azadeh sayarifard

Given the key role of job diagnostic and motivation in achieving career and academic success, it is important to examine the views of operating room students due to the different nature of the field. The aim of this study was to compare the views of freshman and senior operating room students about their job diagnostic and professional motivation.

This descriptive-analytical study was performed on 91 operating room students of Zahedan and Zabol Universities of Medical Sciences in 2019-2020 using convenience sampling. Data collection instruments in this study were two job diagnostic questionnaire of Elham and Hackman and a researcher-made questionnaire of professional motivation. In order to describe the status of the subjects, descriptive statistics were used and the data were analyzed by independent t-tests with SPSS statistical software.

The mean scores of job diagnostic were different in both groups of freshman and senior operating room students. The difference between the mean views of freshman and senior students regarding interest in the chosen field of operating room was 5.28 and 4.02, respectively, and this difference was statistically significant. Also, the difference between the average views of freshman and senior students regarding the enjoyment of activities in the field of operating room was 5.58 and 3.90, respectively, which was statistically significant.

Freshman students have a higher professional motivation than the operating room field at the beginning of entering university due to their different views on job diagnostic.

With the spread of the coronavirus disease 2019 (COVID-19), strict laws such as quarantine were implemented in many countries, including Iran. The spread of this disease and the general quarantine overshadowed the treatment and management of some chronic diseases, including type 1 diabetes, and many families faced a serious challenge in providing medicines and periodic tests for their children. This study was conducted with the aim of investigating the effects of the COVID-19 crisis on disease management in children with type 1 diabetes.

Based on a researcher-made questionnaire, this cross-sectional study was conducted on 85 children with type 1 diabetes between the ages of 2 and 18 years in 6 months at the Children's Medical Center Hospital. This questionnaire is either collected from the parents during the face-to-face visit of the child with type 1 diabetes, or the virtual visit (telemedicine), and they were asked to complete the relevant questionnaire. This questionnaire included demographic information, laboratory tests, and the challenges of patients' families during the pandemic. In order to properly understand the management of this disease, parents were asked to enter the results of tests related to fasting blood sugar and HbA1c 3 times at the beginning of the pandemic, during quarantine, and during the implementation of the study.

Based on the results, the level of HbA1c, the problem of insurance coverage, the problem of attendance, ketoacidosis, and infection before the pandemic, during the pandemic, and at the time of the study among children with type 1 diabetes were unchanged (P>0.05). There was a significant difference between fasting blood sugar levels, insulin levels, blood sugar control levels, and hospitalizations in type 1 diabetes patients before the pandemic, during the pandemic, and the study period (P<0.05).

Increasing the use of continuous glucose monitors and the widespread use of telemedicine visits may improve the impact of the pandemic on disease management. It is suggested that more multicenter studies with a higher sample size should be conducted in order to investigate the impact of the COVID-19 crisis on children with diabetes.

Understanding the relationship between medical students' attitudes towards conflict management and their dominant conflict management styles is crucial for improving their ability to effectively handle challenging situations. This study aimed to determine the relationship between medical students' attitudes towards conflict management and their conflict management styles.

This was a descriptive, analytical study involving 244 first-year general medicine students from Tehran University of Medical Sciences. The Conflict Management Attitude Questionnaire (CMAQ) and the Conflict Management Styles Questionnaire (DUTCH) were used to collect data. Pearson's correlation coefficient and independent t-tests were employed for data analysis.

The results showed that students predominantly used problem-solving (15.80 ± 2.18) and compromising (15.00 ± 2.23) styles. Pearson's correlation analysis revealed a significant positive correlation between the average score of attitudes towards conflict management and the average scores of the compromising and problem-solving styles (P = 0.014, r = 0.162; P = 0.000, r = 0.287, respectively). Additionally, a significant negative correlation was found between the average score of attitudes towards conflict management and the average score of the avoiding style (P = 0.010, r = -0.170). The t-test results indicated a significant difference in the competing style between male and female students (P = 0.038).

Identifying the strengths and weaknesses of clinical education is the first step towards improving the quality of medical education. Then the faculty development programs planners should design, implement and evaluate educational development programs for clinical faculty to improve their educational skills in the clinical education environment.

The pediatric palliative care (PPC) includes active care of the child's body, soul, and mind, as well as family support. The purpose of this study was to develop a model for providing pediatric palliative care based on the point of views of the Irania nurses and the physicians in Iran. The objective of this descriptive analytic study was to develop a model for PPC and to confirm each of the factors presented in the model. Factor analysis was performed using Keizer-Meier (KMO) and Bartlett (BT) tests. A researcher-made questionnaire was used to measure the necessity of providing PPC services. This questionnaire contained 28 questions in three areas or factors (9 items about the children, 12 items related to the family issues, and 7 items related to national health), and the statistical analysis was done by using SPSS 21. The item "Attention to moral concepts in dealing with the family at the family level" had the highest mean score (4.4±0.28). The items "Trying to have a peaceful death in the end stages of life in the child's area" and "Benefiting from equal palliative services at the national level", respectively with average scores of 4.2±0.52 and 4.1±0.4 in the ranks, at the second and third of this necessity. The PPC model was developed based on the results of this questionnaire. According to the result of the questionnaire items used in this study, the palliative care necessity model was developed. It is also concluded that providing PPC in Iran is necessary.

 Many developmental theories have mentioned the motivation to move as a motor driver and used it to explain how children acquire new movement patterns.

 Therefore, the aim of this study was to investigate the relationship between motivation to move and the development of fundamental movement skills (FMS) among urban and rural preschool children in Iran.

 The statistical population of this cross-sectional study included a sample of 4-6-year-old preschool children and their caregivers from Khorramabad urban and rural areas in Iran. A sample of 400 (202 from urban areas and 198 from rural areas) were selected using stratified random sampling. Data collection tools included the Children Movement Motivation Questionnaire (CMMQ) and Test of Gross Motor Development–Third Edition (TGMD-3). The Pearson correlation coefficient and independent t-tests at a significance level of P < 0.05 were used to analyze the research data.

 In both groups of children resident in urban and rural areas, a positive and significant relationship was observed between the CMMQ and TGMD-3. A significant difference was found between urban and rural children on scores of the CMMQ and TGMD-3, with rural children scoring higher on both.

 This work provides support for the link between motivation and motor development in children. Moreover, the child's environment also has an impact on both motivation and development. Both motivation and the child's environment should be considered when developing programs that support typical development or rehabilitation plans for children who are not developing typically.

Mental health literacy is especially important during adolescence and youth, because the peak of the onset of mental disorders occurs in this period. The present study aimed to identify the effective systemic factors for improving Iranian adolescent mental health literacy from the Perspective of policymakers and experts.

This qualitative study was performed on 21 policymakers and health literacy/mental health experts since May 2020 to September 2020 in the workplace of the interviewees in Tehran. Purposive sampling (snowball method) was conducted based on experience, expertise, and the willingness to participate in an interview. All interviews were conducted with the presence of the interviewer at the interviewees' workplace in Tehran. The data were collected through semi-structured interviews and analyzed via the conventional content analysis method.

Five themes were extracted as systemic factors for improving adolescent mental health literacy. Themes were “mental health literacy training”, “integration and coordination of stakeholder organizations”, “resources and facilities”, “continuous assessment” and “provision of information.”

Before policy-making and planning to enhance adolescents' knowledge and awareness of mental health issues, it is necessary to attract policymakers’ attention to the macro level and identify direct and indirect strategies for the correct implementation of policies adopted in this field.

 The purpose of this study was to compare the effectiveness of once-daily versus twice-daily insulin detemir injection in children with type 1 diabetes mellitus (T1DM).

 In this randomized 4-month clinical trial, 60 children aged 33 - 156 months with T1DM were randomly assigned into two groups, once-daily (group 1) and twice-daily (group 2) detemir insulin injection with pre-meal insulin Aspart. The first month of the study was devoted to educating the patients and insulin dose titration. Hemoglobin A1C (HbA1C) measured at the end of the first month and again after the fourth month was considered as the outcome. Hypoglycemia as one of the major complications was defined as blood glucose lower than 70 mg/dL with clinical symptoms or blood glucose lower than 50 mg/dL in the absence of clinical symptoms.

 Mean HbA1C in the fourth month was 8.5% ± 1% in group 1 and 8.5% ± 1.1% in group 2 (P = 0.98). Mean changes in the fourth month compared to baseline were -0.09% (95% CI: -0.47 - 0.3) in group 1, and -0.42% (95% CI: -0.94 - 0.09) in group 2 (P = 0.273). The treatment modification rate was 39% and 15% in groups 1 and 2 (P = 0.02). However, there were no statistically significant differences between the two groups in terms of insulin dose, hypoglycemia, and other complications.

 Twice-daily injections did not change HbA1c in comparison with once-daily injections. However, the lower treatment modification rate in the twice-daily group in the age group of our study was considerable.

Developing a clinical practice guideline (CPG) is very time-consuming, expensive, and requires specialized knowledge; therefore, when an up-to-date and quality CPG is available, it is logical to adapt it according to local conditions. So this study aimed to identify the challenges of CPGs adaptation in Iran to help improve it and provide lessons for low and middle-income countries (LMICs).  

This was a qualitative study that was conducted in 2019. Semi-structured interviews were conducted with 17 participants from two levels, groups involved in the CPGs adaptation process, from research centers and specialized medical associations and policymakers and planners in CPG development and adaptation from the Ministry of Health and Medical Education (MoHME).   

The identified challenges were classified into two basic and operational categories. Basic challenges include believing the need for CPGs adaptation, attention to CPGs adaptation in evaluation and reward systems, access to financial resources, and supervision of the adaptation process. Also, operational challenges were adaptation methodology, forming an adaptation team, consensus on interdisciplinary issues, changing programs and priorities, and external barriers in the work progress path.  

The main challenges of CPGs adaptation in Iran, as one of the LMICs, are related to education, financing, and supervision of adaptation process steps. The most significant proposed interventions to overcome the current obstacles in countries with similar contexts are holding new training courses and programs for these CPG users at different headquarters' and environmental levels, establishing an appropriate motivating system, designing an integrated adaptation system focusing on organizing related supervision affairs like planning, policy-making, and supervision at the MoHME and universities level.

Child Abuse and Neglect (CAN) is a major health problem with serious consequences. Since health care professionals play an important role in identification, management, and reporting CAN cases, they should have precise knowledge on this subject. The aim of this study is to investigate the level of knowledge, attitude and practice of the pediatricians, pediatric residents, and nurses regarding CAN issues as well as their possible needs for any educational programs in this regard.
130 pediatric nurses and physicians working at two pediatric tertiary centers, in Tehran, Iran participated in this descriptive cross-sectional study. An anonymous validated and standardized self-report questionnaire was used as the study instrument. The questionnaire consisted of five sections on demographic information, knowledge, attitude, practice and needs assessment. Analytical statistical tests including t-test, Kruskal–Wallis and Mann-Whitney tests were used to analyze the data.
The level of the participants’ knowledge was moderate (mean score: 16.6±3.17) and their attitude towards child abuse and neglect was at a good level (mean score: 45.72 ±4.25). The results of this study revealed that the overall performance of the participants in dealing with a suspicious case of child abuse and neglect was moderate. Almost all participants (95.5%) indicated the need for educational programs on child abuse both for nurses and physicians.
Results of our study revealed that the overall knowledge, attitude, and practice of the health care professionals in the field of pediatrics regarding child abuse and neglect are not satisfactory and training programs on this issue are mandatory for pediatricians, pediatric residents, and nurses due to their serious role in caring for children.

Thiamine is an essential coenzyme, reduced in type I and II diabetes. There has been little research on thiamine levels and their role in children with diabetic ketoacidosis (DKA).

This study aimed to analyze thiamine deficiency in this patient group.

A cross-sectional study was done in 2019 - 2020 in Children’s Medical Center, a pediatric referral hospital with 350 beds, on children with type I diabetes hospitalized in the PICU for DKA. A blood sample was taken on admission to obtain biochemical laboratory parameters and measure electrolytes and thiamine levels. Blood gases were taken regularly, and the first pH and first bicarbonate level were measured. The time required for pH normalization and recovery from acidosis was recorded. Hospital stay duration was also calculated. Plasma thiamine measurement was done with a Human Vitamin B1 (VB1) ELISA Kit from Bioassay Technology Laboratory. Data were analyzed with SPSS version 22 software.

Of 62 patients, 56.5% were females with a mean age of 63 months. Thiamine level was 1.61 ± 1.17 µg/dL, and 66.1% of the patients were thiamine deficient. Hospitalization duration was 3.52 ± 0.41 days in the thiamine deficient group and 2.47 ± 0.32 days in the normal group (P value < 0.05). The white blood cell (WBC) count was higher in thiamine deficient patients. Thiamine levels were independently and inversely related to age.

Thiamine deficiency is common among children with DKA and could be a prognostic and therapeutic factor.

Child abuse is a significant global concern, with short-term and long-term consequences for the lives of children who are victims of violence. For effective action by decision-makers, the information and analysis obtained from surveillance systems must be used to determine the problem, the magnitude of maltreatment, its relationship with other issues, and the likelihood of preventing maltreatment. Due to the importance of child abuse and the management and control of this event, this study was conducted to design and evaluate a child abuse surveillance system. The system was designed in Visual Studio version 2017 using the C# programming language and ASP.NET framework. SQL Server was used to store the data. The design of the child abuse surveillance system was evaluated according to the usability evaluation. The minimum data set was indexed to collect and store data on abused children by the standard format. Web-based child abuse surveillance system (CASS) has 3 types of users. The system evaluation results showed that the highest number of problems were related to the principle of "help and documentation". Designing a CASS is a practical step in managing and controlling the data of abused children. This system and registration of information will help professionals, managers, and decision-makers make the right decisions to take care of injured children with up-to-date information

Recognizing the status of mental health literacy among women and girls as effective and key individuals in family and society seem to be essential. Therefore, the present study was conducted to evaluate depression literacy among women and girls in Tehran on prevention and effective interventions for improving depression.

This study was part of a large mental health literacy project on residents of Tehran in 2017, with a sample size of 1023 girls and women aged 16-68 years. Random Digit Dialing (RDD) sampling was done using the Australian questionnaire, whose Persian version’s validity and reliability was tested in our previous study. Data were analyzed by SPSS 21 software.In order to determine the effect of demographic variables on predicting depression literacy among participants, multiple regression analysis was performed.

Receiving counseling, relaxation training, having physical activity, and studying self-help books were the most helpful items, respectively, from the participations’ point of view. More than 70% of participants agreed with avoiding stressful situations and close relationship with family and friends, while only 49.8% agreed with coping skills learning. Based on the regression analysis, only higher education and the history of exposure to a person with similar Vignette problem were able to predict mental health literacy in the area of intervention and prevention.

Considering the effects of women’s and girls’ depression on individual, family, and even social life, more attention should be paid to improve depression literacy in this group.

 Adolescents’ exposure to new communication systems via the Internet and mobile phone can be detrimental if cyberbullying is the case.

 The present study aimed to investigate the prevalence of cyberbullying and detect its contributing factors.

 This cross-sectional study was performed in four girls’ and boys’ high schools in District 17, Tehran, Iran. The research sample was selected using the simple random sampling method. The research instrument was a researcher-made questionnaire encompassing three sections (namely, the experience of being cyberbullied, the experience of attempts at cyberbullying, and close friends’ exposure to cyberbullying).

 Eighty-five of the respondents (29.82%) had experienced being cyberbullied, 89 persons (30.90%) had made attempts at cyberbullying, and 117 individuals (40.62%) had friends being cyberbullied. Female gender and secondary high school education significantly increased the likelihood of attempts at cyberbullying and being cyberbullied (P < 0.001). Moreover, there was a significant relationship between an increase in time to use virtual tools per week and aging with attempts at cyberbullying (P < 0.001). There was also a significant relationship between being cyberbullied and attempts at cyberbullying (P < 0.001).

 According to the study findings, the authorities are recommended to implement appropriate educational programs to increase adolescents’ awareness of cyberbullying and culturalization to exploit new communication tools at the school and community levels.

Medical professionalism has a crucial role in educating medical students. The role of professionalism in the clinical environment is therefore an important factor in medical education. This study attempts to evaluate the opinions of medical students in the teaching hospitals of Tehran University of Medical Sciences (TUMS) about the professionalism environment in this university. A sample of 165 students filled out the Persian translation of UMKC-SOM (Climate of Professionalism Survey) questionnaire. This instrument evaluates students’ perspectives on the degree of adherence to professionalism by faculty, residents and other students. The results of the study revealed that the total score of professionalism climate was 53.9 for faculty, 42.09 for residents, and 50.76 for students and the difference between these three groups was statistically significant (p-value < 0.01). Results of further analysis through post-hoc tests for multiple comparisons among the groups revealed that the students found their fellow students and faculty more professional than residents. The study also showed that the medical ethics course had no impact on perceptions observations (p-values > 0.05).The study results also revealed that the students found their fellow students and faculty more professional than residents. This finding demonstrates the importance of teaching professionalism to residents since they serve as role models for students.Further multicenter studies are needed to improve the professionalism climate in the medical teaching environment.

Providing care for terminally ill neonates is an important issue in NICUs. This research aimed to determine nurses’ attitudes toward providing care for terminally ill neonates and their families. A total of 138 nurses working in neonatal intensive care units (NICUs) affiliated to Tehran University of Medical Sciences participated in this cross-sectional study via convenience sampling in 2019. The Data collection tool was the Frommelt attitudes toward caring for terminally ill persons and their families scale. The nurses in this study had the most positive attitudes toward the items “nursing care should include the family of the terminally ill patient, too” (4.2 ± 0.6) and “the care provider can prepare the patient or his/her family for death” (4.1 ± 0.7). The nurses had the least positive attitude toward the item “the time spent on caring for terminally ill patients creates a sense of frustration in me” (1.06 ± 1). The mean score of the attitudes of NICU nurses toward caring for terminally ill neonates and their families indicates the necessity of improving this attitude.

The present study aimed at identifying the prerequisites, facilitators, and barriers to adolescent mental health literacy interventions. To that end, databases PsycINFO, Science Direct, Scopus, Emerald, PubMed, Web of Science, and Google Scholar were systematically searched, out of which 39 articles that had the inclusion criteria were analyzed by the content analysis. Databases searched from September 30, 2018, to October 10, 2018, with the keywords “health literacy,” “mental health literacy,” “mental disorders,” adolescents, students, and more. Seven themes were identified as the prerequisites for interventions to improve adolescents' mental health literacy including education at the school level, parents' education, training of trainers and providers, cooperation and participation among providers, intervention assessment and monitoring, provision of educational content, consideration of the cultural and linguistic issues. Five themes were identified as facilitators: using interactive learning and teaching methods, supplying diverse and stimulating educational content, employing trainers with different backgrounds, having direct contact with people with mental illness, and utilizing technological advancements in education. Finally, short-time intervention, the collaboration between school administrators and researchers, lack of valid information sources were identified as barriers.

 Chest pain is one of the most common reasons for people to go to cardiac emergency clinics. This study was conducted with the aim to evaluate the prevalence of psychiatric disorders in patients with chest pain referred to the heart emergency clinic of Taleghani Hospital, Tehran, Iran.

 This descriptive-analytic study was performed on 103 patients with chest pain who were referred to the emergency department. Furthermore, a follow-up was carried out. Data were collected using a demographic information form and mental health survey (28-item General Health Questionnaire; Goldberg & Hillier, 1979) in the two groups of cardiac and non-cardiac chest pain.

 Among all the referred patients, 74 patients (71.8%) did not have a definitive diagnosis of cardiovascular disorders (CVDs). The results revealed that among the patients with non-cardiac chest pain, 56 (75.7%), 55 (74.3%), 54 (73%), and 22 (29.7%) individuals had phyisical disorder, anxiety, social dysfunction, and depressive disorder. Among the patients, who were definitively diagnosed with CVDs, 14 (48.3%), 10 (34.5%), 7 (24.1%), and 6 (20.7%) individuals had anxiety, physical disoreder, social dysfunction, and depressive disorder. Among all patients, physical disorder had a significant relationship with gender (P = 0.047), and physical and anxiety disorders had a significant relationship‎ with history of recurrent chest pain in the last 6 months (P < 0.05).

 Due to the high number of non-cardiac patients who refer to the emergency department with chest pain complaints, it is recommended that all patients with chest pain complaints be screened for psychiatric diseases.

 One of the community-based interventions for increasing mental health literacy is mental health first aid (MHFA) training. The current study measured literacy regarding MHFA for eating disorders (EDs) among the youth and adolescents.

 This cross-sectional study was performed on those aged 16-29 years in Tehran, Iran. The sample size was 252 individuals. For data gathering, the Mental Health Literacy Questionnaire (MHLQ)‎ was used that was modified for EDs. The validity and reliability of the Persian version of the MHLQ‎ was confirmed. Data were analyzed using SPSS software. To determine the demographic variables that can predict participants' literacy concerning EDs, logistic regression analysis was used.

 Among the participants, 11.5 could successfully diagnose EDs, 34.5 were not at all confident in their ability to help, and 36.95 said they would not seek help if faced with a similar problem. Most of the participants selected “obtaining more information about the problems described in the ‎vignette and available services” and “listening to the problems of the ‎vignette character in an understanding way” as the correct first aid interventions. Family and friends were mentioned as the main influential people. Higher education could significantly predict the ability to correctly diagnose the disorder (P = 0.03) and help-seeking behavior (P = 0.002). Only relatives' history of exposure to the problems described in the vignette could significantly predict higher scores in diagnosing suitable first aid (P = 0.02).

 In general, mental health literacy regarding EDs was not suitable among the participants of this study. Thus, it seems necessary to consider targeted MHFA training, particularly in the field of EDs, to provide training in an understandable language to the community and with emphasis on seeking professional services.

Studies have indicated that diabetic children are at risk of developing other diseases such as depression.

This study was conducted to determine the prevalence of depression in diabetic children and identify factors that influence it.

This cross-sectional study was performed on 125 diabetic children in the 7 - 16 age range who had attended the Endocrinology and Metabolism Clinic of the Children’s Medical Center affiliated to Tehran University of Medical Sciences. Children’s Depression Inventory (CDI) was used to assess depression.

The study showed 44% of the children were nondepressed, 14.4% depressed and 41.6% borderline. Depression in the diabetic children was not significantly associated with age, gender, injection tools, socioeconomic status, body mass index, number of siblings, disease duration, frequency of injections, number of injected units, and frequency of blood glucose monitoring. Depression was significantly associated with the level of mother’s education (P < 0.001), father’s education (P = 0.01), frequency of hospitalization (P = 0.04) and level of HbA1c (P = 0.03).

According to the results of the study, metabolic control reduces the HbA1c level and the frequency of hospitalization, thereby mitigating the risk of depression in the diabetic children. The educational level of parents, especially mother, is also effective in minimizing this risk in diabetic children.

Health literacy (HL) has been recognized as an important concept in patient education and disease prevention. The rising burden of noncommunicable diseases (NCDs) in Iran is significant. Hence, we designed and validated an HL questionnaire on the most important domains of NCDs, including cardiovascular diseases, diabetes, and cancer.

Literature review was conducted to examine the definition and dimensions of HL. After reaching consensus about the HL dimensions and conceptual models in focus group discussions with experts, they designed questions in each domain. Then, face, content, and construct validity as well as reliability were determined by a pilot study on 72 participants. At the end, a cross‑sectional study was implemented on 206 Hamedan university employees, to finalize the questionnaire.

After doing the pilot study and analyzing the collected data and according to the Bartlett’s test of sphericity and Kaiser–Meyer–Olkin = 0.421 with P < 0.001, factor analysis was used. Considering the eigenvalue >1.4, a 27‑item questionnaire in seven domains was obtained which included attitude toward health, understanding information, social support, socioeconomic conditions, access to health services, and application of health information. Cronbach’s alpha was more than 0.70 in all domains except the last one (0.47). The second phase showed that overall 75.2% of the individuals had inadequate HL with lowest scores in the application of health information.

The designed tool seems appropriate for measuring the HL level among the Iranian population in the field of prevention of cardiovascular disease, cancer, and diabetes. The results can help policy makers to improve health promotion interventions.

Exposure to major public health events such as covid‑19 infectious epidemic in any country can be followed by challenges such as epidemiological features, rapidtransmission patterns, and insufficient readiness of health authorities to cope with the outbreak among community.

Postoperative pain has many adverse effects and if not properly controlled, it can cause a wide range of problems.

The purpose of this study is to compare the results of using ketamine and apotel infusion pumps to control pain after posterior fusion surgery.

In this clinical trial study, 72 patients hospitalized for posterior spine fusion surgery were randomly assigned into two groups, including ketamine infusion pumps (ketamin group) and apotel infusion pumps (apotel group). In the ketamin group, 0.2 mg/kg/h of ketamine was infused to by a pain pump with normal saline to 100 cc. In the apotel group, apotel was used instead of ketamine. The rate of pain was evaluated in recovery, and at 6, 12, 18, 24, and 48 hours after the surgery, based on VAS criteria. The rate of sedation was recorded based on Ramsy score.

There was no significant difference between age, sex, BMI, underlying diseases, and smoking in patients with posterior spinal fusion surgery between the groups. Postoperative pain score was significantly lower in the patients with posterior fusion surgery at 6, 12, 18, 24, and 48 hours in the ketamin group compared to the apotel group (P < 0.001). Patients’ satisfaction with the analgesia was significantly higher in the patients at 24 hours (P = 0.001) and 48 hours (P = 0.04) in the ketamine group compared to the apotel. With regards to the Ramsy scores of the patients with posterior fusion surgery, there was no significant difference between the groups (P = 0.16).

The use of a ketamine infusion pump can be more effective than an apotel infusion pump to control pain after posterior fusion surgery.

With the outbreak of coronavirus 2019 (SARS-COV-2), the prevention and control of SARS-COV-2 infection in pregnant women and the potential risk of vertical transmission has become a major concern.

We report the case of a newborn in Iran with the manifestations of myocarditis at birth. The diagnosis of SARS-COV-2 infection was confirmed for the mother and the neonate by real-time reverse transcription polymerase chain reaction (rRT-PCR) using a pharyngeal specimen.

Based on our literature review, there is still insufficient evidence to determine the effect of SARS-COV-2 infection on the fetus. Given the possibility of cardiac injury in SARS-COV-2 disease and manifestation of congenital myocarditis in our case, maternal vertical transmission of SARS-COV-2 could be considered.

The relationship between medical universities and teaching hospitals is a challenging issue. Lack of appropriate relations can create challenges in hospital management and its various functions, such as providing services, education and research. Therefore, this study was conducted to understand the current challenges of the relationship a university of medical sciences using different stakeholders' perspectives.

For data collection, 33 semi structured in-depth interviews and one focused group discussion were conducted. The participants were selected through targeted and snowball sampling, from educational hospitals and university departments. Qualitative content analysis method using qualitative analysis software, MAXQDA, was used for analyzing data. Coding and classification of codes were done by two researchers independently.

After conceptual categorization, the obtained categories were turned into 14 sub-themes and 4 main themes of “decision and policy making”, “resource provision”,” supervision and evaluation” and “information flow”. All these themes are subsets of the main “unity” theme.

analysis of the condition and related challenges emphasized the need for a revision of the relationships between educational hospitals and university departments. According to scientific evidence, this reform should focus on decentralization in order to increase hospitals decision-making power in different aspects. Obviously, due to social responsibility of university and hospitals and the necessity of their accountability to educational expectations and therapeutic needs of the community, the university governance and supervision role should be well defined and implemented correctly.