Clinical Learning Research Articles

Preparation for Practice: Internationally Qualified Nurses’ Perceptions of Clinical and Cultural Practice Learnings Gained Through a New Zealand Competence Assessment Programme

Preparation for Practice: Internationally Qualified Nurses’ Perceptions of Clinical and Cultural Practice Learnings Gained Through a New Zealand Competence Assessment Programme

Impact of Clinical Video Scenarios Used for a Summative Exam to Facilitate Learning.

This article explores the use of clinical vicarious learning dialogue videos as a learning resource for a written summative assessment. A prescribed list of 42 clinical vicarious learning dialogue videos was disseminated to students, and they were informed that these would form the scope of a prosthodontics question in their final year summative exam. The videos captured the learning dialogue between a teacher and student during diagnosis, problem-solving or clinical decision-making in relation to prosthodontic patient interactions. Exam questions were created from screen capture images from the videos based on and around the video content. After the exam, video analytics was captured, and students were invited for an interview using a question guide which was recorded and transcribed and a thematic analysis was performed using a deductive inductive approach. Fourteen students were interviewed, and from these three domains and 10 key themes were identified: learning: learning strategy, learning new skills and knowledge, learning clinical skills, application of learnt skills and engagement; assessment: exam scope and stress, clinical relevance, motivation, generalisable; and video as a learning medium: enjoyable, affordance. Students reported that using these videos facilitated and supported their exam preparations, stimulated learning new content as well as higher-order thinking skills. Students reported they had applied skills learnt from the videos and broadened their cognitive skills and practical experience. The format of the assessment was described as enjoyable and reduced stress. All students reported they watched 'all' the videos which appeared to be supported by the analytics. Clinical vicarious learning dialogue videos were found to help learning, assessment literacy, clinical cognitive skills, stress and motivation for learning.

Medical imaging and radiation science students' use of artificial intelligence for learning and assessment

IntroductionArtificial intelligence has permeated all aspects of our existence, and medical imaging has shown the burgeoning use of artificial intelligence in clinical environments. However, there are limited empirical studies on radiography students' use of artificial intelligence for learning and assessment. Therefore, this study aimed to gain an understanding of this phenomenon. MethodsThe study used a qualitative explorative and descriptive research design. Data was obtained through five focus group interviews with purposively sampled undergraduate medical imaging and radiation science students at a single higher education institution in South Africa. Verbatim transcripts of the audio-recorded interviews were analysed thematically. ResultsThree themes and related subthemes were developed: 1) understanding artificial intelligence, 2) experiences with the use of artificial intelligence with the subthemes of the use of artificial intelligence in theoretical and clinical learning and challenges of using artificial intelligence, and 3) incorporation of artificial intelligence in undergraduate medical imaging and radiation sciences education with the subthemes of student education, ethical considerations and responsible use and curriculum integration of artificial intelligence in relation to learning and assessment. ConclusionParticipants used artificial intelligence for learning and assessment by generating ideas to enhance academic writing, as a learning tool, finding literature, language translation and for enhanced efficiency. Simulation-based artificial intelligence supports students' clinical learning, and artificial intelligence within the clinical departments assists with improved patient outcomes. However, participants expressed concerns about the reliability and ethical implications of artificial intelligence-generated information. To address these concerns, participants suggested integrating artificial intelligence into medical imaging and radiation sciences education, where educators need to educate students on the responsible use of artificial intelligence in learning and consider artificial intelligence in assessments. Implications for practiceThe study findings contribute to understanding medical imaging and radiation sciences students’ use of artificial intelligence and may be used to develop evidence-based strategies for integrating artificial intelligence into the curriculum to enhance medical imaging and radiation sciences education and support students.

Exploring the experiences of female undergraduate nursing students in providing home healthcare to older adults

ABSTRACTBackgroundIn light of the growing ageing population in Saudi Arabia and Saudi nurses’ hesitation to work with the older population, it is important to understand the experiences of nursing students on their clinical placement in home healthcare.MethodsThis study is a descriptive qualitative study based on five focus groups of 3–5 students each. Data were collected from female senior baccalaureate nursing students at a female governmental university in Saudi Arabia, and during their placement in home healthcare. Data were analysed using thematic analysis.ResultsFive main themes emerged : struggling with their own family; struggling with cultural and social beliefs; struggling during clinical training; struggling with domestic caregivers; and reflections for the future were considered important impressions in clinical experience.ConclusionThe culture of Saudi Arabian society is an important factor in shaping the training experience of female nursing students either positively or negatively, specifically in the context of home healthcare nursing for older patients. The results of this study show how important it is for students to be prepared for the clinical environment, the nature of the work, and the role of the home healthcare nurse in order to improve their clinical learning.

Developing CLOUT: A Longitudinal, Cross-Program Chief Resident Curriculum to Increase Psychological Safety in the Clinical Learning Environment.

Psychological safety in the clinical learning environment is essential for learning and thriving. The authors aimed to leverage the leadership position and influence that chief residents hold and invited them to participate in a longitudinal professional development curriculum designed to provide them with the tools to promote psychological safety. A total of 66 chief residents from 25 residency programs, along with 18 faculty allies, participated in 5 workshops, which were designed to increase their understanding of and effective responses to workplace mistreatment or bias directed toward trainees. These skills-based workshops focused on effective coaching, conflict management, and self-regulation of emotions for themselves and their trainees. There was a significant improvement in self-reported efficacy in these domains at the completion of the curriculum and evidence of behavior change as assessed by baseline and final case scenario responses. Additionally, the relationship building that resulted by bringing all chief residents together further enhanced the curriculum's impact as assessed qualitatively. Providing chief residents with skills and resources to become change agents through a longitudinal curriculum in a cohort model improves individual self-efficacy and responses to exemplar cases. Assessment of the overall impact on individual programs and institutional climate is planned.

A Critical Look at Racism in the Clinical Learning Environment.

Academic medicine has long acknowledged the importance of diversity, equity, and inclusion (DEI) in the pursuit of health equity. Despite this recognition, the clinical learning environment (CLE) has struggled to foster an equitable and inclusive ecosystem that supports diverse learners and faculty.Efforts to dismantle racism in medicine represent an important approach to supporting diverse learners and faculty in the CLE, but they have fallen short of their intended impact. The reasons for this failure are complex and may include a limited understanding of the impact of racism and a misguided conviction that knowledge of harm suffered by minoritized groups is a sufficient driver of change.To advance understanding and increase motivation to dismantle racist systems within academic medicine, this paper posits 2 frameworks, Interest Convergence (IC) and Critical Whiteness Study (CWS). IC asserts that racial equity progresses only when it aligns with the interests of the majority, while CWS examines how Whiteness as a social construct upholds power and privilege, often to the detriment of White individuals themselves.Utilizing these frameworks, the authors detail how Whiteness negatively impacts the health of White people and impedes entry to medical school for low- and middle-income, first-generation White students. The authors illustrate how practices-such as patient- and family-centered care and competency-based medical education-which are intended to improve care and medical education for all, are fully aligned with and integral to DEI principles. The authors conclude that racism and upholding Whiteness cause harm to majority as well as minoritized peoples, while DEI principles provide the foundation for best practices in the CLE and improve outcomes for all.

Clinical Readiness for Practice of Nursing Students: A Concept Analysis

Introduction: The concept of clinical readiness for practice among nursing students is yet to be analyzed, and there is a lack of empirical evidence on its usage among academics and clinicians. Methods: This concept analysis is anchored on a systematic literature review that adhered to the PRISMA guidelines and incorporated the eight iterative steps of Walker and Avant’s concept analysis method. This concept analysis method involved: (1) choosing a concept; (2) determining the objectives of the analysis; (3) identifying usages of the concept; (4) determining the defining attributes; (5) identifying a model case; (6) identifying other cases, including borderline, contrary, and related cases; (7) identifying antecedents and consequences; and (8) defining empirical references. The integrative thematic data synthesis method was adopted. Results: The concept of nursing students’ clinical readiness for practice is said to have four interrelated attributes. These attributes included (1) professional skills, (2) communication skills, (3) self-management skills, and (4) self-confidence. The two antecedents for nursing students’ clinical readiness to practice are (1) personal factors, including demographic characteristics, prior healthcare experience, income, and emotional intelligence; and (2) educational factors, including the clinical learning environment, clinical internship program, learning resource, and learning strategy. The consequence of clinical readiness for the practice of nursing students includes obtaining practice skills that can lead to more personal and job-related satisfactory outcomes. Conclusions: clinical readiness for practice in nursing encompasses the acquisition and integration of professional knowledge, skills, effective communication abilities, and self-management capabilities and the application of these competencies with confidence toward the provision of high-quality care to patients. Clinical Relevance: Understanding the components of clinical readiness is crucial for nursing educators, preceptors, and healthcare institutions to ensure that nursing students are adequately prepared for the challenges they will face in clinical practice. By recognizing the importance of professional knowledge, skills, communication, and self-management in clinical readiness, educators and training institutions can tailor their curricula, programs, and support systems to better prepare nursing students for the demands of real-world healthcare settings. This focus on clinical readiness ultimately delivers safe, effective, and compassionate patient care.

Exploring pre-requisites for clinical learning indicators: A scoping review.

Understanding how clinical learning takes place and what could stand as an indicator of clinical learning is crucial. There are existing challenges in the clinical learning environment that require clinical indicators. These serve as accountability standards in settings that have challenges of human resources and material poverty. Thus, clinical indicators are pre-requisites for self-regulation and self-directedness to promote lifelong learning. The reality that exists in today's Malawian health education institutions and clinical settings requires that those in training receive support and guidance on how essential competencies and skills can be acquired during training. The objective of this scoping review was to identify current literature on clinical learning indicators among health professional students. The Joanna Briggs Institute's (May 2020) standards for scoping reviews including narrative synthesis were followed in the conduct of this review. The protocol was registered in the Open Science Frameworkhttps://osf.io/yj9nr. The results generated seven themes on clinical learning process and these are (1) planning for learning, (2) awareness of self-directedness in clinical learning, (3) knowledge of achievement of learning outcomes, (4) educators' evidence of students' clinical learning, (5) students' perspective on clinical learning, (6) students' knowledge of achievement in practice and (7) impact of prior knowledge on clinical learning. Clinical learning indicators among undergraduate health professionals are essential and clinical learning should be a planned endeavour by the students before the clinical placement settings.Contribution:This study contributed to understanding clinical learning indicators and self-regulated learning practices among healthcare students.

Sustained impacts of the COVID-19 pandemic on medical student learning and well-being in rural Australia: findings from a repeated national multicentre survey

ObjectiveThe impact of COVID-19 on medical students has predominantly been assessed by one-off survey studies at the pandemic onset. This national study investigated the sustained impacts of the COVID-19 pandemic...

Theoretical and Clinical Learning Experiences and Expectations of Midwifery Students Using the Artificial Intelligence Tool ChatGPT: A Qualitative Study

ABSTRACTChatGPT is one of the most popular artificial intelligence tools today. The number of users is increasing rapidly every day. ChatGPT, which is used in many fields for different purposes, has the potential to revolutionise the field of education and health. The study aims of the study is to investigate the learning experiences and expectations of midwifery students who use ChatGPT in their theoretical and clinical education. This study was conducted through an interpretive paradigm based on Heideggerian hermeneutic phenomenology, a qualitative research method. In the study, the maximum diversity sampling method, one of the purposive sampling methods, was used. One‐to‐one in‐depth interviews were conducted with a total of 17 midwifery students. The study data were collected through a three‐part interview form. The data obtained were analysed with the MAXQDA program. As a result of the data analysis, three main themes and seven sub‐themes were identified. The main themes are The Role of ChatGPT in Midwifery Education, The Effect of ChatGPT on Student Development and Concerns about the Use of ChatGPT. Midwifery students use ChatGPT for various purposes in theoretical and clinical courses. Although students are satisfied that artificial intelligence tools save time and make learning practical, students have some concerns about ChatGPT.

The challenging reality of the clinical learning environment at Damascus University Faculty of Dental Medicine in Syria: A qualitative study

Introduction In Syria, specialist dentists undergo five years of undergraduate education and four years of postgraduate education. In the latter, students engage in treating complex cases as part of their professional training. This study aimed to obtain in-depth qualitative understanding of the clinical learning environment at Damascus University Faculty of Dental Medicine, Syria. Methods Semi-structured interviews were held with eight postgraduate dental students at Damascus University Faculty of Dental Medicine. The faculty has eight clinical departments; therefore, a single participant was purposively sampled from each department. The male-female ratio of the eight interviewed participants was 1:1. All interviews were conducted between 26th April 2020 and 8th January 2021. Data were analyzed inductively using reflective thematic analysis. Pragmatic saturation was discussed during the analysis and the authors made an interpretative judgement to stop data collection at the eighth interview. Results Major themes which emerged covered different aspects of the clinical learning environment such as clinical training, social interaction and assessment procedures. Faculty’s negligence of their teaching duties was one of the most recurrent themes. In clinical training and due to faculty inaccessibility, students had to rely on themselves or their senior peers in training. The social climate was perceived negatively and assessment was described as unfair and biased. Discussion This study employed Gruppen’s conceptual framework to conduct a theory informed analysis of the clinical learning environment in a dental school with limited resources. The findings highlight important areas of improvement that needs addressing, including the unavailability of teaching staff, neglect of student needs, a competitive social atmosphere, and inconsistent assessment practices. Future research ought to focus on understanding the perspectives of teaching faculty and decision makers regarding the obstacles to implementing substantial reforms aimed at enhancing the clinical learning experience.

Effect of an online training intervention on evidence-based practice in clinical nurses. #Evidencer Project

BackgroundOnline learning is becoming increasingly essential for health professionals, and it is necessary to understand how this modality affects clinical nurses' learning of Evidence-Based Practice (EBP). For this reason, the present study sought to assess the effectiveness of an online training program in improving nurses' EBP competence.MethodsA quasi-experimental study with a pretest–posttest design was conducted with a control group and without randomization for a period of 6 months. The intervention was an online self-learning course based on Melnyk’s seven steps of Evidence-Based Practice (EBP). The course was structured into sequential modules requiring 72 h of work, with task completions and tests necessary for progression. Participants had three months to complete the course. EBP competence was measured with the EBP-COQ Prof© questionnaire. Data analysis included percentages, means, standard deviations, chi-square tests, student's t-tests, and a two-way repeated measures analysis of covariance (ANCOVA).ResultsThe analysis of the changes observed in each dimension and the overall EBP competence between the intervention group (IG) and the control group (CG) showed a significant group*time interaction in three of the four dimensions of the questionnaire. The results indicated that the online Evidence-Based Practice (EBP) course significantly improved knowledge, skills, and utilization three months after its completion. In the IG, the mean score was 44.04 (standard deviation (SD) = 7), compared to 37.83 (SD = 8.5) in the CG (p < 0.001). Regarding skills, the IG had a mean score of 24.24 (SD = 3.8), while the CG scored 23.01 (SD = 3.1) (p = 0.008). For utilization, the mean score in the IG was 36.77 (SD = 6.8), and the CG was 33.12 (SD = 6.3) (p = 0.005). Overall competence also showed a statistically significant difference, with the IG achieving a mean score of 141.22 (SD = 20.0) compared to the CG with a mean score of 130.34 (SD = 16.7) (p < 0.001).ConclusionsTraining through an online education platform for three months (72 h) is an effective tool for improving the competence in Evidence-Based Practice (EBP) of clinical nurses. A significant increase was observed in knowledge and moderate improvements in skills and the application of EBP. These online courses, adapted to the needs of professionals, can be an efficient way to prepare nurses and improve their application of EBP in a clinical setting.

Why we should talk about institutional (dis)trustworthiness and medical machine learning.

The principle of trust has been placed at the centre as an attitude for engaging with clinical machine learning systems. However, the notions of trust and distrust remain fiercely debated in the philosophical and ethical literature. In this article, we proceed on a structural level ex negativo as we aim to analyse the concept of "institutional distrustworthiness" to achieve a proper diagnosis of how we should not engage with medical machine learning. First, we begin with several examples that hint at the emergence of a climate of distrust in the context of medical machine learning. Second, we introduce the concept of institutional trustworthiness based on an expansion of Hawley's commitment account. Third, we argue that institutional opacity can undermine the trustworthiness of medical institutions and can lead to new forms of testimonial injustices. Finally, we focus on possible building blocks for repairing institutional distrustworthiness.

Validity and Reliability Study of the Turkish Version of the "Uncivil Behavior in Clinical Nursing Education Scale" for Nursing Students.

Background and Purpose: Nursing undergraduate students may encounter unkind behaviors during their clinical education. This study aimed to test the psychometric properties of the Turkish version of the "Uncivil Behavior in Clinical Nursing Education (UBCNE) Questionnaire," which measures nursing students' perceived levels of uncivil behavior in the clinical learning environment. Methods: The study was conducted in four steps: translation, face and content validity, confirmatory factor analysis, and reliability assessment. Data were collected from 216 nursing students from Turkey. Results: In the exploratory factor analysis (EFA), a unidimensional factor structure with an eigenvalue above 1 was detected, and therefore the scale was analyzed as a single dimension. In the EFA with 13 items, the Kaiser-Meyer-Olkin value was 0.943, and the Barlett test result was 1862.965 (p <05). The fit indices for the class were calculated as χ2/df = 2.218, root-mean-square error of approximation = .075, and comparative fit index = 0.961. Cronbach's coefficient α (alpha) for Turkish culture was .942. Conclusion: The study showed that the Turkish version of the UBCNE scale is a valid and reliable measurement tool for assessing perceived incivil behaviours in nursing students' clinical education.

Development of ultrasound-based clinical, radiomics and deep learning fusion models for the diagnosis of benign and malignant soft tissue tumors.

The aim of this study is to develop an ultrasound-based fusion model of clinical, radiomics and deep learning (CRDL) for accurate diagnosis of benign and malignant soft tissue tumors (STTs). In this retrospective study, ultrasound images and clinical data of patients with STTs from two hospitals were collected between January 2021 and December 2023. Radiomics features and deep learning features were extracted from the ultrasound images, and the optimal features were selected to construct fusion models using support vector machines. The predictive performance of the model was evaluated based on three aspects: discrimination, calibration and clinical usefulness. The DeLong test was used to compare whether there was a significant difference in AUC between the models. Finally, two radiologists who were unaware of the clinical information performed an independent diagnosis and a model-assisted diagnosis of the tumor to compare the performance of the two diagnoses. A training cohort of 516 patients from Hospital-1 and an external validation cohort of 78 patients from Hospital-2 were included in the study. The Pre-FM CRDL showed the best performance in predicting STTs, with area under the curve (AUC) of 0.911 (95%CI: 0.894-0.928) and 0.948 (95%CI: 0.906-0.990) for training cohort and external validation cohort, respectively. The DeLong test showed that the Pre-FM CRDL significantly outperformed the clinical models (P< 0.05). In addition, the Pre-FM CRDL can improve the diagnostic accuracy of radiologists. This study demonstrates the high clinical applicability of the fusion model in the differential diagnosis of STTs.

Exploring clinician perspectives of systems-based practice: A physician training challenge.

Systems-based practice (SBP) has been a competency in US graduate medical education for over 20 years, but it is not well implemented. SBP is loosely defined as physician's responsiveness to the larger system of healthcare. The aim of this study was to describe healthcare professionals' perspectives regarding: (1) their knowledge and beliefs about SBP and (2) their beliefs regarding factors in clinical learning environments (CLE) that facilitate or hinder operationalisation and learning of SBP. Semi-structured interviews were conducted between November 2020 and April 2021 with 42 individuals from four health systems. Participants were healthcare professionals involved in graduate medical education, including physicians and interprofessional clinicians (e.g., nursing staff). Interviews were transcribed and coded using a social constructivist, codebook thematic analysis approach and themes were agreed upon through discussion amongst the research team. Five themes were constructed: (1) SBP remains a challenge to define, (2) SBP may be intuitively understood, particularly when framed at the microsystem level, (3) SBP aligns with the Health Systems Science framework, (4) SBP learning must be intentionally integrated into the CLE, through training such as onboarding and (5) multidisciplinary settings and work processes are critical to engage in SBP. Workload compression is a barrier to SBP implementation. Healthcare professionals highlighted that current CLEs are not designed to prioritise SBP. Graduate medical education programmes may benefit from focusing systems content at the microsystem level and purposefully integrating onboarding procedures, clinical settings and rotations specifically designed to teach SBP into their residencies.

Nurturing clinical teachers' professional learning: A phased approach.

Nurturing clinical teachers' professional learning: A phased approach.

Sociodemographic bias in clinical machine learning models: A scoping review of algorithmic bias instances and mechanisms

BackgroundClinical machine learning (ML) technologies can sometimes be biased and their use could exacerbate health disparities. The extent to which bias is present, the groups who most frequently experience bias, and the mechanism through which bias is introduced in clinical ML applications is not well described. The objective of this study was to examine instances of bias in clinical ML models. We identified the sociodemographic subgroups (using the PROGRESS-Plus framework) that experienced bias and the reported mechanisms of bias introduction MethodsWe searched MEDLINE, EMBASE, PsycINFO and Web of Science for all studies that evaluated bias on sociodemographic factors within ML algorithms created for the purpose of facilitating clinical care. The scoping review was conducted according to the JBI guide and reported using the PRISMA extension for scoping reviews. ResultsWe identified 6448 articles, of which 760 reported on a clinical ML model and 91 (12.0%) completed a bias evaluation and met all inclusion criteria. Most studies evaluated a single sociodemographic factor (n=56, 61.5%). The most frequently evaluated sociodemographic factor was race (n=59, 64.8%), followed by sex/gender (n=41, 45.1%), and age (n=24, 26.4%), with one study (1.1%) evaluating intersectional factors. Of all studies, 74.7% (n=68) reported that bias was present, 18.7% (n=17) reported bias was not present, and 6.6% (n=6) did not state whether bias was present. When present, 87% of studies reported bias against groups with socioeconomic disadvantage. ConclusionMost ML algorithms that were evaluated for bias demonstrated bias on sociodemographic factors. Furthermore, most bias evaluations concentrated on race, sex/gender, and age, while other sociodemographic factors and their intersection were infrequently assessed. Given potential health equity implications, bias assessments should be completed for all clinical ML models.

Implementing a Trauma-informed approach in undergraduate nursing student clinical education: Strategies for clinical nurse educators

AimTo discuss strategies for clinical nurse educators to integrate a trauma-informed approach while supporting undergraduate nursing students’ learning in the clinical environment. BackgroundUndergraduate nursing students’ risk of exposure to clinical related critical incidents coupled with their higher rates of personal traumas such as adverse childhood experiences, adds to the complexity of experiential learning. Clinical related critical incidents may compromise nursing students’ academic abilities and their well-being. The implications of clinical related critical incidents may extend to future nurse retention and recruitment as students question the perception of the profession’s identity. The cumulative effect from trauma may impact nursing students’ mental health making them vulnerable to trauma-related symptoms and disorders. DesignA discussion paper is used to support the application of a trauma-informed approach throughout clinical learning experiences. MethodWith relevant literature, a trauma-informed approach is emphasized for developing and maintaining safe environments that foster learning and optimize the health and well-being of nursing students. ResultsThe key assumptions and principles of a trauma-informed approach as outlined by the Substance Abuse and Mental Health Services Administration underpinned the proposed strategies that clinical nurse educators may use while preparing for clinical, during, and after experiences. ConclusionA trauma-informed approach may encourage undergraduate nursing students to adopt key tenets into their future clinical practices so they can effectively support patients, families, and their colleagues.

The Effect of Scenario-Based Group Discussion Training on the Nursing Students' Creativity: A Randomized Educational Controlled Trial.

Applying the clinical scenario teaching method using approaches such as group discussion facilitates the possibility of learning and developing creativity in a real clinical learning environment. However, few studies have been done in this field. The present study aimed to evaluate the effect of scenario-based group discussion training on the creativity level of nursing students. This study was a randomized controlled educational trial from January to October 2019 conducted on nursing students at Shiraz University of Medical Sciences. Nursing students were randomly assigned into intervention and control groups (22 per each group). The students in the intervention group participated in a training program consisting of three 60-min sessions per week for two consecutive weeks. In each session, 2-3 scenarios were presented, and the students discussed about it. Each student was asked to submit a practical activity in a written story. In the control group, the training was conducted in the usual way (Students' presentation and discussion of presented content without scenario presentation). Data were collected using a validated creativity questionnaire. Data were analyzed in SPSS software, version 22, using Chi-square and t-test and the significance level was considered p < 0.05. The results showed that immediately after the intervention, a difference was observed between the groups concerning the mean score of fluency (p = 0.02) and originality (p = 0.03), but there was not a significant difference between the groups concerning the overall score of creativity (p = 0.09). It can be concluded that scenario-based group discussion training is effective for improving the dimensions of the fluency and originality creativity of nursing students. It seems that scenario-based education is an appropriate radical method for traditional education methods. Trial Registration: IRCT Registration Number: IRCT20140503017546N13; Registration Date: 09.05.2018.