A BSTRACT Medical education is socially responsible for a global educational movement that transforms the development and presentation of medical schools in higher education. Therefore, in the present systematic review, we aimed to evaluate the impact of socially accountable health professional education. Published research articles were reviewed by searching the relevant terms invalid databases. In the initial search, 2340 records were obtained. At this stage, 1482 records were deleted due to duplication, and 773 records were removed due to indirect connection with the subject. Then, 85 articles were retrieved for full-text review. Finally, the complete review led to the selection of nine studies that met all inclusion criteria. Based on the results of the present systematic review, among the nine reviewed articles, four studies (44.44%) evaluated the effectiveness of social accountability on increasing the sense of empowerment, self-confidence, competencies such as teamwork, communication skills, and readiness for work. Three studies (33.333%) assessed the effectiveness of social accountability on providing further and better medical services and reducing infant mortality. Also, in two articles (22.22%), students’ lack of knowledge about social accountability was studied. Social accountability can help cultivate a healthy and skilled medical workforce and be effective in improving health services provided to the people. On the other hand, there are different perceptions and views on what social responsibility really is and how its effectiveness can be measured. Also, it is highly important to provide awareness in this regard for students.
The high prevalence of foot problems among older people and their destructive effects on independence and quality of life are among significant issues in geriatrics (Menz, 2008). Foot problems decrease mobility in older people and are considered important risk factors for falls. Impaired foot protective sensation (Chaiwanichsiri et al., 2009), foot pain, hallux valgus and deformities of the lesser toes (Awale et al., 2017;Menz et al., 2018) have been indicated to have relationships with falls in older people. In addition, reduced range of motion of the ankle joint and reduced strength of the toe flexors have been identified as risk factors for falls in older people (Menz et al., 2006).The ability to carry out daily activities independently and painlessly has a determining effect on the older people's health-related quality of life. Musculoskeletal problems are among the main causes of disability and reduced quality of life in older people (Jover et al., 2015;Minetto et al., 2020). Studies indicate that foot problems have
We report a 74-year-old male with a recent history of COVID-19 pneumonia who was admitted with acute periumbilical and left lower quadrant pain and respiratory distress. Laboratory data showed pre-renal azotemia and microscopic hematuria. An abdominopelvic computerized tomography (CT) scan with intravenous contrast was conducted, showing signs of right renal vein thrombosis (RVT) with extension to inferior vena cava (IVC), without any evidence of renal ischemia. The patient did not have any risk factors for thrombosis except for probable hypercoagulopathy due to COVID-19 and diabetes mellitus. He was not an appropriate candidate for surgical or radiologic thrombectomy, thus received heparin infusion accordingly. Unfortunately, he died after the cardiopulmonary arrest on the second day of admission. Considering his respiratory distress, we suspect pulmonary embolism as the most probable cause of death.
Pulmonary embolism (PE) is the most severe clinical presentation of venous thromboembolism (VTE), which can be challenging to diagnose due to its non-specific symptoms. The overlapping clinical symptoms of Coronavirus disease 2019 (COVID-19) and PE may make distinguishing between the two difficult. Thus, the diagnosis of PE may be delayed or missed, with grave consequences for the patient's outcome and safety. We herein present the case of a 63-year-old Iranian female admitted to our hospital showing symptoms of delirium superimposed on dementia. Soon after her admission, she developed a fever and respiratory symptoms. However, overestimating the likelihood of COVID-19 pneumonia and attributing the patient's symptoms to this disease led to a delayed diagnosis and treatment of pulmonary embolism, resulting in the patient's death. During the COVID-19 pandemic, a high index of suspicion is required for the timely diagnosis of PE, especially in patients with identifiable risk factors. This is specifically true for older patients who cannot express their symptoms due to neurocognitive disorders.
Introduction and Objective: The study of the methods of controlling labor pain is very important. One of the methods of pain relief is spinal anesthesia. Due to the different opinions about the effects of spinal anesthesia on the delivery process and maternal and fetal consequences, this study aimed to evaluate the effects of spinal anesthesia and compare it with normal vaginal delivery without spinal anesthesia. Methods: In this retrospective cohort study, 120 mothers, who were admitted to the maternity ward of Firoozabadi Hospital for delivery, were examined. The patients who met the inclusion criteria were divided into two groups of 60 people, one group receiving spinal anesthesia and one without spinal anesthesia, and then, were evaluated in terms of clinical variables and complications of the mother and fetus. Data were analyzed using SPSS statistical software. Results: The mean age of the mothers was 26.6 ± 5.9 years. Five mothers (4.2%) who received spinal anesthesia underwent emergency cesarean section and a significant difference was shown between the two groups ( P = 0.02). The mean duration of the active phase of labor did not show a statistically significant difference between the two groups ( P = 0.2), but the duration of the second phase of labor was significantly longer in the mothers who received spinal anesthesia ( P = 0.008). Conclusion: Spinal anesthesia can be used as a low-complication method in vaginal delivery to reduce pain.
It is thought that an excessive motor cortical facilitation is involved in the physiopathology of chronic pain in fibromyalgia. Studies have shown that transcranial direct current stimulation (tDCS) changes motor cortex excitability according to the stimulation polarity. Based on these effects, it is conceivable to hypothesize that tDCS, which can modulate brain activity, may induce pain relief in patients with fibromyalgia. Fifty older women with fibromyalgia were included in this randomized, doubleblind, single-center placebo-controlled trial study. Patients received sham stimulation or real tDCS with the anode centered over the primary motor cortex (M1) and the cathode over the contralateral supraorbital area (2 mA for 20 minutes for 10 sessions). Pain intensity was evaluated using the visual analog scale for pain. Assessments were done before treatment and 30 days after the last session of stimulations. The mean age of participants was 58.20 years (SD = 7.80) with an age range from 55 to 74 years.Results showed no statistically significant baseline difference among patients in demographics and clinical characteristics. Comparing visual pain analogue between the sham and treatment groups revealed a statistically significant difference (p value < 0.001) for VAS immediately after intervention and 1 month post intervention between the sham and treatment groups. Analysis of data also showed a significant reduction in pain immediately after intervention and one month post-intervention in the treatment group compared to the sham group. Anodal tDCS is an effective non-invasive technique for pain reduction in elderly women with FM. The clinical improvements observed in the current study may have considerable impacts on pain experienced by elderly women with FM.
This meta-analysis aimed to summarize the evidence regarding attitudes of Iranian nurses and related factors towards end-of-life (EOL) care. PubMed, Web of Science, Scopus, Magiran, Iranmedex, Scientific Information Database, and Google Scholar search engine were searched using Persian and English appropriate keywords from the earliest records up to September 11, 2020. A total of 849 nurses were included in six studies. After a meta-analysis of the mean score of nurses' attitudes, the pooled mean was 80.07 out of 120 (Q(5)=4.32, I-squared=0.00%; 95%CI: 73.53–86.60; p < 0.001). Marital status, ward type, education level, a history of participating in EOL care workshops, personal study of EOL care, experience of caring for a dying family member or close people, natural and approach acceptance, fear of death, and professional autonomy had a significant positive relationship with nurses' attitudes towards EOL care. Therefore, further large-scale studies considering potential confounding variables are needed to confirm our findings.
Background: Pulmonary embolism (PE) is the most serious clinical presentation of venous thromboembolism (VTE), a major cause of sudden death. In the current Coronavirus disease 2019 (COVID-19) pandemic, when a patient presents with respiratory symptoms, many serious possible non-Covid causes including PE may be considered the next priority after COVID-19 on the differential diagnosis list. Thus, the correct diagnosis may be delayed or missed, with grave consequences to the patient’s outcome and safety. Case Presentation: We herein present a case of a 63-year-old Iranian female who was admitted to our hospital showing symptoms of delirium superimposed on dementia. Soon after admission, she developed fever and respiratory symptoms. However, overestimating the likelihood of COVID-19 pneumonia and attributing the patient’s symptoms to this disease led to delayed diagnosis and treatment of pulmonary embolism, resulting in the patient’s death.Conclusions: During the COVID-19 pandemic, a high index of suspicion is required for the timely diagnosis of PE, especially in patients with identifiable risk factors. This is specifically true for patients who are unable to express their symptoms due to neurocognitive disorders.
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