مجله دانشکده پزشکی اصفهان
پیاپی 648 (هفته چهارم دی 1400)

General practitioners acquire most of their learning in internal and surgical departments. The purpose of this study was to determine the current status of education in these departments from the students` point of view to help improve clinical education.

This was a cross-sectional study conducted in Alzahra hospital in Isfahan, Iran. The target population consisted of clerkships in two departments of internal medicine and surgery in the academic year of 2017-2018. A researcher-made tools was used to collect data, and after completion by the clerkships, data were reported descriptively. Quantitative data were reported as mean ± standard deviation and qualitative number (percent).

Out of 260 questionnaires, 154 were completed (response rate of 60%). The highest mean percentage of achievement of clinical skills in both internal (68.71 ± 68.71) and surgical (56.95 ± 27.98) groups was history taking, and the lowest in both internal (20.81 ± 23.20) and surgical (26.44 ± 13.37) groups was practical skills. The most suitable person/place to teach all the skills, except the practical skills, was the teachers/on the bed, and for the practical skills, was practice and personal experience/on the bed.

The level of clinical skills acquisition is not desirable, and the lowest results are related to practical skills. It seems that bedside teaching by the clinical teachers has played the most important role in increasing the skills of clerkship in various fields. Further studies are needed to determine the exact factors affecting the achievement of clinical skills.

 Different nutrients affect brain functions. This research investigated the effects of acute, sub-chronic, and chronic consumption of sucrose and different kinds of chocolate (with various cocoa and carbohydrate percentage) as portable nutrients on anxiety, locomotor activity, food consumption, and body weight differences (BWD) in male rats.

 Thirty-five male Wistar rats (200-250 g) were divided into five experimental groups: standard food (control), dark chocolate, milk chocolate, white chocolate, and sucrose for 14 days. Anxiety and locomotor activities were evaluated on days 1,7, and 14 using open field test (OFT). Then, food consumption and BWD were measured.

 The sub-chronic consumption of sucrose and white chocolate significantly decreased total crossing number of OFT compared to control group. Moreover, acute consumption of sucrose tended to significant decreases in central crossing number. The sub-chronic dark chocolate consumption showed a significant enhancement of central crossing number. In different mono-diet of nutrients, the food consumption showed significant decreases in all groups compared to control group. The BWD had significant decreases in the first seven days. In addition, The BWD showed significant decreases in sucrose, milk chocolate, and dark chocolate during the final seven days.

 Anxiety significantly decreased by sub-chronic consumption of dark chocolate and acute sucrose consumption. Moreover, sub-chronic sucrose and white chocolate consumption decreased locomotor activity in subjects. While, regardless of nutrient types, the mono-diet could cause major weight loss. Further weight loss occurred with a high concentration of cocoa in the dark chocolate mono-diet.

Burn is one of the costliest and most harmful damages. Burn wounds, even if they are non-lethal, can have the worst physical, psychological, social, and economic effects. Silver sulfadiazine ointment is the gold standard for wound management burns. However, different studies have shown different results in comparing the use of silver sulfadiazine ointment with new dressings containing silver nanoparticles. The purpose of this study was to compare the-cost effectiveness of silver nanocrystal dressing with silver sulfadiazine in burn wound healing.

This research was based on the Health Technology Assessment Plan approved by the National Health Research Institute of Iran. Using the systematic review method, the PubMed, Scopus, Proquest, Google Scholar, Cochrane, Up To Date, Iranmedex, and Scientific Information Database (SID) databases were used to compare the effectiveness and cost of silver nanocrystal with silver sulfadiazine ointment. Considering the diversity of studies in terms of methodology and the limitation of studies appropriate to the research question, since there was no possibility of meta-analysis, narrative review was used to analyze the results of the studies during the years1990 to 2017.

In the initial search of the databases, 213 articles were found; of which, 60 articles were deleted due to duplication, and 153 studies were selected After reviewing the titles and abstracts,122 studies were excluded. Out of 31 full-text articles, 13 articles were finally included in the study. The results of analysis showed that wound infection, healing time, pain, need to skin grafts, and duration of hospitalization were less than that for silver nanocrystals compared to sulfadiazine. Moreover, the cost of treatment for silver nanocrystals was lower than that of silver sulfadiazine.

Treatment with silver nanocrystals is more effective and less costly than silver sulfadiazine. Given to the limited number of the articles in line with the objectives of the study, it is necessary to perform further studies before finalizing any decision regarding the cost-effectiveness and making suggestions to replace the dressing.