Health care is fallible and prone to diagnostic and management errors. The major categories of diagnostic errors include: (1) no-fault errors--the disease is present but not detected; (2) system errors--a diagnosis is delayed or missed because of the imperfection in the health care system; and (3) cognitive errors--a misdiagnosis from faulty data collection or interpretation, flawed reasoning, or incomplete knowledge. Approximately one third of patient problems are mismanaged because of diagnostic errors. Part of the solution lies in improving the diagnostic skills and critical thinking abilities of physicians as they progress through medical school and residency training. However, this task is challenging since both medical problem-solving and the learning environments are complex and not easily understood. There are many interacting variables including the motivation of the medical student (e.g. deep versus surface learning), the acquisition and evolution of declarative and conditional knowledge (e.g. reduced, dispersed, elaborated, scheme, and scripted), problem-solving strategies (e.g. procedural knowledge-guessing, hypothetical deductive, scheme inductive, and pattern recognition), curricular models (e.g. apprenticeship, discipline-based, body system-based, case-based, clinical presentation-based), teaching strategies (e.g. teaching general to specific or specific to general), the presented learning opportunities (PBL versus scheme inductive PBL), and the nature of the learning environment (e.g. modeling critical thinking and expert problem-solving). This paper elaborates on how novices differ from experts and how novices can be educated in a manner that enhances their level of expertise and diagnostic abilities as they progress through several years of medical training.

There are few estimates of influenza burden in the WHO Region for the Eastern Mediterranean. In this study we estimated the burden of severe acute respiratory infection (SARI) and influenza-associated SARI (F-SARI) in selected provinces of Islamic Republic of Iran, the trends of SARI and confirmed cases of influenza (F-SARI) over 12 months (seasonality), and the age groups most at risk. Using the electronic Iranian influenza surveillance system and data of cases in sentinel hospitals of 3 selected provinces, we estimated the monthly trend (seasonality) of incidence for SARI and F-SARI, overall incidence of SARI and F-SARI and their disaggregation by age with the aid using the Monte Carlo technique. The age groups most at-risk were children aged under 2 years and adults older than 50 years. ‫و‬

This study showed the prevalence of influenza infections among Iranian pilgrims and general population and suggests continuing surveillance, infection control and appropriate vaccination especially nowadays that the risk of influenza pandemic threatens the world, meanwhile accurate screening for MERS-CoV is also recommended.

ImportanceThe protein-based SARS-CoV-2 vaccines FINLAY-FR-2 (Soberana 02) and FINLAY-FR-1A (Soberana Plus) showed good safety and immunogenicity in phase 1 and 2 trials, but the clinical efficacy of the vaccine remains unknown.ObjectiveTo evaluate the efficacy and safety of a 2-dose regimen of FINLAY-FR-2 (cohort 1) and a 3-dose regimen of FINLAY-FR-2 with FINLAY-FR-1A (cohort 2) in Iranian adults.Design, Setting, and ParticipantsA multicenter, randomized, double-blind, placebo-controlled, phase 3 trial was conducted at 6 cities in cohort 1 and 2 cities in cohort 2. Participants included individuals aged 18 to 80 years without uncontrolled comorbidities, coagulation disorders, pregnancy or breastfeeding, recent immunoglobulin or immunosuppressive therapy, and clinical presentation or laboratory-confirmed COVID-19 on enrollment. The study was conducted from April 26 to September 25, 2021.InterventionsIn cohort 1, 2 doses of FINLAY-FR-2 (n = 13 857) or placebo (n = 3462) were administered 28 days apart. In cohort 2, 2 doses of FINLAY-FR-2 plus 1 dose of FINLAY-FR-1A (n = 4340) or 3 placebo doses (n = 1081) were administered 28 days apart. Vaccinations were administered via intramuscular injection.Main Outcomes and MeasuresThe primary outcome was polymerase chain reaction–confirmed symptomatic COVID-19 infection at least 14 days after vaccination completion. Other outcomes were adverse events and severe COVID-19. Intention-to-treat analysis was performed.ResultsIn cohort 1 a total 17 319 individuals received 2 doses and in cohort 2 5521 received 3 doses of the vaccine or placebo. Cohort 1 comprised 60.1% men in the vaccine group and 59.1% men in the placebo group; cohort 2 included 59.8% men in the vaccine group and 59.9% in the placebo group. The mean (SD) age was 39.3 (11.9) years in cohort 1 and 39.7 (12.0) years in cohort 2, with no significant difference between the vaccine and placebo groups. The median follow-up time in cohort 1 was 100 (IQR, 96-106) days and, in cohort 2, 142 (137-148) days. In cohort 1, 461 (3.2%) cases of COVID-19 occurred in the vaccine group and 221 (6.1%) in the placebo group (vaccine efficacy: 49.7%; 95% CI, 40.8%-57.3%) vs 75 (1.6%) and 51 (4.3%) in cohort 2 (vaccine efficacy: 64.9%; 95% CI, 49.7%-59.5%). The incidence of serious adverse events was lower than 0.1%, with no vaccine-related deaths.Conclusions and RelevanceIn this multicenter, randomized, double-blind, placebo-controlled, phase 3 trial of the efficacy and safety of FINLAY-FR-2 and FINLAY-FR-1A, 2 doses of FINLAY-FR-2 plus the third dose of FINLAY-FR-1A showed acceptable vaccine efficacy against symptomatic COVID-19 as well as COVID-19–related severe infections. Vaccination was generally safe and well tolerated. Therefore, Soberana may have utility as an option for mass vaccination of the population, especially in resource-limited settings, because of its storage condition and affordable price.Trial Registrationisrctn.org Identifier: IRCT20210303050558N1

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The aim of this study was to identify problems arisen by conventional curricula, the guidelines for development of an appropriate educational model for 21st century, and the advantages and disadvantages of the last two curricular models. The medical education literature published from 1995 through 2002 of four reputable journals in medical education were searched (Academic Medicine, Teaching and Learning in Medicine, Medical Education, and Medical Teacher). First the possibly best articles were identified. During the second screening process 76 of 180 articles were found to be highly relevant to our questions. A review of the chosen articles revealed a concept map which starts from currently applied hypothetical-deductive reasoning (HDR)-based curricula in many medical schools all around the world. Results revelaed that continuing cyclical process might be time consuming, enhance burden of faculty and might be stressful for students involved. Current issues in health care system are possibly attributable to current HDR-based curricular models including PBL. Advantages of reiterative PBL theory can not be denied, but it appears that its limited application should be mainly seen in some academic classes to develop some generic transferable skills simultaneously with other teaching methods. Therefore vast application of HDR in clinical settings is not recommended according to our study. However the relationships demonstrated between factors and outcomes mentioned in the concept map can be used to run some new studies to test some hypotheses.

Influenza can affect any person in any age group, and is annually responsible for the death of 290,000 to 650,000 people in the world. This disease seasonally or once every few years, causes a lot of costs through its pandemics.

Background: The aspects of the epidemiology of bloodstream Candida infections including clinical features, the causal agents, underlying conditions, and risk factors have not been well-defined in Iranian pediatric patients. The aim of this observational study was to identify uncommon Candida species isolated from blood and other normally sterile specimens of the neonates and children admitted to intensive care units at Children's medical center, Tehran, Iran. Methods: The study was carried out prospectively on patients < 16 years, who were hospitalized in Children's medical center, Tehran, Iran, during 25 months, from June 2014 to July 2016. Blood and other normally sterile specimens were collected from 6,075 pediatric patients and only pure growth of yeasts were included the study. The yeast isolates were subjected to DNA extraction, PCR of ITSregion, and sequencing followed by Blast analysis to accurately identify the species. Results: A total of 16 out of 136 isolates were recognized as uncommon or rare Candida species. According to the sequence analysis, these isolates were identified as C. orthopsilosis (N = 5, 3.7%), C. glabrate (n = 4, 2.5%), C. dubliniensis (n = 2, 1.5%), C. lusitaniae (n = 2, 1.5%), C. kefyr (n = 2, 1.5%), and C. intermedia (n = 1, 0.75%) Conclusions: Candida species, which were once considered harmless, have now been recognized as causative agents of candidemia. It is essential to consider, manage, and control the conditions that lead to the development of these unusual but severe cases of candidemia.