Tehran University Of Medical Sciences Research Articles

A placebo-controlled, crossover trial to investigate the efficacy of tiotropium bromide or placebo added to usual care in stable symptomatic post-hematopoietic stem cell transplantation (HSCT) bronchiolitis obliterans syndrome (BOS).

Despite the fundamental progress in hematopoietic stem cell transplant, this treatment is also associated with complications. Graft-versus-host disease is a possible complication of HSCT. Bronchiolitis obliterans syndrome (BOS) is the pulmonary form of this syndrome. Due to the high morbidity and mortality rate of BOS, various studies have been conducted in the field of drug therapy for this syndrome, although no standard treatment has yet been proposed. According to the hypotheses about the similarities between BOS and chronic obstructive pulmonary disease, the idea of using tiotropium bromide as a bronchodilator has been proposed. A randomized, double-blind, placebo-controlled, and crossover clinical trial is being conducted to evaluate the efficacy of tiotropium in patients with BOS. A total of 20 patients with BOS were randomly assigned (1:1) to receive a once-daily inhaled capsule of either tiotropium bromide (KP-Tiova Rotacaps 18 mcg, Cipla, India) or placebo for 1 month. Patients will receive tiotropium bromide or placebo Revolizer added to usual standard care. Measurements will include spirometry and a 6-min walking test. This study was approved by the Research Ethics Committees of Imam Khomeini Hospital Complex, Tehran University of Medical Science. Recruitment started in September 2022, with 20 patients randomized. The treatment follow-up of participants with tiotropium is currently ongoing and is due to finish in April 2024. The authors will disseminate the findings in peer-reviewed publications, conferences, and seminar presentations. Iranian Registry of Clinical Trial (IRCT) IRCT20200415047080N3. Registered on 2022-07-12, 1401/04/21.

Maternal education and its influence on child growth and nutritional status during the first two years of life: a systematic review and meta-analysis

The first 1000 days of life are critical for a child's health and development. Impaired growth during this period is linked to increased child morbidity, mortality, and long-term consequences. Undernutrition is the main cause, and addressing it within the first 1000 days of life is vital. Maternal education is consistently identified as a significant predictor of child undernutrition, but its specific impact remains to be determined. This study presents a systematic review and meta-analysis investigating the influence of high versus low maternal education levels on child growth from birth to age two, using population-based cohort studies. Databases including PubMed, Scopus, EMBASE, Web of Science, ERIC, and Google Scholar were searched from January 1990 to January 2024 using appropriate search terms. We included population-based cohort studies of healthy children aged two years and under and their mothers, categorizing maternal education levels. Child growth and nutritional outcomes were assessed using various indicators. Two reviewers independently conducted data extraction and assessed study quality. The Newcastle Ottawa scale was utilized for quality assessment. Random-effects models were used for meta-analysis, and heterogeneity was assessed using the Cochrane Q and I2 statistic. Subgroup and sensitivity analyses were performed, and publication bias was evaluated. The literature search retrieved 14,295 titles, and after full-text screening of 639 reports, 35 studies were included, covering eight outcomes: weight for age z-score (WAZ), height for age z-score (HAZ), BMI for age z-scores (BMIZ), overweight, underweight, stunting, wasting, and rapid weight gain. In middle-income countries, higher maternal education is significantly associated with elevated WAZ (MD 0.398, 95% CI 0.301-0.496) and HAZ (MD 0.388, 95% CI 0.102-0.673) in children. Similarly, in studies with low-educated population, higher maternal education is significantly linked to increased WAZ (MD 0.186, 95% CI 0.078-0.294) and HAZ (0.200, 95% CI 0.036-0.365). However, in high-income and highly educated population, this association is either absent or reversed. In high-income countries, higher maternal education is associated with a non-significant lower BMI-Z (MD-0.028, 95% CI-0.061 to 0.006). Notably, this inverse association is statistically significant in low-educated populations (MD-0.045, 95% CI-0.079 to-0.011) but not in highly educated populations (MD 0.003, 95% CI-0.093 to 0.098). Maternal education's association with child growth varies based on country income and education levels. Further research is needed to understand this relationship better. This study was a student thesis supported financially by Tehran University of Medical Sciences (TUMS).

Workforce and Employment Status of Sleep Medicine Graduates in Iran


 
 
 
 Background and Objective: Sleep medicine is a multidisciplinary specialty that focuses on diagnosing and treating sleep disorders. Sleep medicine fellowship programs in Iran commenced in 2012 at Tehran University of Medical Sciences, Tehran, Iran. This study aimed to investigate the human resources and employment status of sleep medicine fellowship graduates in Iran.
 Materials and Methods: This study was a descriptive cross-sectional study conducted in Iran in 2022 using conven- ience sampling and included 41 sleep medicine fellows in Iran. Data collection tools included a demographic question- naire and a researcher-made survey. Data were analyzed using the SPSS software.
 Results: Out of 57 sleep medicine fellows, 41 individuals with an average age of 44.95 ± 7.57 years participated in the study. Only 12% of the fellows were satisfied with their income, and all participants expressed dissatisfaction with their insurance coverage. 92% considered the existence of a national guideline for sleep medicine to be crucial, while 66.7% felt the curriculum of medical sleep medicine had some deficiencies.
 Conclusion: Lack of a suitable national guideline for treating and preventing sleep disorders, lack of insurance coverage for tests and respiratory assist devices, and high costs of establishing and equipping specialized sleep clinics are major challenges recognized by sleep medicine fellows. Additionally, due to the low priority given to these diseases by authorities and the inappropriate distribution of sleep medicine specialists in the country, access to appropriate treatment for sleep disorders is only feasible in giant cities.
 
 
 

Dissatisfaction and Protest of First-Year Obstetrics and Gynecology Residents and Related Factors: A Qualitative Study

Background: Physical and emotional stress during the residency period can have lasting negative effects on residents’ health as well as patient care. Such stress can cause emotional and psychological burnout, decreased physician productivity, impaired job performance, and poor social relationships. First-year residents have more burnout and stress due to many factors. This study aimed to investigate the reasons for the protest of this group of residents. Methods: This qualitative study was conducted with the participation of residents and professors of obstetrics and gynecology in one of the teaching hospitals of Tehran University of Medical Sciences in spring of 2021. Data were collected through individual face-to-face interviews and group discussions. The conventional content analysis method was used to analyze the data. To ensure the accuracy of the qualitative data, the criteria proposed by Lincoln and Guba were considered. Results: A total of 14 participants were interviewed and 16 people participated in focus group discussion sessions. From the text of the interviews, two themes were extracted. Participants’ experiences showed unbearable pressure, domination, and anonymity as stressors in first-year obstetrics and gynecology residents. Conclusion: The results showed that the main reason for the protest of the first-year residents was the wrong behavior of the second-year residents and the lack of supervision over these behaviors. Launching a kindness campaign was a suggested solution in this research that could help improve communication between residents and the educational atmosphere.

Prevalence of psychosis and its relationship with substance use disorder in patients with bipolar disorder in Iran

BackgroundThe correlation between psychosis and bipolar disorder is a crucial and complex matter that requires attention and study. In this study, researchers examined the relationship between the current episode status, substance use disorder, different types of substance use, and psychotic symptoms in inpatients with bipolar disorder. MethodsThe study included 150 patients who were diagnosed with bipolar disorder based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). These patients were referred to the emergency department of Roozbeh Psychiatric Hospital in Iran between November 2019 and February 2020. The Structured Clinical Interview for the DSM-5 (SCID-5) questionnaire was used to diagnose the patient's bipolar disorder, including episodes of depression and mania, as well as their substance use disorder. The type of substance used and the pattern of its use were also evaluated using this questionnaire. Additionally, a faculty member of the psychiatry department at Tehran University of Medical Sciences carefully evaluated the patient's condition for the presence of psychotic symptoms using a psychiatric diagnostic interview. ResultsOut of 150 inpatients diagnosed with bipolar disorder, 89 (59.3 %) had comorbid substance use disorder. Among these 89 patients, 42 (47.2 %) had psychotic symptoms, whereas 79 (52.7 %) of the total 150 inpatients had psychotic symptoms. There was no significant relationship between substance use disorder (p-value=0.86), the type of substance used in a recent episode (p-value=0.93), and the current episode type (p-value=0.69) with psychotic symptoms. LimitationsThe study's generalizability is limited to hospital patients with bipolar disorder. Additionally, since it was a cross-sectional study, causal interpretation was not possible. ConclusionsThe study suggests a primary link between bipolar disorder and psychosis, independent of substance use. Longitudinal multicenter studies with larger sample sizes are recommended.

HISTOPATHOLOGICAL FEATURES OF MICE LIVER AND KIDNEY ON ORAL ACUTE TESTING OF WHITE RADISH TUBER LYOPHILISATE

Background and aim: Radish tuber (Raphanus sativus L.) is one of the plant species often consumed by society as a vegetable. Currently, its use is beginning to expand as a medicinal plant, including its use for diabetes, pharyngitis, sinusitis, cardiac fibrosis, diuretics, and bacterial infections. This study aims to determine the histopathology of the liver and kidney organs in male albino mice (Mus musculus) by testing the oral pungency of white radish (Raphanus sativus L.). Methods: This experimental study used 12 mice weighing 25–30 grams, divided into 4 treatment groups: Group 1 was administered aquadest, Group 2 received a dose of 400 mg, Group 3 received 800 mg, and Group 4 received 1600 mg of the medication. The treatment was carried out for 14 days, and then the mice were euthanized to see the histopathology of the hepatic and kidney tissues. Results: In the histopathology of the liver and kidney in treatment groups 1, 2, 3, and 4, the results were normal, mild, moderate, and severe damage, respectively. In kidney histopathology, there are signs of damaged tissue, such as bleeding, edema, and inflamation cells. Conclusion: It can be concluded that the higher the dose of white radish lyophilizate, the greater the potential to cause toxicity to the liver and kidney organs.                       Peer Review History: Received 3 December 2023;   Revised 29 January 2024; Accepted 27 February; Available online 15 March 2024 Academic Editor: Prof. Dr. Gorkem Dulger, Duzce University, Turkey, gorkemdulger@yandex.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 8.0/10 Reviewers: Prof. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

URINARY SCHISTOSOMIASIS AMONG SCHOOL-AGE CHILDREN IN SELECTED RURAL COMMUNITIES IN HADHRAMOUT GOVERNORATE, YEMEN

Background: Urinary schistosomiasis is a potentially life-threatening public health issue in some areas of Yemen, particularly in Hadhramout rural communities. It is considered as one of the most common neglected tropical parasitic diseases. This study aimed to investigate the prevalence of urinary schistosomiasis and associated risk factors among school-age males and females in selected rural communities of Hadhramout, Yemen. Methods: A total of 450 students participated in this cross-sectional study. Urine samples were collected, then examined for haematuria and Schistosoma haematobium (S. haematobium) eggs using urine dipsticks and filtration technique respectively. To assess knowledge and practices regarding the transmission of urinary schistosomiasis, a pre-tested questionnaire was employed. Results: An overall (66)14.7% of participants tested positive for S. haematobium, and of those, 54 (12.0%) developed haematuria with a statistically significant difference (p=0.001). A total of 35(53.0% eggs/10 ml urine) had heavy intensity of infection, with a significant difference (p=0.001) between the different communities visited: high in Al-Dhulaya'a (18.2 eggs/10 ml urine) and low in Yabaith (6.1 eggs/10 ml urine). S. haematobium infection showed significantly higher (p=0.002) in males (13.8%) than females (0.9%), and increased with age of participants. Multivariate logistic analysis of risk factors were significantly associated with the prevalence of urinary schistosomiasis such as swimming activities (p=0.016), washing clothes (p=0.14), time spent in infested areas more than 15 minutes (p=0.012), habits of defecation/urination in open water sources (p=0.44), self-reported symptoms suggestive of the disease (p=0.03), participants with a history of illness (p=0.014), lack of awareness of schistosomiasis (p=0.050), and no prior treatment with praziquantel (p=0.001). Conclusions: Urinary schistosomiasis remains highly prevalent among schoolchildren in rural communities in Hadhramaut. The study highlights the urgent need to implement preventive measures, safe drinking water supply, proper sanitation, and vector control programs in order to reduce transmission and morbidity caused by schistosomiasis.                       Peer Review History: Received 3 December 2023;   Revised 28 January 2024; Accepted 27 February; Available online 15 March 2024 Academic Editor: Dr. Marwa A. A. Fayed, University of Sadat City, Egypt, maafayed@gmail.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Dr. Owanaro Peter, Nigeria,  Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria. owonaropeter@gmail.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

The association between dietary total antioxidant capacity and hearing loss: results from the Tehran employees Cohort Study

BackgroundDespite numerous studies that have explored the association between individual antioxidants or specific combinations and the risk of hearing loss, there is lack of information regarding the relationship between dietary total antioxidant capacity (dTAC) and hearing loss. The conflicting results on this association further highlight the need for more research in this area. This study aims to investigate the association between overall dietary antioxidant intake and the risk of hearing loss among Iranian adults.MethodsThis cross-sectional study recruited 3443 adult participants aged between 19 and 67 years (with an average age of 41.4 years ± 8.8) who were employed at Tehran University of Medical Sciences in Iran. Participants underwent dietary assessment using a validated Food Frequency Questionnaire (FFQ). The hearing status of each participant was evaluated by a licensed audiologist in a soundproof room, using diagnostic audiometry that adhered to American National Standards specifications and followed standard audiometric clinical procedures. The dietary total antioxidant capacity (dTAC) was calculated using the Ferric Reducing-Antioxidant Power (FRAP) values.Results43.6% of male participants had hearing loss, while 26.8% among female participants. After accounting for various confounding factors, no significant association was observed between higher levels of dTAC and reduced odds of hearing loss in the overall population. However, among men under the age of 40, higher levels of dTAC were associated with decreased odds of hearing loss, even after adjusting for several covariates (OR: 0.56, 95% CI: 0.31–1.02, Ptrend = 0.02). This relationship was not evident in men over 40 years of age or among women.ConclusionThe study found an inverse relationship between higher antioxidant intake in the diet and lower odds of hearing loss, specifically among men who were 40 years old or younger. However, this relationship was not observed in the overall population or among women. Additional prospective studies are necessary to validate these results.

Overview, Trends, and Collaboration on Immunization, Vaccination, and Immunomodulation Therapies for Periodontitis: A Scientometric Study.

To identify patterns and trends in the field of immunization, vaccination, and immunomodulation therapies for periodontitis. Metadata were collected from the Scopus database on publications related to these topics from January 1986 to February 2024. Several types of papers were included in this study, a total of 22 publications. Data were extracted from relevant publications and loaded into SciVal for analysis that were used to identify trends and patterns in the data, including cross-country collaboration, thematic evolution, and keyword distribution. Mohsen Amin of Tehran University of Medical Sciences in Iran and S. Aadil Ahamed and Annie Kitty George of Saveetha Institute of Medical and Technical Sciences in India were found to be notable contributors in this field. India leads in terms of academic paper production, followed by Iran and China. The journals Expert Review of Vaccines and International Immunopharmacology have published significant papers in this field. According to Lotka's Law, most authors have written only one paper, reflecting the distribution of productivity in many academic and scientific fields. Collaborations were observed between Iran and Canada, Korea and New Zealand, and the United States and Belgium. This study provides useful insight into the predominant trends and patterns in the scientific literature in the field of immunization, vaccination, and immunomodulation therapies for periodontitis. The findings of this study may help to understand the dynamics of the production on immunization, vaccination, and immunomodulation therapies could reduce the inflammation and progression of periodontitis, thus improving the patient's oral and overall health. How to cite this article: Mauricio F, Mendoza R, Silva H, et al. Overview, Trends, and Collaboration on Immunization, Vaccination, and Immunomodulation Therapies for Periodontitis: A Scientometric Study. J Contemp Dent Pract 2024;25(2):128-133.

Drug use and its correlated factors among university students in Tehran

ABSTRACT Objective This study aimed to investigate the prevalence of lifetime, last year, and last month use of illicit drugs and associated factors among the first to fourth-year students at the Tehran University of Medical Sciences in Iran. Method Sampling method was multi-stage cluster sampling. Anonymous self-administered questionnaires were distributed to 1050 students. We provided prevalence of lifetime, last 12 months, last month, and daily use for the main classes of drugs. Using the bivariate and multivariate logistic regression model, we evaluated correlated factors of any drug use in the past 12 months. Results Overall, 945 students participated in this study. A total of 6.6% reported any illicit drug use in the past 12 months (11.2% among males vs. 3.1% among females) Cannabis was the most used drug in the past year, reported by 4.9% of the participants, followed by methylphenidate (2.9%). There was an association between illicit drug use in the past 12 months with smoking cigarettes and using alcohol in the past 12 months and drug use among friends or family members. Conclusions The prevalence of drug use among the students at Tehran University of Medical Sciences has increased compared to similar previous studies, which call for preventive measures.

Evaluating Clinical Presentations and Diagnostic Procedures in Pediatric Autoimmune Hepatitis

Background: The aim of the current research was to assess the clinical manifestations and diagnostic methods used in juvenile cases of Autoimmune Hepatitis (AIH).
 Methods: This study employed a retrospective cross-sectional design to investigate pediatric patients diagnosed with AIH at Children’s Medical Center Hospital, which is affiliated to Tehran University of Medical Sciences (TUMS), Tehran, Iran. The study included patients who received routine examinations, treatments, and follow-ups during the period from 2018 to 2021.
 Results: The present investigation encompassed the evaluation of 52 pediatric patients, mostly female, with a mean age of 7.76 years. The vast majority of patients have encountered the occurrence of acute AIH. Positive findings for the Anti-Smooth Muscle Antibodies (ASMA) test were seen in 50% of the patients. The mean score for fibrosis in the observed individuals was 2.56, whereas the mean value for the Hepatitis Activity Index (HAI) in a subset of 29 patients was found to be 7.34. One patient succumbed to the condition, one case underwent transplantation, and another individual was identified as a candidate for liver transplantation.
 Conclusion: Patients with AIH saw a decrease in long-term survival. There was no observed disparity in prognosis based on gender; nevertheless, it was noted that males had a shorter lifespan, perhaps attributable to an earlier beginning of the illness. The presence of cirrhosis at the time of diagnosis constituted a significant risk factor for unfavorable prognosis, as it was associated with an elevated overall risk of mortality owing to liver dysfunction.

Challenges facing international students at Iranian universities: a cross-sectional survey

BackgroundThis study examines the challenges faced by international students at Tehran University of Medical Sciences (TUMS) and provides insights into their experiences and needs.MethodologyA self-developed structured questionnaire was administered to international students who completed their first year at TUMS. Data were collected from 165 participants (76% response rate) and analyzed using SPSS 22.0.ResultsThe study reveals that international students encounter various challenges, including difficulties accessing information, language barriers, ineffective communication, administrative inefficiencies, cultural issues, financial constraints, and limited scholarship opportunities. Analysis of students’ characteristics indicates that the length of study at TUMS is significantly associated with the challenges experienced. The findings highlight the importance of enhancing support services and resources for international students, such as language classes, academic counseling, scholarships, and cultural exchange programs.ConclusionAddressing these challenges can foster a more supportive environment, contributing to the academic success and well-being of international students at TUMS and similar universities.

The association of dietary nitrates/nitrites intake and the gut microbial metabolite trimethylamine N-oxide and kynurenine in adults: a population-based study.

Dietary nitrate and nitrite may affect the gut microbiota and its metabolites, such as trimethylamine N-oxide (TMAO) and kynurenine (KYN). However, this association and the exact mechanism are still unclear. Therefore, this study aimed to assess the association between dietary consumption of nitrite and nitrate on TMAO and KYN levels in adults. This cross-sectional study was employed on a subsample baseline phase of the Tehran University of Medical Sciences (TUMS) Employee's Cohort Study (TEC). A total of 250 adults aged 18 years or older were included in the current analysis. Data on the dietary intakes were collected using a validated dish-based food frequency questionnaire (FFQ), and dietary intakes of nitrite and nitrate were estimated using the FFQ with 144 items. Serum profiles and TMAO and KYN were measured using a standard protocol. The findings of this study demonstrate a significant association between the intake of animal sources of nitrate and nitrite and the likelihood of having elevated levels of TMAO and KYN. Specifically, after adjustment, individuals with the highest intake adherence to nitrates from animal sources exhibited increased odds of having the highest level of TMAO (≥51.02 pg/ml) (OR = 1.51, 95% CI = 0.59-3.88, P = 0.03) and KYN (≥417.41 pg/ml) (OR = 1.75, 95% CI = 0.73-4.17, P = 0.02). Additionally, subjects with the highest animal intake from nitrite sources have 1.73 and 1.45 times higher odds of having the highest levels of TMAO and KYN. These results emphasize the potential implications of animal-derived nitrate and nitrite consumption on the levels of TMAO and KYN. The present evidence indicates that a high level of nitrate and nitrite intake from animal sources can increase the odds of high levels of TMAO and KYN. Further studies suggest that we should better evaluate and understand this association.

Using Modern Learning Method to Teach Pharmacy Students Psychopharmacotherapy

Background: Applying modern educational methods for digital native students seems necessary. Active learning strategies promote students’ skills and knowledge. This study was conducted to design and evaluate active learning methods by teaching psychopharmacotherapy to pharmacy students.
 Methods: This was a quasi-experimental study with three randomized study groups (control, game, and multimedia), using a pre-and post-test design, conducted on 155 students of 5-year pharmacy in 2022 at the Faculty of Pharmacy of Tehran University of Medical Sciences, Iran. Overall, 18 clinical cases were designed for the basic structure of interventions. After teaching psychopharmacotherapy contents through lecturing, the pre-test was held. The next steps were playing the educational game, studying the multimedia case-based learning files, and then completing questionnaires, respectively. Then, a post-test was held.
 Results: 65.33% of participants were female and 34.66% were male. The pre-test and post-test scores comparison showed no difference in control group (P=0.409). However, in the serious game and multimedia groups, the average score of pre-test and post-test had a statistically significant difference (P<0.001, P=0.002 respectively), this difference was higher in the serious game group. Questionnaire evaluation showed substantial differences between game and multimedia groups.
 Conclusion: The educational interventions were able to improve student's knowledge and skills so they can better help patients and promote public health. In the sections of Confidence, Social Interactions, Fun, Focused attention, Learnability, Relevance, and Perceived Learning, the serious game far outweighed the multimedia case-based learning.

Missed nursing care in emergency departments: a cross-sectional descriptive study

BackgroundMissed care refers to the omission or delay in performing any aspect of patient’s care (either a part of the care or the entire care). Currently, missed care has become a growing concern at the international level, which threatens the quality and safety of care and cases many unwanted consequences. This study aims to investigate the frequency and types of missed nursing care in the emergency departments of selected hospitals affiliated to Tehran University of Medical Sciences.MethodsThis is a cross-sectional and descriptive- observational study that was conducted with the aim of determining the frequency and types of missed nursing care in the emergency departments of selected hospitals affiliated to Tehran University of Medical Sciences from January 2020 to June 2020. The research community included all nursing care offered in the designated areas, as well as all nurses working in the emergency departments of selected hospitals. Finally, 146 nurses were selected by census method. The information was collected by self-reporting method and the researcher’s observation. Demographic information questionnaire, a researcher-made checklist were used to determine the frequency and types of missed nursing care. 384 observations were made for each item. Descriptive statistics methods were used to analyze the data.ResultsThe area of checking equipment and emergency trolley(mean = 81.80) had the lowest and the area of patient communication(mean = 55.72) had the highest level of missed care.ConclusionsThe level of missed nursing care in the emergency departments of selected hospitals affiliated to Tehran University of Medical Sciences was found to be high and the highest amount was related to the field of communication with the patient. Therefore, it is recommended that the details of missed nursing care in each area should be considered by nursing managers.

Nursing Instructors’ and Students’ Experiences of Transition from Face-to-Face Education to Virtual Education during the Coronavirus Disease 2019 Pandemic

Introduction. The coronavirus disease 2019 (COVID-19) pandemic necessitated the suspension of most educational activities and a shift from face-to-face (FTF) education to virtual education (VE). These changes were associated with new educational experiences for both instructors and students. This study aimed to explore nursing instructors’ and students’ experiences of VE during the COVID-19 pandemic. Method. This descriptive qualitative study was carried out in 2021. Participants were 21 bachelor’s, master’s, and Ph.D. nursing students and six nursing instructors purposively selected from the Faculty of Nursing and Midwifery of Tehran University of Medical Sciences, Tehran, Iran. Data were gathered through FTF or online in-depth semistructured interviews and were analyzed through conventional qualitative content analysis as proposed by Graneheim and Lundman (2004). Results. Eight subthemes and three main themes were developed during data analysis. The main themes and subthemes were VE as a double-edged sword (VE as a threat, VE as an opportunity, and necessity to improve VE), weaknesses in clinical education (reduced quality of clinical education and necessity to compensate for students’ retarded clinical learning), and reduced reliability of virtual student evaluation (cheating as a problem of virtual evaluation, stresses and tensions of virtual evaluation, and necessity to use new strategies in virtual evaluation). Conclusion. Despite the different shortcomings and challenges of VE during the COVID-19 pandemic, educational experiences gained in this period can be used to improve the quality of nursing VE in future epidemics and pandemics.

Burnout and Its Related Risk Factors: A Comparison Study of Nurses Working in Two Different Wards

Background: Nursing is a physically and emotionally demanding job, making nurses highly susceptible to burnout. Burnout is associated with many deleterious consequences affecting health care outcomes. Objectives: We aimed to evaluate and compare burnout and its associated risk factors in nurses working in 2 different wards: operating rooms and surgical wards. Methods: This cross-sectional analytical study was conducted on 100 operating room nurses and 100 surgical ward nurses at Vali-Asr Hospital, Tehran University of Medical Sciences. Data collection instruments included a demographic questionnaire and Maslach Burnout Inventory (MBI). Data were analyzed using SPSS version 22. Results: Overall, the burnout score in surgical ward nurses was 69.22, while it was 67.97 in nurses working in operating rooms (P = 0.449). Scores of emotional exhaustion, depersonalization, and personal accomplishment subscales in nurses of surgical wards were 54.66, 81.16, and 71.85, respectively. These rates for operating room nurses were 53.02, 80.44, and 70.47, respectively; however, these differences were not statistically significant. There was a significant correlation between working shifts and burnout (P = 0.002). Satisfaction with income was significantly associated with the working environment (P = 0.047). Conclusions: The levels of burnout were high in nurses in both operating rooms and surgical wards. Due to nurses' pivotal role in the health system, identifying burnout and eliminating its causes are highly crucial.

Metamotivation in medical education: The 4F conceptual framework

Introduction Several models and frameworks have been developed in the past two decades to explain motivation regulation in different fields. However, a comprehensive framework that explains the dimensions of metamotivation in medical education is lacking. This study aims to address this gap by presenting a conceptual framework to understand metamotivation in medical education. Method This study was conducted at Tehran University of Medical Sciences in 2022–2023. We applied Crawford’s guidance on developing a conceptual framework via collecting data from three sources: experience, literature, and theory. We developed the initial draft of the conceptual framework by identifying gaps in existing models. A panel of experts reviewed the draft and provided feedback on the framework’s generation, explanation, and argumentation. The final model was designed in the form of a graphical presentation. Findings The study’s conceptual framework clearly distinguishes between motivational challenges and motivational problems, and outlines four phases that explain each phase’s importance, components, and implementation process. The first phase focuses on promoting metamotivational knowledge among learners. In the second phase, learners face motivational challenges and aim to manage them optimally to prevent motivational problems. The third phase occurs when a motivational problem arises, and learners use motivational regulation strategies to resolve it. In the fourth and final phase, learners use psychological skills to stabilize and strengthen the metamotivational process. Conclusion This study’s conceptual framework focuses specifically on the context of medical education to provide guidance for future research and interventions on metamotivation. By presenting this framework, we aim to capture the attention of researchers toward the topic of metamotivation and encourage further exploration of its dimensions.

Experiences of medical educational managers in the early COVID-19 pandemic: A qualitative thematic analysis.

The coronavirus (COVID-19) pandemic changed and disrupted education at medical universities. Educational managers face new challenges and special complexities to manage this situation. This study aimed to explain the experiences of educational managers of Iranian medical universities in the early COVID-19 pandemic. This descriptive-qualitative study was conducted at the Tehran University of Medical Sciences, 2020-2021. The study population included all educational managers in one of the positions of the dean of the faculty, educational Vice-Chancellor, head of the department, and other relevant educational directors in medical sciences universities during the COVID-19 pandemic. Data collected from semi-structured interviews were analyzed in MAXQDA2020 software using the thematic analysis approach. Four main themes and nine subthemes were identified: "The ups and downs of the transition from face-to-face training to virtual training," "Crisis in educational management," "Testing and Evaluation: Obstacles and Problems," "Education and lessons learned from COVID-19." Themes identified from the experiences of educational managers provide new information about the negative and positive effects of the COVID-19 pandemic on the learning and teaching process of medical sciences students. Lessons learned and experiences of educational managers in medical sciences universities amid the COVID-19 pandemic will help health education policymakers so that they can create transformation and innovation in the education of medical science students. Strengthening the e-learning infrastructure will help to create a foundation for a rich way of educating medical students in the post-corona era and when the outbreak of other emerging diseases is inevitable in the future.

Exploring medical students’ perceptions of empathy after cinemeducation based on Vygotsky’s theory

BackgroundMedical students’ empathy toward patients with Alzheimer’s is rarely found in formal medical curricula. Based on Vygotsky’s theory, watching films and reflection can be considered as effective methods to improve empathy. The present study aimed to explore medical students’ perceptions of empathy toward patients with Alzheimer after participating in an educational program by using interactive video based on Vygotsky’s theory.MethodsThis qualitative study was conducted at Tehran University of Medical Sciences in 2022. The population included all 40 medical students. Firstly, the Still Alice movie which is about the feelings of a professor who was diagnosed with Alzheimer’s disease was shown to the students. Secondly, the students reflected on their experiences of watching the movie. Thirdly, a session was held for group discussion on the subject of the movie, the patient’s feelings, the doctor’s attitude, the social environment surrounding the patient shown in the movie, and the necessity of empathy toward patients with Alzheimer’s disease. The reflection papers were analyzed using the conventional qualitative content analysis method.ResultsAfter analyzing 216 codes from 38 reflection papers, four categories, including communication with a patient with Alzheimer’s, understanding the patient with Alzheimer’s as a whole, medical science development, and the student’s individual ideology, were extracted.ConclusionReflection and group discussion after watching movie by providing opportunities for social interaction about personal interpretations will lead to active role in enhancing empathy. Based on the perceptions of the medical students, they gained a perspective to consider the patient as a whole and pay attention to establishing a proper relationship with the patient.