محمدرضا صبری

Congenital heart disease is one of the most common birth defects. This study aims to examine the process of clinical guideline implementation to identify strengths and weaknesses.

In this cross-sectional study, healthy term and term neonates born from January 2023 to July 2023 were evaluated at Shahid Beheshti Hospital in Isfahan. The data collection tool was a checklist. The pulse oximetry (POX) was performed for healthy newborns within the first 24 hours after birth and before discharge from the hospital. Oxygen saturation (SpO2) < 89% in the baby's hand and foot was considered positive screening. If the SpO2 level was between 90-94%, the screening was repeated one hour later and if in the case of the same results, the newborn was referred to a specialist for further assessment. Healthy neonates with positive test results were followed up two months after primary POX screening.

Out of 500 neonates, 472 (94.4%) had a SpO2 level ³ 95%. Among the 21 cases who had a positive screening, one case had cardiac diseases (i.e., complete atrioventricular septal defect/pulmonary hypertension). Two healthy neonates with a positive screening were diagnosed with PFO after two months of follow-up. The assessment of the implementation process of newborn screening based on the checklist recommendations of clinical guidelines increased from 58.3 % to 91.6 % within six months.

The implementation of the critical congenital heart disease clinical guideline was found to be favorable and acceptable in this study and recommended for other hospitals to implement.

Congenital heart defects (CHDs) are the most common type of birth defect. Affected children and adolescents with CHD require special care in dentistry because of their susceptibility to infective endocarditis from poor oral hygiene infections. The purpose of this study was to design and evaluate a mobile-based educational oral health application for children and adolescents with CHD.

This developmental study was conducted in 2021-2022 at the Pediatric Cardiovascular Research Center in Isfahan. My Structured Query Language (MySQL) system was used to design the database of educational oral health application. Also; the development phase was based on the Android platform. The design and development of a mobile-based educational oral health application was carried out in five stages, including analysis, design, development, implementation, and evaluation. A researcher-made questionnaire was used to evaluate the application. The statistical population of this was composed of 51 children and adolescents (3-18 years of age) with CHD and their parents.

The results of the evaluation of the usability of the educational oral health app from the children and adolescents' perspective with CHD showed that the "user-friendliness", "ease of use" and " educational impacts" of the app were evaluated as good.

The usage of this mobile application can be useful in improving the oral and dental health of children and adolescents with CHD.

Syncope is a temporary loss of consciousness with a loss of postural tone. Medicinal treatment of reflex syncope has shown to have no significant effect in reducing the recurrence of syncope. A 36-month follow-up of our pilot cohort showed that non-pharmacological treatments alone were effective in reducing relapse rates. The purpose of this study is to investigate long-term results and 8-year follow-up of previous patients.

The current study is a continuation of a prospective pilot cohort which was done between August 2013 and 2014 in two academic hospitals in Isfahan (Dr. Chamran heart center and Imam Hossein children hospitals). This current study examines the 8-year follow-up results of children with reflex syncope who were treated with non-pharmacological treatments alone or with drugs. Therefore, the patients who participated in the pilot study were enrolled (30 patients in the pharmacologic group and 40 patients non-pharmacological group). Finally, on 26 patients in the pharmacologic group and 31 patients in the non-pharmacological group (after applying the exclusion criteria), the incidence of syncope and pre-syncope attacks was compared between these two groups of patients using the Chi-square test.

Our study showed that within 5 years after the last follow-up, the incidence of syncope and pre-syncope in patients with a history of vasovagal syncope who did not continue the diet or tilt exercises was different between the two groups of patients (without medication and drug recipient) was not significantly different, even the incidence of presyncope increased significantly again in both groups. The incidence of syncope in the period of 5 years after the last follow-up from the previous study was slightly increased in the group of patients without medication compared to the previous periods, but in the group of patients receiving medication, this incidence decreased slightly.

In order to prevent recurrence, the use of non-pharmacological methods is effective, but for the stability of this recovery, follow-up and continuation of these methods is necessary.

 Seeing as the active participation of faculty members in the development of world science depends highly on their language knowledge, the Deputy of Education of Isfahan University of Medical Sciences with the approach of developing academic interactions has implemented wide range of language instruction programs. This study endeavored to determine the views of faculty members on the English language instruction program, measuring the level of learning and examining opportunities and challenges through evaluation based on the Kirk Patrick model.

 The population of this cross-sectional descriptive study consisted of faculty members participating in English language instruction classes in the academic year 2020, who were included in the study by census during three semesters (72 individuals). The instrumentation was a questionnaire developed by the researchers to examine the views of the respondents, with authenticated validity and reliability. Data analysis was done using descriptive statistics and average comparison tests, Pearson, Spearman, and Paired t-test.

 Sixty-five questionnaires were analyzed. The average final score of the questionnaire is 87.94 out of 130. Suitability and useability of the course, interest in participating in subsequent program and recommending to other colleagues, and the importance of persuading the lecturer to learn English from the opportunities of the program and intensive and stressful course and interference with professors' classes or not having the opportunity to do homework It can be considered as one of the challenges of the course Besides, the scores evaluated by teacher after the English language instruction program led to significantly higher scores, which in turn indicated the applicability of the program.

 Faculty members had a high score of the language instruction program and the level of learning has increased. Obtaining the findings of this study and examining its opportunities, it is possible to elevate the English language instruction programs and greatly reduce its shortcomings.

Empowerment workshops are mandatory for faculty in various fields of education, research and culture. The effectiveness of the workshops increases the level of professional commitment and improves the quality of teaching, and ultimately improves the medical and diagnostic services of patients. Despite holding these workshops for many years, less feedback has been reflected on their consequences. Therefore, the purpose of this study is to investigate the impact of participating in the mentioned workshops on the quality of teaching and the commitment of the faculty.

A cross-sectional analytical study was performed in 2016 at Isfahan Medical School. The statistical population consisted of 538 faculty members working in Isfahan Medical School and sampling included the selected professors (433 people). The scores of teaching quality, professional commitment, evaluation and participation in faculty empowerment workshops in the last five years were obtained. Data were analyzed using Chi-square, t-test and Pearson correlation through SPSS.

Of the total faculty, 80% had an evaluation score above 85 (out of 100) and a professional commitment score above 17 (out of 20). The mean scores of teaching quality and professional commitment were 8.85± 0.65, 19.30± 0.85 and direct and significant correlations (r = 0.33 and P <0.001), respectively. The mean evaluation score was 93.07 ± 4.23 out of 100 and had a direct and significant correlation with the empowerment score (r = 0.12 and P = 0.012). Results show that Mean empowerment score was 1.4±1.5 out of 5 and had no significant correlation with professional commitment or teaching quality.

The findings showed on the one hand the high scores of the faculty in the quality of teaching, professional commitment and evaluation and on the other hand the low acceptance of the faculty to participate in the workshops and the weak correlation between the two. Given that high face-to-face scores in evaluation can lead to misconceptions about self-efficacy and consequently reduced self-efficacy. Therefore, it is recommended that faculty be empowered in self-assessment.

As overweight and obesity in children and adolescents continue to increase, this study was designed to explore the factors that facilitate or hinder weight control in obese and overweight adolescents.

This qualitative study was conducted as a personal interview with 12 adolescents aged between 12 and 18 years who succeeded in losing weight and those who did not, from the clinic at the Pediatric Cardiovascular Research Center at the Isfahan Cardiovascular Research Institute, in 2019. We used a purposeful sampling method and a qualitative analysis method to analyze the data.

Seven categories consisting of willpower and perseverance, support and encouragement of others, tendencies to beauty, lack of a rush to achieve results, adequate physical activity, understanding the disadvantages of obesity, and understanding the benefits of weight loss were identified as facilitating factors in this study. Seven other factors were reported as obstacles of weight loss, including misconceptions,  lack of family cooperation in lifestyle modification, lack of awareness about the effects of obesity, concern about dietary restrictions, lack of management and supervision of school cafeterias, parental misbehavior in handling adolescents with overweight or obesity, and their psychological damages.

The results of the present study show that in order to bring adolescents to the ideal weight, individual, environmental and familial factors and the interaction between them should be considered. The findings of this study could be used by health officials and policymakers to develop programs to prevent and control overweight and overcome obesity.

Congenital heart defects (CHD) are the most common type of birth defects. The main screening tests used to identify babies with congenital heart defects include prenatal echocardiography and postnatal clinical assessment. Routine pulse oximetry has been reported as an additional screening test that can potentially improve the early diagnosis of critical congenital heart disease (CCHD).

This study is a multi-stage evolutionary study that was conducted for 12 months from March 2021 to March 2022 at Pediatric Cardiovascular Research Center in Cardiovascular Institute, Isfahan, Iran. In the first phase, after identifying the topic and aims of the present study, questions were designed through the PICO method including (population, intervention, control, and outcomes). Then conducting systematic searches, the quality of all existing clinical guidelines (CG) of this field were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument and a committee consisting of pediatric cardiologists and neonatologists in the field. Next, based on the opinions of experts, the quality of 1 out of 6 clinical guidelines for early detection of critical congenital heart disease at birth by pulse oximetry was assessed as optimal. Finally, the clinical guidelines draft was evaluated using the Delphi method and the panel of experts. After expert panel meetings and consensus between members, the final version of the guideline for early detection of critical congenital heart diseases at birth by pulse oximetry was developed.

In the present study, criteria of clinical practice regarding the stages of newborn screening by pulse oximetry at birth were determined based on the evidence and health conditions and were presented in twenty-eight recommendations and six sections. The final recommendations were presented in the results section.

The finding of the present study showed that physicians, nurses, and midwives can apply the recommendations of this clinical guideline for the early detection and referral of neonates with critical congenital heart disease.

Congenital heart diseases (CHDs) are the most common type of birth defect. Success in the early detection of critical congenital heart diseases (CCHDs) using pulse oximetry technology depends on a large extent on physicians’ awareness of neonatal clinical examinations. The aim of this study was to investigate physicians’ awareness of newborn pulse oximetry screening for early detection of CCHD in Isfahan City, Iran.

A total of 65 physicians participating in the meeting at the continuing education programs at Isfahan University of Medical Sciences were enrolled in this descriptive-analytical, cross-sectional study in 2019-2020. Data were collected by a questionnaire, developed by the researchers, which validity and reliability were confirmed. Data analysis was conducted using SPSS software.

Of physicians participated to this study, 51 were pediatricians (78.5%). The most physicians (49.2%) had a moderate level of awareness of neonatal screening at birth by pulse oximetry. The results of linear regression analysis showed that only the doctors' workplace (hospital or office) was significantly associated with their awareness of neonatal screening at birth by pulse oximetry (P = 0.01, β = -0.31). In total, 7% of the variations in physicians’ awareness about neonatal screening at birth by pulse oximetry were predicted by this variable.

Physicians, particularly pediatricians, as the first line of health care providers to the newborns at birth, need more knowledge about the neonatal pulse oximetry screening, for early detection and referral of neonates with CHDs.

Tetralogy of Fallot (TOF) is the most common congenital cyanotic heart disease. The purpose of this study was to evaluate the efficacy of intraventional ventricular outflow tract stenting and insertion of surgical Gortex shunt in infants with less than 6 months of age before total correction surgery of these patients.

In this cross-sectional prospective study, 24 patients with TOF who were less than 6 months of age, were not eligible for total correction surgery, and were admitted to Chamran Hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, were studied. 12 patients with less than of 2 months of age were stented and 12 patients were shunted. After 3 to 6 months, all patients underwent complete surgery, and the results were compared.

The length of intensive care unit (ICU) stay during the first procedure was shorter in stent group (1.41 ± 0.66 vs 2.83 ± 0.71 days, P = 0.001). Patients in stent group had less O2</sub> saturation levels at the time of stent implantation compared to the shunt group (67.50 ± 2.02 vs 74.50 ± 3.98 percent, P = 0.001). There were no significant differences between the two groups after total correction in ICU (P = 0.881) and hospital stay times (P = 0.559). One patient from each groups died in the follow-up period.

Stenting for the right ventricular outflow tract can be a better method in low-weight and young-age patients who are not good candidates for total correction; this method has fewer complications and hospital stay period.

Departments are the major sub-system of university and quality improvement of the universities rides on the quality improvement of the departments. The researchers developed, implemented, and evaluated the appropriate components based on the results of self-assessment and external evaluation of institutional accreditation.

In a case study on 32 departments of Medical Schools, based on accreditation standards, department promotion components were identified. The components were prioritized in terms of importance, measurability and viability with proper scale and weighted by the experts with a focus group. The componentschr('39') validity was determined by the expert opinion and implemented in the departments after training. A valid and reliable instrument was developed for monitoring and evaluating the fulfillment of the components.

The components of improvement in the department performance including formulation and implementation of the operational plan, website, training areas, faculty memberschr('39') viewpoints about the department leader, faculty management viewpoints on department accountability, along with a gudline for measuring these components were reached. The mean of the components was 79%. The lowest achievement was related to the component of school participation in the activities of the department and timely presentation of the operational plan (72%) as well as the achievement highest was observance of clinical education standards (92%).

Promotion of website, operational plan, areas of education, increased faculty participation, increased order in the formation of department councils, and increased department accountability were the main results of this study. Evaluation of the department was done on the basis of the realization of the interventions as a chief factor for promoting the executive guarantee. Due to the continuous follow-up and direct supervision of the Faculty Board, the results revealed that the components were in a favorable condition.