and health system managerial reasoning) were held in 2 days each. To assess the quality of the tests and also the Olympiad itself, students were asked to take part in a survey. Most participants (94%) believed there was a difference between the Olympiad and the usual university exams. Also about 60% found the quality of the event satisfactory and 72% said they would encourage friends to take part in the following year’s Olympiad. It appears that such events, creating an exciting and happy atmosphere, could help nurture educational creativity in students and inspire them to go beyond routine studying and thus fill certain educational gaps in health system. The Olympiad being the first medical experience of the kind, further studies and modifications will certainly be necessary to improve it further.

Introduction: Health system management is regarded a chief duty and skill of health care providers. However, medical students do not receive enough training for it. The first national Olympiad for students of medical sciences was designed to motivate students for acquiring managerial skills, improve reasoning and problem solving skills, and also propagate team working in students in an excitingly competitive and joyful atmosphere. Methods: Designing a model for the olympiad included four phases: building up a framework for designing the exam questions, determining topics of the exam, setting the exam questions and administering it, and finally judging. In summer 2009 the first national olympiad for the students of medical sciences on reasoning & decision making in health system management was held in Isfahan University of Medical Sciences. The first two days of the five-day-long open source olympiad were spent on individual competition. The following three days were devoted to group competitions. Six groups of three Students competed in this part. Results: After 19 months, with the help of a large group of university teachers with related specialties, a framework for the selection of the exam questions was built up. The themes of the Olympiad were decided to be Health policy and health economics. The topic for group competition phase was current problems in implementation of the family physician project in Iran. In the individual competition phase, the students were to answer 194 questions and in the group phase they were asked 3 open-ended questions. 106 students studying different medical fields nationwide participated in the event 71 students (66.98%) were girls. most participants were students of medicine (33 students) and others were students of nursing (26 students), health management (20 students), and other fields of study (27 students). Conclusion: Considering the significance of medical students' awareness of heath system management and the importance of improving reasoning and decision making abilities in them, holding such examinations could facilitate the achievement of these objectives.

Clinical reasoning is not only a critical skill in medicine, but also central to the clinical practice. Considering that there is no method of assessing clinical reasoning based on the theoretical framework of medical expertise research, we could approach assessment in an innovative way taking the model of clinical reasoning as a guide. In this model three major components of clinical reasoning (i.e. information gathering, hypothesis formation and hypothesis evaluation) have been measured, treating them collectively as a single score that reflects clinical reasoning competency. This battery permits the inclusion of different formats of clinical reasoning tests that cannot be administered simultaneously and assesses different aspects of clinical reasoning. This article explains the process of designing and implementing the battery of clinical reasoning in the first Olympiad for medical sciences students using action research method.

Payesh2009; 8: 343-348Accepted for publication: 27 November 2008[EPub a head of print-17 August 2009] Objective(s): To evaluate the effect of menopausal training for husbands on perceived social support by peri menopausal women.Methods: In this clinical trial, 102 women aged 45-60 years were randomly assigned in two groups in Gonabad, Iran. Demographic questionnaire and social support scale completed by all of the women and knowledge questionnaire completed by their husbands, then face to face education about menopause were scheduled for husbands in intervention group. One month later all of the women completed social support scale and their husbands completed knowledge questionnaire.Results: The mean knowledge score of husbands in intervention group was higher after training (10.40 vs 7.35) and the difference was statistically significant (P

Introduction. Continuous evaluation is necessary for improving and promoting the quality of clinical education. The purpose of this study was to determine the views of nursing and midwifery students of Gonabad University of Medical Science about the condition of clinical education. Methods. This was a cross-sectional survey in which 140 nursing and midwifery students registered as day or night students were selected by census sampling method. They were studied using a questionnaire consisted of 4 sections about instructor’s performance, cooperation of staff, patients and students, facilities and equipments of clinical environment and clinical evaluation system. Data was analyzed by SPSS software using descriptive statistics, t-test, Mann Whitney and Pearson correlation coefficient. Results. Most of the students evaluated the instructor’s performance, good with the mean and standard deviation of 62.3±15.7, cooperation of staff, patients and students, at a borderline level(between good and intermediate) with the mean and standard deviation of 51.4±22.4, facilities and equipments, at an intermediate level with the mean and standard deviation of 30.64±19.2 and clinical evaluation system at an intermediate level with the mean and standard deviation of 37.6±27.7. There was no significant difference between nursing and midwifery students' viewpoints about different aspects of clinical education. Conclusion. In order to improve the situation of clinical education in nursing, it is recommended to provide facilities and equipments for clinical environments and revise the tools and process of clinical evaluation. These points have been confirmed by other studies as well. Improving instructors' performance and encouraging professional cooperation could lead to the improvement of clinical education.

Target groups: General physicians Educational goals After reading this tutorial, the learner should know the following: • define chronic stable angina • differentiate between acute coronary syndromes and chronic stable angina • identify methods to diagnose and evaluate chronic stable angina • identify pharmaceutical treatments of chronic stable angina • identify pharmaceutical therapies to improve chronic stable angina prognosis • provide necessary recommendations for patients suffering from chronic stable angina • follow up the patients with chronic stable angina Keywords: Angina pectoris, Stable, Chronic, Clinical practice guideline

فراگیر باید در پایان مطالعه این خودآموز: • تعریف و انواع یبوست را بداند. • روش‌های بررسی و تشخیصی یبوست را بداند. • توصیه‌های غیر دارویی لازم برای درمان یبوست را فراگرفته باشد. • درمان‌های دارویی یبوست را در شرایط مختلف بداند. • نحوه‌ی پیگیری بیمار مبتلا به یبوست را فراگرفته باشد. • اندیکاسیون‌های ارجاع بیمار به متخصص را فراگرفته باشد. واژگان کلیدی: یبوست، راهکار بالینی، مزمن، بالغین

Background: Free radicals are the known mechanisms responsible for inducing colitis with two origins: Inflammatory cells and tissues. Only the inflammatory cells can be controlled by corticosteroids. Our aim was to assess the importance of neutrophils as one of the inflammatory cells in inducing colitis and to evaluate the efficacy of corticosteroids in the treatment of inflammatory bowel disease (IBD). Materials and Methods: Thirty-six mice were divided into six groups of six mice each. Colitis was induced in three groups by exposing them to acetic acid through enema (group 1), ex vivo (group 3), and enema after immune suppression (group 5). Each group had one control group that was exposed to water injection instead of acetic acid. Tissue samples were evaluated and compared based on macroscopic damages and biochemical and pathological results. Results: Considering neutrophilic infiltration, there were significant differences between groups 1, 3, 5, and the control of group 1. Groups 3, 5, and their controls, and group 1 and the control of group 3 had significant differences in terms of goblet depletion. Based on tissue originated H 2 O 2 , we found significant differences between group 1 and its control and group 3, and also between groups 5 and the control of group 3. All the three groups were significantly different from their controls based on Ferric Reducing Ability of Plasma (FRAP) and such differences were also seen between group 1 with two other groups. Conclusion: Neutrophils may not be the only cause of oxidation process in colitis, and also makes the effectiveness of corticosteroids in the treatment of this disease doubtful.

BACKGROUND: Efficacy of xanthine oxidase inhibitors on the improvement of cardiac performance is not clearly defined. This study was designed to study the efficacy of allopurinol on the improvement of left ventricular ejection fraction (LVEF) in patients with chronic heart failure. METHODS: A randomized, double blind, placebo controlled clinical trial was performed on two groups of patients suffered from class II to III heart failure of New York Heart Association classification. 16 cases were in intervention group who intake allopurinol (100 mg/day in the first three days, 200 mg/day in the second three days and 300 mg/day for one month); 15 cases were in control group and intaked placebo like case group. Left ventricular ejection fraction was measured by echocardiography with Simpson's method and compared before and after the intervention. FINDINGS: The mean of LVEF before and after intervention, in case group were 38.8±9.9 and 41.9±9.7 respectively (p0.05). In intervention group EF was increased 3.1% from base level. CONCLUSION: Allopurinol can be effective in improvement of cardiac performance. However its clinical use for heart failure patients needs to be approved by more trials, in various situations and longer periods. KEY WORDS: Heart failure, left ventricular ejection fraction, xanthine oxidase inhibitors, allopurinol, clinical trial.