Search

Background: There have been many challenges with clinical interventions and policy decisions to enhance the quality of life and care for patients facing life-threatening illnesses, thus highlighting the need for ethical considerations and guidelines for palliative care of terminally ill patients. Aim: To document the development of guidelines for addressing ethical concerns in the palliative care of terminally ill patients in Islamic Republic of Iran. Methods: The guidelines were developed in 4 phases: a scoping review of existing palliative care guidelines on PubMed, Scopus, Web of Science, Google Scholar, and 2 Persian databases; focus group discussions to improve the drafts guidelines; online opinion poll of 32 experts, including ethicists, religious scholars, psychologists, palliative care specialists, and sociologists; and a national workshop to produce the final guidelines for government approval. Results: We published the "National palliative care ethical guidelines and regulations for terminally ill patients" in Islamic Republic of Iran after endorsement and approval by the High Council of Medical Ethics. The guidelines provides recommendations on 5 main aspects of palliative care: structure, composition and qualification of interdisciplinary teams; the roles and responsibilities of ethics advisors; general ethical principles governing palliative care practice; specific guidelines for psychological, spiritual and religious support; and protocols for ethical decision-making in end-of-life care. Conclusion: Considering the challenges associated with palliative care, it is necessary to provide ethical guidelines specific to the needs of terminally ill patients. These guidelines will serve as a steppingstone towards integrating palliative care into the national healthcare services in Islamic Republic of Iran. [ABSTRACT FROM AUTHOR]

Abstract Background In the diagnostic reasoning process medical students and novice physicians need to be made aware of the diagnostic values of the clinical findings (including history, signs, and symptoms) to make an appropriate diagnostic decision. Diagnostic reasoning has been understood in light of two paradigms on clinical reasoning: problem solving and decision making. They advocate the reasoning strategies used by expert physicians and the statistical models of reasoning, respectively. Evidence-based medicine (EBM) applies decision theory to the clinical diagnosis, which can be a challenging topic in medical education. This theoretical article tries to compare evidence-based diagnosis with expert-based strategies in clinical diagnosis and also defines a novel concept of category-oriented likelihood ratio (LR) to propose a new model combining both aforementioned methods. Discussion Evidence-based medicine advocates the use of quantitative evidence to estimate the probability of diseases more accurately and objectively; however, the published evidence for a given diagnosis cannot practically be utilized in primary care, especially if the patient is complaining of a nonspecific problem such as abdominal pain that could have a long list of differential diagnoses. In this case, expert physicians examine the key clinical findings that could differentiate between broader categories of diseases such as organic and non-organic disease categories to shorten the list of differential diagnoses. To approach nonspecific problems, not only do the experts revise the probability estimate of specific diseases, but also they revise the probability estimate of the categories of diseases by using the available clinical findings. Summary To make this approach analytical and objective, we need to know how much more likely it is for a key clinical finding to be present in patients with one of the diseases of a specific category versus those with a disease not included in that category. In this paper, we call this value category-oriented LR.

Background & Objective: Previous studies have addressed the electrolyte abnormalities such as hypocalcemia in COVID-19 patients. We aimed to compare the laboratory findings especially the electrolyte levels among COVID-19 patients and healthy controls and evaluate their prognostic values. Methods: This case-control study included 91 COVID-19 patients and 169 healthy individuals. Their laboratory parameters including electrolytes, albumin, liver enzymes, complete blood count, vitamin D, and parathyroid hormone (PTH) were compared. We also analyzed the association between these markers and the major outcomes including severity, mortality and hospitalization. Results: Among patients with COVID-19, 59.3% of the patients had hypocalcemia on admission while in control group only 32.5% had low calcium level (OR=3.02, 95% CI: 1.79-5.13, P<0.001). The rates of death and ICU admission were significantly higher among the patients in hypocalcemic group than those of eucalcemic group (85.7% vs 14.3% and 33.3% Vs 9.1%, respectively). However, there was no significant difference in the mean PTH and vitamin D levels between the two groups. In terms of the severity of the infection, 74.1% of patients in hypocalcemic group had a severe infection while 24.3% of the patients in eucalcemic group were diagnosed with severe infection (OR=8.89, 95% CI: 3.38-23.37, P<0.001). Conclusion: Patients with COVID-19 may present with considerable laboratory abnormalities including hypocalcemia. The hypocalcemia would be also associated with worse major clinical outcome and higher mortality risk. [ABSTRACT FROM AUTHOR]

Purpose: Improving physicians' critical thinking abilities could have meaningful impacts on various aspects of routine medical practice, such as choosing treatment plans, making an accurate diagnosis, and reducing medical errors. The present study aimed to measure the effects of a curriculum integrating critical thinking on medical students' skills at Tehran University of Medical Sciences, Iran. Methods: A 1-group pre-test, post-test quasi-experimental design was used to assess medical students' critical thinking abilities as they progressed from the first week of medical school to middle of the third year of the undergraduate medical curriculum. Fifty-six participants completed the California Critical Thinking Skills Test twice from 2016 to 2019. Results: Medical students were asked to complete the California Critical Thinking Skills Test the week before their first educational session. The post-test was conducted 6 weeks after the 2 and half-year program. Out of 91 medical students with a mean age of 20±2.8 years who initially participated in the study, 56 completed both the pre- and post-tests. The response rate of this study was 61.5%. The analysis subscale showed the largest change. Significant changes were found in the analysis (P=0.03), evaluation (P=0.04), and inductive reasoning (P<0.0001) subscales, but not in the inference (P=0.28), and deductive reasoning (P=0.42) subscales. There was no significant difference according to gender (P=0.77). Conclusion: The findings of this study show that a critical thinking program had a substantial effect on medical students' analysis, inductive reasoning, and evaluation skills, but negligible effects on their inference and deductive reasoning scores. [ABSTRACT FROM AUTHOR]

Nowadays, improvement of thinking skills of students is one of the universally supported aims in the majority of medical schools. This study aims to design longitudinal theme of reasoning, problem-solving and decision-making into the undergraduate medical curriculum at Tehran University of Medical Sciences (TUMS). A participatory approach was applied to design the curriculum during 2009-2011. The project was conducted by the contribution of representatives of both basic and clinical faculty members, students and graduates at Tehran University of Medical Sciences. The first step toward integrating cognitive skills into the curriculum was to assemble a taskforce of different faculty and students, including a wide variety of fields with multidisciplinary expertise using nonprobability sampling and the snowball method. Several meetings with the contribution of experts and some medical students were held to generate the draft of expected outcomes. Subsequently, the taskforce also determined what content would fit best into each phase of the program and what teaching and assessment methods would be more appropriate for each outcome. After a pilot curriculum with a small group of second-year medical students, we implemented this program for all first-year students since 2011 at TUMS. Based on findings, the teaching of four areas, including scientific and critical thinking skills (Basic sciences), problem-solving and reasoning (Pathophysiology), evidence-based medicine (Clerkship), and clinical decisionmaking (Internship) were considered in the form of a longitudinal theme. The results of this study could be utilized as a useful pattern for integration of psycho-social subjects into the medical curriculum. [ABSTRACT FROM AUTHOR]

Physicians all through the world visit patients under time limitations. The most important troubled clinical skill under 'time constraint' is the diagnostic approach. In this situation, clinicians need some diagnostic approaches to reduce both diagnostic time and errors. It seems that highly experienced physicians utilize some special tactics in this regard. Evidence-based medicine (EBM) as a relatively new paradigm for clinical practice stresses on using research evidences in diagnostic evaluations. The authors aimed to evaluate experts' strategies and assess what EBM can add to these tactics. They reviewed diagnostic strategies of some veteran internists in their busy outpatient clinics and proposed an evidence-based diagnostic model engaging clinical experience and research evidence. It appears that every clinician utilizes a set of 'key pointer' questions for decision-making. In addition to use of evidence-based resources for making differential diagnosis and estimating utility of various diseases, clinicians should use 'key pointers' with significant likelihood ratios and from independent systems to reduce time and errors of history taking. Clinical trainees can improve their practice by constructing their own set of pointers from valid research evidences. Using this diagnostic model, EBM can help physicians to struggle against their 'time constraint'. [ABSTRACT FROM AUTHOR]

Islamic and non-religious ethics discourses have similarities and differences at the levels of meta-, normative, and applied ethics (e.g. biomedical ethics). Mainstream biomedical ethics (MBME) uses the language of contemporary, non-religious, Western ethics. Significant effort has been dedicated to comparing Islamic biomedical ethics (IBME) and MBME in terms of meta- and normative ethical positions, and final decisions on practical ethical issues have been reached. However, less attention has been given to comparing the general approaches of the two aforementioned discourses to ethical reasoning. Furthermore, IBME uses different languages to approach ethical reasoning, but identification and conceptualization of these approaches are among the important gaps in the literature. The aim of this study was to conceptualize general approaches to ethical reasoning in IBME. Through review and content analysis of the existing literature and the comparison between the languages employed by IBME and MBME, an inductive distinction have been made. The languages used in conceptualized approaches include the followings: (i) a language in common with the one employed by MBME; (ii) MBME language adjusted to the basic, common beliefs of Muslims; (iii) a language based on fatwas; and (iv) a language based on IBME principles. In the authors' opinion, major challenges of the above-mentioned four approaches include, respectively: identifying the lack of religious sensitivity or Islamic considerations regarding an issue; acknowledging specific beliefs as the basic, common beliefs of Muslims; diverse fatwas and relations between juridical soundness and ethical soundness; and agreement on the same principles and rules as well as who should apply them. [ABSTRACT FROM AUTHOR]

Background: Adherence to medical ethics principles by medical professionals is required to improve health-care system's quality. Recognizing medical ethics' challenges and attempting to resolve them are important in the implementation of medical ethics in practice. This study aimed to explore such challenges at Iran's medical sciences universities in 2018., Materials and Methods: This descriptive, qualitative study utilized a conventional content analysis approach for data analysis. This study was conducted using purposeful sampling from participants with experience in teaching or practicing of medical ethics field, and by considering maximum variety of disciplines (e.g., gynecology, internal medicine, surgery, and medical ethics). The data were gathered using semi-structured interviews. The interview guide was designed based on previous research findings by two members of the research team and contained the main interview questions and participants had the opportunity to express their perspectives in detail. Participants were chosen from clinical and ethical faculty members as well as managers. The data collection process continued until the data saturation stage, beyond which no new information or concept achieved by continuing interviews., Results: After interviewing 14 faculty members and managers, findings were classified into 4 themes, 9 categories, and 42 sub-categories; four main categories of medical ethics challenges are affected by cognitive, educational, practical, and structural factors, respectively., Conclusion: This study suggested that medical ethics' cognitive and educational challenges can alleviate using educational programs intended for improving qualitative and quantitative aspects of medical ethics teaching for medical professionals ranging from students to faculty members. Medical ethics' structural and practical challenges are within policymaking and scheduling activities dealt with through future researches by health-care system's managers and planners., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)