مریم اعلا

The COVID-19 pandemic has created opportunities and challenges for education and research as the two main academic activities in medical sciences disciplines, which due to their mutual influence can be used to propose solutions for improving these two areas. The present study was conducted to compare two review articles, each of which dealt with one of these two areas.This comparative study with a qualitative explanatory design was conducted in three steps. First, two review articles were selected that investigated the opportunities and challenges caused by the coronavirus pandemic to propose strategies for the post-corona era. Then, both studies were carefully studied and described. Finally, two researchers separately extracted the similarities and differences mentioned in the two articles and compared them to remove the inconsistencies. A panel of experts confirmed the findings. The opportunities and challenges mentioned in the two articles were extracted and categorized into two areas based on similarities and differences. The similar proposed strategies for the post-corona era were continuing to use virtual space facilities, diversifying the communication methods with students and research participants, and providing and developing suitable electronic infrastructure. Comparing two review articles and determining the similarities and differences between the opportunities and challenges caused by the COVID-19 pandemic and the strategies for the post-COVID-19 era related to medical education and clinical research, led to proposing strategies that could promote these two related areas coherently.

Educational programs need to be evaluated in order to achieve educational goals, improve quality and maintain dynamics. Regardless of the type of evaluation, in every evaluation there is a possibility of bias in the evaluator's decisions. Therefore, meta-evaluation is necessary. The purpose of this research is to Meta-evaluate the PhD program in the field of medical education in Iran University of Medical Sciences, using the Staffel Beam meta-evaluation scale.
Research

This study is a cross-sectional research using Staffel Beam's meta-evaluation checklist, which includes four standards. The utility standard had 7 indicators, feasibility, 3 indicators, propriety 8 indicators, accuracy had 12 indicators, and each of which was checked separately.

The results indicated that the highest overall score was related to the accuracy and the lowest was assigned to the practicality and ethical issues. The highest amount of evaluation power was related to the feasibility standard and the lowest was related to the propriety standard. In the final review of four meta-evaluation indicators, it is clear that the status of the feasibility standard is very good and the moral standard indicator is average. The standards of usefulness and accuracy are also in good condition.

Taking into account of the scores, it seems that the focus should be on training the evaluators and the topic of evaluation to improve the current circumstance. Moreover, maintaining the standards with high score is important. However, more attention should be paid to ethical issues in evaluation, such as making agreements between the evaluator and the evaluation client.

Fourth-generation libraries can no longer be satisfied with web software facilities and must use technologies, including digital realities to increase the level of service and attract clients. Therefore, this review aimed to identify the roles and effects of these technologies in libraries.

In this systematic review, PubMed, Web of Science, Scopus, and Google Scholar advanced search were used to extract and compile documents. Retrieved articles were entered into Endnote software. Two researchers independently explored the content of the articles against the inclusion and exclusion criteria and removed the irrelevant ones. Differences were resolved by consensus with a third researcher.

Fifty-two articles were selected for final analysis. The findings showed that in all kinds of libraries, the use of digital reality technologies can provide and receive new services, strengthen the process of training users, enhance their information literacy, improve the professional activity of librarians, save money, and finally manage and enrich library resources and knowledge sharing in research networks.

Modern libraries face many challenges, such as lack of funds to run communication infrastructure, lack of staff involvement in operational activities, and the need to train skilled personnel to provide services; however, they can present an attractive image of their services through knowledge sharing in the research networks, strengthening education, increasing information literacy, and effective resource management.

Foot ulcer is one of the greatest complications of diabetes. If there is no effective pressure reduction in the ulcer, healing may be delayed. In this regard, the use of offloading methods for the prevention and treatment of foot ulcers in diabetic patients is known as a common therapeutic approach. Since evidence-based recommendations should be considered for the use of the above methods, we decided to provide applicable guidelines in this area by localizing the recommendations and localizing the IWGDF practical guide.

In this study, the adoption of the international evidence-based clinical guidelines on the offloading interventions to prevent and heal diabetic foot ulcers was carried out using the ADAPTE methodology  in  a working group consisting of orthopedic, physical medicine and rehabilitation specialists was performed during three stages of set up, adoption, and finalization. AGREEII tool was used to evaluate the quality of the selected clinical guidelines. Also, in order to reach a consensus for the relevant recommendations, three Delphi rounds and one face-to-face meeting were used.

The IWGDF 2015 clinical guide was selected. The quality score of this guideline based on AGREEII tool in each of the 6 areas was more than 70% and varied between 81.3% and 100% with good quality. The IWGDF guideline for offloading interventions for the prevention and treatment of diabetic foot ulcers included 13 recommendations.

In IWGDF guideline, a total of 13 recommendations regarding foot wear and offloading interventions in the prevention and treatment of foot ulcers in patients with diabetes in accordance with the health care system of our country were adapted.

One of the most important factors in studentschr('39') learning process is academic motivation that can affect different aspects of studentschr('39') performance in educational environments and directly affects their academic success. Motivation is also considered as the key to learnerschr('39') learning. The main goal of this study is to provide ways to increase educational motivation in postgraduate students.

This study is in the field of applied research and with nominal group technique. The statistical population of the study consisted of PhD students in medical education of Iran University of Medical Sciences. The study was conducted by asking the basic questions and then answering it in the nominal group process.

Variables such as benefiting from the presence of professors, the improvement of the learning environment, the proper interaction between the teacher and the subject, and the creation of appropriate welfare facilities would respectively be effective factors in increasing educational motivation among postgraduate students.

Identifying the factors influencing graduate students to continue education is essential. In this way, policy makers would be able to apply effective strategies to help graduate students in continuing education.

Diabetic foot infection is the most common complication of diabetic foot ulcer (DFU) leading to amputation. The treatment requires special attention to disease conditions, proper diagnosis, appropriate sampling for cultures, careful selection of antibiotics, rapid determination of the patient’s need for surgical intervention, and wound care. Clearly a systematic approach or, if possible, an evidence-based approach by using clinical guidelines about diabetic foot infections will lead to better outcomes. In this regard, this article aims to adopt the IWGDF clinical practice guideline on DFU infection.

In this study, the adoption of the international evidence-based clinical guidelines on the DFU infection was carried out using the ADAPTE methodology, which involved three stages of setup, adoption, and finalization. AGREE II tool was used to evaluate the quality of the selected clinical guideline.

The results of this adopted clinical guideline according to the national facilities and access to equipment are described with 26 recommendations along with related reasons for the diagnosis and treatment of diabetic foot ulcer infections. The recommendation categorized into six different categories including Classification/ Diagnosis, Osteomyelitis, Assessing severity, Microbiological considerations, Surgical treatment, Antimicrobial therapy.

The mentioned recommendations in the diagnosis and treatment of diabetic foot ulcer infections extracted based on the methodology of systematic review studies. Actually the opinion of experts have been prepared and adjusted according to the limitations, equipment and facilities in the country. But in general, there are some challenges in diabetic foot infections should be considered as well. So monitoring the treatment of infection, optimal duration of antibiotic treatment, optimal treatment of infection in low-income countries, time and type of imaging studies, selection of medical or surgical treatments and hospitalization conditions are some of these challenges. However the definition and practical clinical application for the concept of bacterial bioburden of the wound for wound healing, evaluating the cost-effectiveness of new technologies in improving treatment and appropriate interpretation of microbiological (genotypic) microbiological tests are important too.

Diabetic foot ulcer (DFU) is one of the common reasons for non-traumatic amputation of the lower limbs, which requires proper diagnosis, proper collection of specimens, careful selection of antibiotics, treatment of infection based on the disease condition, quick decision about whether or not surgery is necessary and other types of wound care. Probiotics are suggested as non-pathogenic microorganisms due to antibiotic resistance in the treatment of DFU. The effects of probiotics on immune function, skin diseases, and diabetes have been studied and recent evidence suggests their effect on DFU through controlling hyperglycemia, improving immune function, and modulating the microbiota as possible mechanisms. In this review article, we discuss the role of probiotics in healing chronic infected wounds of the diabetic foot from several perspectives including the role of microbiota in glycemic control, the effect of probiotics on the immune system, inflammatory markers, wound healing acceleration, and infection control. Topical application and oral intake of probiotics, especially when used as adjunctive therapies with antibiotics, seems to facilitate the healing process of infected diabetic foot ulcers.

Due to the current unpredictable changes following the global coronavirus disease (COVID-19) pandemic, significant changes have taken place in the healthcare systems. Most of the clinical and evidence-based care services for patients with diabetic foot has been disrupted. Therefore, many patients with diabetic foot ulcers cannot receive the necessary care, despite its great significance. All healthcare providers, including physicians and nurses, have difficult tasks and responsibilities during the COVID-19 crisis. Although patients with diabetic feet are at risk of infection, hospitalization, amputation, and death, they must remain out of hospitals, and distance educational and therapeutic services must be provided for them. This study aimed to introduce and describe the recommendations of the International Working Group on the Diabetic Foot (IWGDF) for the care of patients with diabetic feet during the new COVID-19 pandemic.

The purpose of this study is to identify patterns of information sharing in the field of evidence-based medicine to determine the main areas of evidence dissemination, including co-authorship patterns and citation networks, and to provide a scientific horizon for improving evidence-based medical research in Iran. Accordingly, evidence-based medicine related research at the Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences is suggested.

This study is a bibliographic study using scientometric methods. In this regard, the network of co-authorship and analysis of scientific articles indexed with the subject of evidence-based medicine in the Scopus database from 2004 to 2019 were analyzed.

The status of scientific production of evidence-based medicine of Endocrinology and Metabolism research Institute has been increasing in recent years. The Journal of Diabetes and Metabolic Disorders contains a great collection of information about evidence-based medicine in this field and its contents have been widely cited in many Iranian journals. In lexical analysis, the most widespread evidence was osteoporosis.

The results indicated that evidence-based medical research topics are widely focused on other medical fields such as osteoporosis and obesity and have shifted from evidence-based clinical practice to evidence-based clinical management.

Diabetic foot is one of the main complications of diabetes, which is caused by a significant proportion of patients with diabetes and which imposes costs on the family and the health system around the world. This review aims to summarize the latest findings in the field of diabetic foot based on clinical guidelines.

In this review study, in order to achieve the best clinical guide in the field of diabetic foot by determining the search strategy and inclusion criteria, all related clinical guides were searched in the databases and websites of clinical guidelines.  Clinical guidelines related to diabetic foot care were searched and retrieved from January 2000 to early 2019 and screened separately by two researchers to select the selected clinical guideline.

Based on the study criteria, the clinical guide of the International Diabetic Foot Working Group was selected as the most complete guide in the field of diabetic foot. This summary is based on the International Working Group on the Diabetic Foot (IWGDF) Guidance 2015, consist of five documents including prevention of foot ulcers in at‐risk patients, footwear and offloading principles, diagnosis, prognosis and management of peripheral artery disease, foot infections in patients with diabetes and enhance healing of chronic ulcers of the foot in diabetes.

This Summary Guidance for Daily Practice is intended to overview of the main aspects of the prevention and treatment of foot problems in patients with diabetes. This summary guidance is adviced at healthcare providers and specialists in foot care throughout the world.

Peripheral arterial disease (PAD) is common in diabetic patients, and about half of the patients with diabetic foot ulcers (DFU) have concomitant peripheral arterial disease (PAD). The purpose of this study was to select an appropriate and comprehensive clinical guide in the management of DFU. The part of the practical guide that pertains to this is based on three systematic reviews in three sections of diagnosis, prognosis, and treatment for DFU in patients with PAD.

In this study, the ADAPTE methodology process consiss of the three stages of preparation, acceptance or final adoption and finalization for the localization of an international clinical guide.

Results are presented in the form of questions and recommendations in three sections, i.e. diagnosis, 2 questions and 3 recommendations, diagnosis  prognosis and treatment. In the diagnosis section, and in the prognosis section (2 questions and 6 recommendations), and in the treatment section (3 questions and 8 recommendations).

In this practical guide, our take home massage, i.e. what we should learn and practice is summarized as follows:  1) We examine a patient with diabetes for peripheral arterial disease yearly. 2) Despite the best possible treatment in patients with DFU, if the wound does not improve after six weeks, we should refer the patient to a vascular surgeon. 3) Patients with PAD, associated with foot infections are at high risk for extreme amputation of the lower limbs and need urgent interventions. 4) All patients with diabetes with ischemic DFU should receive appropriate therapeutic treatment, similar to that for cardiovascular patients.

Peripheral neuropathy is one of the most common problems in diabetic patients. The increased risk of Diabetic Foot Ulceration (DFU) and amputation would be a complication of diabetic neuropathy. The aim of this study was to compare the DFU healing in different severity classification of neuropathy.

This is a retrospective study that was conducted over a two-year period from April 2016 to March 2018 according to the information of patients records with Diabetes Mellitus (DM) referred to clinic of diabetes and metabolic disorders of Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences. Wound healing criteria including area, depth and healing duration were studied. Accordingly, changes in the area and depth of wounds were evaluated and reported during the first, third and sixth months after baseline. Data were analyzed using descriptive and inferential statistics using SPSS software version 16.

The results of the study of patients with neuropathic ulcer showed that males and age group of 56 to 65 years had the highest frequencies. In addition, most of these patients suffered from type 2 DM (79%). The rate of wound healing, which was measured by area and depth of wound in three time periods, differed in different severity classification of neuropathy; at mild level of neuropathy the area and depth of wound decreased faster but in severe neuropathy, duration of wound healing in both mentioned criteria has increased. Regarding to the increase in the duration of DM, the healing time increased too. However the rate of wound healing decreased with increased age (p-value = 0.001).

Evidence suggests that early identification of neuropathy can reduce the incidence of DFU and amputation. Due to the slow healing of the size and depth of the wound in diabetic patients with severe neuropathy, it is necessary to prevent DFU by conducting preventive care and educational interventions.

Learning is an integral part of the educational system today. Although numerous studies have been performed regarding the beneficial effects of virtual training, virtual workshops have received less attention. The purpose of this study was to understand the perceived satisfaction, usefulness and efficiency of virtual workshops of postgraduate students from Tehran University of Medical Sciences. In this descriptive – comparative study, 57 faculty members and postgraduate students participated in virtual workshops. As a first step, 42 educational contents based on priority needs assessment workshops were prepared. These contents put in www.farasa.net address and participants accessed to them for three months. After three months, participant's opinions related variables using questionnaire consisted of three parts (demographic information, visual continuum of assessment of satisfaction from face to face and virtual, and 35 items to investigate the usefulness and efficacy etc) were studied. Reliability was calculated using Cronbach's alpha method (0.937). For analysis nineteenth version of analysis software (SPSS) was applied. The findings showed that there are significant difference (p < 0.000) between the satisfaction from virtual and face to face Workshops. In addition to the variables of ability used in the educational system, the efficiency of virtual methods, the designed content in the system, interactive learning activities, learning environments, ease of use, perceived value, satisfaction, usefulness, and behavioral intention of learning in range (38/0 to 90/0) showed a significant positive correlation with each other. In general, the workshop participants had positive attitudes toward the benefits of virtual workshops. In order to further satisfy the learners, it is suggested that scheduled virtual workshops were planned.

One of the factors affecting the process of teaching – learning are students´ learning styles. The aim of this study was to determine the learning styles of undergraduate nursing students at universities across the country. This cross sectional study of nursing students studying in academic year 1389-90 was conducted in 25 provinces of Iran. The questionnaire included demographic information and 12 questions related to learning styles (Kolb), respectively. Totally 1925 undergraduate nursing students completing the questionnaire participated in the study. Data were analyzed by using descriptive statistics and chi-square test. In this study, most nurses belonging to the age group 18-23 years (89/7%). Most students were female (64/8%) and unmarried (87%). The majority of students (%43/1) had accommodative learning styles and learning styles of others were Divergent (%36/5), Convergent (%11/3) and Assimilative (%9/1). nursing students have different learning styles and teachers should consider it and make use of different teaching methods. In this regard, experimental studies recommended assessing different teaching methods on nursing students learning.

Today، the internet has been emerged as a potentially effective medium for information exchange and in recent years، the use of web-based training programs has been steadily considered in the prevention and management of chronic diseases such as diabetes. This technology provides an opportunity to make health care more accessible for a large number of people and reduce costs. This review provides a descriptive discussion of web-based behavioural interventions for the management of type 2 diabetes mellitus. Systematic literature searches were performed using Medline، Embase، Psycinfo، Web of Science and Cochrane library to retrieve articles written in english and published between 2000 and 2012 which fulfilled all inclusion criteria. The search keywords were “diabetes” AND “intervention” AND (“internet OR web”). Only randomised controlled trials and quasi experimental studies were included in this review. A total of 15 studies were reviewed. Goal-setting، personalised coaching، interactive feedback and online peer support groups were some of the successful approaches which were applied in e-interventions to manage type 2 diabetes mellitus. Strong theoretical background، use of other technologies and longer duration of intervention were proven to be successful strategies as well. The web-based interventions have demonstrated some level of favourable outcomes، provided they are further enhanced with proper e-research strategies.

Despite the large number of patients presenting with hirsutism and high prevalence of polycystic ovary syndrome، for which hirsutism is an important sign، no national guidelines are currently available to Iranian primary-care and family physicians for its diagnosis and management. We have integrated highest levels of evidence and expert consensus to provide a national guideline to standardize and unify the Iranian primary-care and family physician’s approach to hirsutism.

Learning style is one of the factors that affect learning and academic achievement of learners so that understanding it helps individuals adopt a more appropriate way of learning. Teachers'' learning styles also affect selected teaching activities and learning environment. This study assesses the learning styles of students and faculty members in pre-clinical stage of medical education at Tehran University of Medical Sciences. This study was conducted in the 2011-12. 221 medical students and 106 faculty staff in preclinical stage at Tehran University of Medical Sciences participated in a census study. Kolb''s Learning Style Inventory was used to conduct the research. Much of the students’ learning style was converging (34. 4%) and accommodating (30. 8%) while the majority of the faculty learning style was respectively converging (41. 5%) and absorbent (26. 4%). There was a significant difference (p=0. 000) between learning styles of the students and the faculty staff. Similarity between learning style of medical students and the faculty increases learning motivation and achievement. We recommend that the faculty، regardless of their learning preferences، use laboratory and problem solving method in their teaching. In addition، the communication skills of medical students should also be strengthened.

In recent decades، there have been numerous attempts to define precisely what is meant by small group teaching. Many writers argue that small group teaching method is among the most difficult and highly skilled of teaching techniques، in which in addition to the primary objective of teaching students to think، the tutor must have a number of subsidiary objectives if the small group is to function. In other words، the interpersonal and interactive nature of small groups makes them a challenging and appropriate vehicle for engaging students in their own learning. However، not only do tutors have to learn how to teach using small group methods but students also have to learn how to work in small groups. On the other hand، nowadays it is not only that there are more students participating in higher education than before; it is also the case that students are coming from more diverse backgrounds، so inclusion and internationalization are matters to concern ourselves with، and there is a need for providing a more diversified curriculum، that they are responsible not only for what is taught but also، in part، for how students learn. These entire changes mean that the small group is now seen as a means of fostering student engagement، cooperative and collaborative learning. Planning for effective small group teaching is as important as planning any other teaching activity. This point sometimes goes unrecognized because learning in small groups can at first glance appear unstructured. Some lecturers are put off by the seemingly informal، loose or open-ended nature of small group learning، or they fear this informality will be a recipe for chaos، whereas behind the facade of the informal group lies a backdrop in which all the learners are playing within a known set of rules which are spoken or unspoken. In this paper، after the introduction of the context and features of small groups، the necessity of planning for this teaching method is mentioned. Moreover، stages of group development and management as well as the teaching - learning nature in small groups are described. Next، the teacher and learner skills needed for teaching and learning in small groups and other qualifications required to teach in a small group، such as instructional space group، and the use of small groups in clinical and medical education are offered.

Quality of nursing care services directly influences individuals’ health status. Compiling codes of ethics according to the religion and culture of each population could be an appropriate approach in improving quality of health care services especially nursing care. Hence, the most important priority in our national health system is developing ethical guidelines.For this purpose a task force has been established in collaboration with nurses, physicians, lawyers and clergymen who were expert in the field of medical ethics. The code of ethics for Iranian nurses was drafted in 2010. The draft that included 12 values and 71 regulations of professional ethics were finally approved in the second session of the Ethics Supreme Council of the Ministry of Health and Medical Education on 6 March, 2010. The values consist of concepts such as maintaining human dignity, adherence to professional obligations, accountability and responsibility, patient privacy, promotion of scientific and practical competence and respect to individual’s autonomy. Also, 71 regulations of professional ethics divided to five sections including "Nurse and Community" consisting of 9 items, “Nurse and Professional Commitments" with 14 items, "Nurse and Clinical Services" with 23 items, "The Nurse and Other Healthcare Providers in Medical Team" with 15 items, and also "Nurse, Education and Research" including 10 items.

Continuing shifts in health and healthcare systems, technologies, population profiles, expectations and demands have led to the realization that the education of nurses, and therefore, nursing curricula, must be subjected to evaluation, revision, and maybe even dramatic change. Faculty support for curriculum development is mandatory for the process to begin and for a successful outcome to be achieved. In fact this is obtained through open and thoughtful consideration of the reasons for curriculum development and honest attention to factors that could be limiting.Attention to the values of individual and collective faculty, the extent of curriculum development that might be necessary, and the timeframe for the undertaking, will influence whether approval is gained and curriculum development is occured.Generally the idea of engaging in curriculum development arises among a small group of faculty members who believe that the current curriculum is no longer adequate to prepare students to practice competently in the healthcare and societal contexts they will encounter when they graduate. So identifying reasons why curriculum development is necessary, the extent of the curriculum development that might be required, and possible timelines are important ideas to present to colleagues when seeking their support for curriculum development.

Nurses’ Quality Of Life (QOL) could be affected by many different factors which threaten qualified nursing care. The aim of this study was the assessment of Quality Of Life of nurses.

Using a cross-sectional study design, we evaluated Nurses’ Quality Of Life in four domains included physical, psychological, social and environmental health. 850 nurses from 17 provinces selected by Random sampling and fill the WHOQOL-BREF questionnaire. The survey data was processed using the SPSS statistical software package (version 15).

The result suggested that half of nurses had a moderate evaluation and satisfied with their QOL. The majority of values belong to the physical health and the minority related to the environmental health. The K Square test did not show any statistically significant correlation between the QOL domains and factors such as carrier experience, gender, kind of employment, and patients group. However, there was significant correlation between QOL and their position in hospital and shift work.

The findings of our study showed that, about half of the nurses evaluate their quality of life in mediocre level. The results of this study can be used by stockholder and policy makers. It is hoped the research can be done in the whole country that all nurses involved in and also establish quality of life database that nurses achieved can be monitored continuously.