فهرست مطالب سید اسماعیل مناقب

 Dyslipidemia is a major risk factors for cardiovascular disease. This research aimed to determine the knowledge of the doctors in this field in Shiraz and its related factors.

 This analytical cross-sectional study was performed among urban general family physicians in 1400. Cluster random sampling was done from 8 centers out of 32 comprehensive health centers covered by 2 main health centers that cover the whole city of Shiraz (86 people from each main health center). A researcher-made questionnaire was used which included 12 questions about dyslipidemia. The questionnaire was delivered to the physicians in the workplace, and the completed questionnaire was taken one day later. Statistical analysis was done with SPSS-20 software. The effect of factors on the score of the questionnaire was investigated by linear regression analysis.

 172 questionnaires were completed of which 98 (57%) were male and 69 (40%) were female and the average age of the participants was 44.7 ± 9.7 years. The average score was 64% of the total score in prevention and treatment. (3.2 ± 0.9 of 5 points and 4.5 ± 1.4 of 7 points, respectively). 50.6% of doctors were aware of national guideline, and only 32.6% had read that. None of the investigated factors significantly affected the total score, including participating in Continuing Medical Education and studying the guidelines.

 General family physicians’ knowledge about dyslipidemia was less than expected. Physicians’ awareness and studying of the national guideline was unsatisfactory. It is required to design effective and targeted Continuing Medical Education and to prepare and effective use of clinical guidelines targeted to family physicians. In the future, similar studies should be conducted to monitor the knowledge of doctors at regular intervals to improve the quality and quantity of education after graduating.

Diabetes is a multifactorial metabolic disorder characterized by chronic hyperglycemia. Type 2 diabetes is the most common type of diabetes and is the main cause of nephropathy, neuropathy, retinopathy and 60% cause of foot amputation, so this is an expensive disease.The aim of this study was to investigating and comparing of the diabetic patients' care between the Family Medicine Specialist Clinics (FMSCs) versus Family Medicine general Clinics.

254 patients with type 2 diabetes enrolled in this descriptive-analytic study. 64 cases selected from the family medicine specialist clinic (43 female, 21 male) and 190 patients from Family Medicine general Clinics (97 female, 93 male). Patients were 30 years or older and it had been at least two years since diagnosis of type 2 diabetes.

The efficacy of the family medicine specialist clinic was significantly better than the family medicine general clinics in management of the body mass index (p<0.001), blood pressure measurements (p<0.001), foot observation (p<0.01), sensory and vascular foot examination (p<0.01) and micro albuminuria measurement(p<0.01) There was no significant difference between mean of BMI, glycosylated hemoglobin, fasting blood sugar (FBS), two-hour blood sugar and systolic blood pressure in two groups

The results of current study showed that the efficacy of family medicine specialist clinic in diabetic care was higher than family medicine general clinics.

In order to meet the social accountability, the Minimum capabilities of general practitioners in Iran have been developed by the Council of general medical education. The aim of this study was to evaluate medical interns and family physicians regarding Minimum capabilities of general practitioner by self-evaluation.
This descriptive cross sectional study was performed on family physicians and interns of Jahrom University of Medical sciences in 2011. From the forty participants, 20 interns were selected by census method, and 20 family physicians by simple random sampling. Data gathering tool was a Valid and reliable questionnaire containing 83 items in 8 areas including health promotion, clinical and communication skills, practice procedures, attitudes, medical ethics and Legal Responsibilities, information technology, basic sciences, research and personal development. The results were analyzed using independent T-test of SPSS 16.
The mean age of family physicians was 30.7; 45% were male. The mean age of interns was 24.5 and 80% were female. The capabilities of family physicians were evaluated strong except in the area of research that was average. The ability of using Internet was evaluated strong, except in the areas of research, personal development and information technology that were average. Comparing capabilities of interns and family physicians in the eight areas using independent t-test, showed that except in the field of research (P value=0.19), there was a significant difference (PValue Improve the ability of medical students in the field of information technology, research, personal development and lifelong learning is essential.

Medical ethics is one of the lessons which were added to general medical curriculum in recent years. Experimental nature of this course requires having its own training and assessment methods. In this way, the viewpoints of the teachers can have a prominent role. This study aimed to determine teacher's opinions about teaching and evaluation methods of medical ethics course at Shiraz and Jahrom Universities of Medical Sciences in the year 2012.
This cross sectional study was carried out in the year 2012 at Shiraz and Jahrom Universities of Medical Sciences.The study population consisted of teachers of medical ethics at these two universities. Sampling was performed as census and all medical ethics teachers (23 persons) were enered to this study. The study instrument was a researcher-made questionnaire which its validity was approved by the five expert's opinions and its reliability was determined as Cronbach's alpha measure 74%. This questionnaire had four main areas: 1- Appropriate time for teaching. 2- Appropriate place for teaching. 3- Appropriate method for teaching. 4- Appropriate method for evaluation which was set as the 5-choices Likert scales from completely agreed to completely disagree. The questionnaires were sent to the teachers and delivered after filling out. Obtained data were analyzed with SPSS version 14 package as descriptive statistics.
FINDINGS: Based on the teachers opinion, the best time for teaching was clerckship period (43.5%), internship in second place (30.4%) and basic sciences in the last place (8.7%). the best palce for teaching was classroom (43.5%) and Clinical Skills Lab in second place (21.7%). The best method for teaching was lecture (56.5%) and group discussion (21.7%). The best way of evaluation was written exam (52.2%) and work report and observation of medical interview correspond with 17.4% and 8.7% were in second and third places.
It is suggested that to teach this lesson as a longitudinal course especially in clinicalcourse. In the other words, the concepts made simple or quite theoretical can be tought in the basic sciences phase; practical and complex concepts can be tought in the clinical phase. Although in this study, lecturing and writing exams are most welcome, but this may be due to the lack of familiarity of the teachers with other existing methods.

Spiritual health is one of the most well-defined four aspects of health. The findings suggest that spiritual beliefs help patients to face negative effects of chronic diseases.This study were designed to survey the viewpoints of the patients toward the spiritual health in Jahrom.
This was a cross-sectional study on 321 hospitalized patients of internal and surgery wards of the hospitals in the city of Jahrom who were selected by available sampling, in the year 1391. A questionnaire containing 10 questions, which was narratived by 4 professors and its validity was calculated with Chronbachalpha 87%, delivered to the patients personally and the information analysed by Spss16 software in descriptive statistics level and by t-test and oneway anova test and the average score for the patientsview by 30 or less considerd as a negative view and more than 30 as a positive one.
The average score of viewpoints was varied from 36.5±4.7 in illiterate individuals to 37.6±5.2 in licensed ones. Average score of Viewpoint of patients toward the spiritual health was associated with gender and disease (p=0.00). But, there was no significant association between Average score of viewpoint of patients toward the spiritual health with hospital ward (p=0.09). Also using one-way ANOVA test was observed significant association between Average score of viewpoint of patients toward the spiritual health with the level of education (p = 0.000).
According to the average score obtained, it was seen that patients had a positive perspective towards spritual health. Patients believe spirituality has a positive impact on the treatment and recovery process. Patients want their spiritual needs are addressed and met. Physicians must to take care of their patient's religious beliefs. And they can play an important role in the spiritual support of their patients.

Increased attention to professional medical ethics has led to an increase in the importance of the content of medical ethics course. In order to effectively teach this course¡ taking advantage of corresponding teachers plays a dominant role. This study was carried out with the aim of determining medical ethics teachers'' perspective about the priority of the issues of this course at Shiraz and Jahrom Universities of Medical Sciences in 2012.
This study was a descriptive and cross sectional study conducted at Shiraz and jahrom universities of medical sciences in 2012. The studied population consisted of teachers of medical ethics at the two above-mentioned universities. Sampling was done in a census way and all medical ethics teachers at Shiraz and jahrom medical sciences universities¡ reaching 22 people¡ entered the study. The research tool was a researcher-made questionnaire that its validity was approved by 5 experts and its reliability was determined about 74% by Cronbach''s alpha. Data were entered into the software and analyzed in a descriptive statistics level.
In order¡ bad news with a mean score of 4.8¡ physician - patient relationship with a mean score of 4.7¡ abuse cases in treatment with a mean score of 4.4¡ physicians'' and patients'' rights with a mean score of 4.4 had the highest scores¡ while simulation with a mean score of 3.1¡ research ethics with a mean score of 3.1¡ ethics in animals'' nests with a mean score of 3.5 had the lowest scores.
The most important issues in the medical ethics course included the patient-physician relationship¡ relating bad news and fundamental communicative skills. Some of the topics such as simulation and ethics in animals'' nests were of less importance.

Learning is a complex process in which various factors involved. This study was conducted with aim of evaluating the clinical learning environment based on DREEM model (Dundee Ready Education Environment Measure) from the perspective of nursing students of Jahrom University of Medical sciences. This study is a descriptive cross – sectional one performed in hospitals of Jahrom University of Medical sciences in 2012. Research community was nursing students of Jahrom University of medical sciences and sampling method was census. Data collection was done through the valid and reliable (α=0.79) DREEM questionnaire. The 50-question questionnaire included five areas of Learning, Professors, Students’ Academic Self-Perception, Atmosphere dominating the learning environment, and Students’ Social Self-Perceptions. 174 nursing students participated in this study. Data were analyzed by SPSS15. In the field of “learning”, 34% had negative attitudes to learning and 51.9% had positive attitudes to learning. In the area of “professors”, 39% believed in retraining, and 58.1% thought of the movement in the correct direction. In the area of student perceptions of their academic ability, 48.1% assessed it satisfactory and in the area of educational environment 65.1% of students chose "many cases require changes". In the area of students’ perception of their social condition, 56.6% evaluated it as "not very bad". The area of Academic Self-Perception was evaluated to have "many negative aspects" and the field of Perceptions of Atmosphere as " a terrible environment and in need of drastic changes" which demand more attention to be paid to these areas by the University training officials. Moreover, DREEM model can be used for monitoring and assessing modification actions and changes made in educational programs.

Breaking bad news is an unavoidable part of the medical profession، and doctors and patients stand at the two sides of this function. There are different views about how to break bad news in different cultures and societies. In this study we assessed the viewpoints of hospitalized patients on how to break bad news. This cross sectional study was performed in 2011 at the Jahrom University of Medical Sciences. Sample size of 110 patients was calculated and the method of sampling was simple random sampling. Target population was the hospitalized patients of Peymanyeh and Motahari hospitals in Jahrom. Entry criteria consisted of being admitted to the above hospitals، and exclusion criteria included severely ill patients and patients with mental disorders. A reliable self-administered questionnaire was designed and validated. The questionnaires were completed and returned by 110 patients. Data were analyzed using the SPSS16 software through descriptive analysis. One hundred and ten patients were included in this study. The factor analysis showed three elements: methods of breaking bad news، the people involved in the breaking bad news process، and timing and location. Of participants 78% wanted to be told the bad news while their relatives were present، 63. 2% wanted to be told the bad news in a private and quiet room. Almost all respondents emphasized the need for religious advisors and psychological counselors (77. 2% and 62. 5% respectively). Most of participants (91. 5%) wished to receive all the information about the etiology of their disease، and 74. 8% of them wanted to be told whether their illness was cancer. This study showed that there are different views on how to break bad news in different cultures and societies. Social and cultural differences must be considered in breaking bad news. In our country، patients’ families could have a prominent supporting role in the delivery of bad news to patients.

The Main challenge in training about breaking bad news is selection of appropriate educational method. This study was performed to assess the results of role-playing method versus group discussion in training about this skill. This was an interventional double blind study, performed in 2009-2010 in Jahrom University of Medical Sciences. 30 medical students were involved in this study (15 students in each group). At first, their breaking bad news skills were evaluated with an Objective Structured Long Examination Record (OSLER1). Then the first group participated in group-discussion workshop and the second one participated in role playing workshop. Their breaking bad news skills were re-evaluated by OSLER2 after the course. The score of OSLER1 and OSLER2 of both groups were compared. Results were analyzed by T test and paired T test. there was no significant difference in OSLER scores between groups before intervention (p=27.42). The mean score of the first group before workshop (10.5 3.44) was significantly different from it after (19.8 5.44) training (p=.000). Also the mean score of the second group before (27.70 0/833) and after (27.70 0.833) training were significantly different (p=0.000). There was significant difference between two groups’ scores after training (p=0.000). Our training intervention was effective in producing significant change in medical students’ breaking bad news skills, but training by Role-playing method was more effective than group discussion method.

Appropriate breaking bad news skills are essential to the practice of high quality medicine. This study was performed in order to assess the educational benefits of training on breaking bad news skills by role play versus group discussion methods. This interventional double blind study was performed in 2009-2010 in Jahrom University of Medical Sciences. Determination of the sample size and sampling method was based on census. 30 interns were involved in this study. They were divided into two groups randomly. Their knowledge and attitude about breaking bad news skills were evaluated with valid and reliable questionnaires. Then, group one participated in group discussion workshop and the other group participated in the role play workshop. Their knowledge and attitude were re-evaluated after the course. The scores of pre-course and post- course of both groups were compared. The results were analyzed in SPSS 11.5 using t-test and paired t-test. The mean score of knowledge and attitude of both groups before training were compared and the results showed that there was no significant difference between them (p=0.618 and p=0.329). The mean scores of knowledge of groups one and two before and after training were compared and there was a significant difference (P<0.0001). The mean scores of the attitude of groups one and two before and after training revealed a significant difference (p=0.001). The mean scores of the knowledge and attitude of groups one and two after training were compared and there was a significant difference (P<0.0001, P<0.0001). Although both methods were effective in producing significant changes in medical student’s knowledge and attitude, role playing was more effective.

Pronouncing bad news is one of the most difficult duties of a physician. Lack of education in this field may negatively affect physician-patient relationship. These skills are not taught in our country vastly and effectively. The aim of this study was to assess knowledge and attitude of clinical teachers, family physicians and interns of Jahrom University of Medical Science about giving bad news. This study was conducted among a census sample of 40 clinical teachers, 22 family physicians, and 30 interns in 2009 in Jahrom University of Medical Sciences. A questionnaire was designed by the researcher, then its validity and reliability was determined. Data was analyzed by SPSS software using ANOVA and independent T test. The average scores of knowledge and attitude were 15.96 (out of 25) and 34.43 (out of 52) among faculty members, 16.72 and 35.22 among family physicians, and 15.26 and 33.43 among interns group. Knowledge level in all 3 groups was medium and their attitudes toward training in these skills were positive. No significant difference was found between knowledge and attitude of these 3 groups (respectively: p=0.095 and p=0.548). According to the result of this study and considering the fact that these skills are currently learnt through inactive methods and via try & error technique, there is a real need for developing planned courses in Iranian medical universities.

Breastfeeding and the complementary feeding have a prominent role in the growth and development of children. This survey was designed to assess the nutritional status of children under two years in urban and rural areas of Jahrom.

This was a cross-sectional study on 435 children aged 18-24 months and living in rural and urban areas. Data were collected through a questionnaire and descriptive and analytic statistics were employed.

In this survey, the mean (SD) age of the children was 20.86  3.305 years. Exclusive breast feeding was 55.4 percent and the mean (SD) age of exclusive breastfeeding was 5.49 ± 1.64 years. Moreover, 26.9 percent of the children were fed with artificial milk. The mean (SD) age to start supplementary feeding was 6.040.956 and that of continuation of breast feeding until 2 years of age was18.58  5.321.

Considering the considerable lack of exclusive breast feeding and its resulting complications and consumption of about two times as much artificial milk in the urban as compared to rural areas, it seems that there should be an attempt to educate mothers on the disadvantages of lack of exclusive breast feeding and advantages of breastfeeding specially in rural health care centers.

Good doctor patient communication has been shown to have a positive impact on a number of health outcomes in previous studies. But few such studies has been done in IRAN. We have designed this trial to assess the educational benefits of communication skills workshop based on Calgary-Cambridge guideline on the knowledge, attitude and practice of family physicians. Materials and MethodsThis study was performed in 2007 in Jahrom University of Medical Sciences. This was an interventional, double blind and forward study. The population studied was 24 family physicians from Jahrom University of medical sciences. They were divided randomly in two groups consisting of 12 family physicians in each group. Inclusion criteria were family physician of Jahrom University of medical sciences and exclusion criteria were discontinued workshop. To evaluate the practice of family physicians we assessed satisfaction of their patients. 5 patients from each doctor were polled. Baseline knowledge, attitude and practice of each doctor were assessed using questionnaires. Then, 1 group of doctors participated in the communication skills workshop, while the other group did not. Two months after the communication skills workshop, knowledge, attitude and practice of both groups of doctors were re-assessed. The scores of both groups before and after the communication skills workshop were compared. Results were analysed using SPSS 11.5. ResultsThe mean scores of knowledge, attitude and practice of both groups before the workshop were compared and the results showed that there was no significant difference between the two groups (corresponding: p=0.830, p=0.924 and p=0.891). The mean score of knowledge, attitude and practice of both groups after educational intervention were compared and the results showed that there was significant difference between both groups (corresponding: p=0.000, p=0.000 and p=0.000).ConclusionOur training intervention was effective in producing significant change in family physician's knowledge and attitude as well as the patient's satisfaction.

LBW and neonatal mortality in Jahrom city are higher than average of Iran; LBW causes neonatal mortality and morbidity. So this study performed to survey prevalence impact factors on LBW to design an interventional plane. This was a cross-sectional and descriptive study. In this survey 92 mothers with LBW child selected by census method. Information was collected by a standard questionnaire that includes demographic specification, knowledge, practice and the situation of health body of mothers in pregnancy and before pregnancy. The questionnaire completed by the educated questioners. Statistical analysis was carried out by SPSS version 11. The results indicated that 53% of mothers were their grades under diploma, and 71.4% didn’t refer in order to receive consult before pregnancy and 53.6% of mothers with LBW child were belong to the high risk group and they had history of the high risk factors in last pregnancy the most factor was the history of LBW in before pregnancy. This study suggests performing another survey on quality of prenatal care and impact of before care pregnancy to prevent LBW.