مجله دانشکده پزشکی اصفهان
پیاپی 190 (هفته چهارم تیر 1391)

As an inevitable necessity, continuing education has caught the attention of health policymakers worldwide. Policy making, setting standards, and accreditation of continuing medical education have been endorsed as a law in Iran. The current study aimed to identify how the titles and contents of continuing education conferences are prepared. It also tried to highlight the existing challenges in this field. The qualitative study was performed through in-depth interviews with a wide range of educators, lecturers, and experts of continuing education. Overall, 6 educators, 20 lecturers, and 3 experts of continuing education unit of the Iranian Ministry of Health participated in the study. All educators and lecturers were faculty members. The findings were examined using content analysis. On the whole, the following four domains were extracted: program contents, accreditation, holding programs, and evaluation domains. Not reviewing the titles of programs and employing traditional education techniques were the most important challenges of the process. Therefore, we suggest the establishment of "continuing education needs assessment committees" in universities. Licenses should be granted on the basis of accreditation and needs assessment results. The program titles should be reviewed by specialized councils. The mode of presentation should change from lecturing to combined methods of online tutorials, self-learning, panels, workshops, and case reports. "Continuing education evaluation committees" should be established in universities. Finally, lecturers and educators should be allocated points for promotion and program executives should be financially supported.

Evaluation and storage of serous fluid have a major role in clinical diagnosis and prognosis. We tried to evaluate and compare the quality of smears that have been prepared from refrigerated serous effusions according to preservative material in different days. This prospective, interventional, analytical study was performed on refrigerated serous effusions in the cytopathology deportment of Alzahra Hospital (Isfahan, Iran) during 2007-08. Totally, 20 samples, including 15 for malignant and 5 for benign cases, were selected. The samples were divided into two groups, i.e. a group without any protective material and another with albumin as a protective. Their morphological changes for diagnostic cells were evaluated on days1, 3, 6, 9, 12, and 15. The mean age of the participants was 60.3 ± 11.9 years. The percent of diagnostic cells between first to 6 days in both benign and malignant cases in albumin contained fluid were more than non-protected ones (P < 0.001). As time passed, the number of diagnostic cells decreased in both preserved and non-preserved groups. In fact, until the 3rd day, all specimens had diagnostic cells but on the 15th day, none of them had any diagnostic cells. The morphology of cytological preparation was preserved and interpretable after 6 days. Although we cannot preserve effusions for more than one week in our institution, adding albumin as a protective factor would provide the chance for longer preservation.

Orthostatic hypotension is a common autonomic dysfunction in Parkinson's disease. Major hypotheses proposed in the etiology of orthostatic hypotension include sympathetic denervation and treatment with dopaminergic drugs. The purpose of this study was to determine the contribution of each of the above factors in the incidence of orthostatic hypotension in patients with Parkinson's disease. The current study was conducted as a case-control study in the second half of 2008 and first half of 2009. The study population included patients with Parkinson's disease. Individuals who had received more than 500 mg/day levodopa for over 6 months were placed in the case group. Patients who had not received any levodopa until the time of the study were placed in the control group. Exclusion criteria were having a concomitant disease or taking medications that cause orthostatic hypotension. Study variables included demographic characteristics, severity of the disease, orthostatic hypotension, postprandial hypotension, and nocturnal hypertension. Using a mercury sphygmomanometer, the presence or absence of orthostatic hypotension was determined in all patients. Postprandial hypotension and nocturnal hypertension were identified using a portable device for ambulatory blood pressure monitoring. Hoehn and Yahr staging scale was used in order to identify the severity of the disease. The data was analyzed using appropriate descriptive and analytical tests (chi-square test and t-test) in SPSS16. Overall, 50 patients were studied in two groups of 25. No significant differences were observed between the two groups in terms of age, sex, and the severity of the disease. Therefore, the patients in the control group were appropriately matched with those in the case group (P > 0.05). The frequency distribution of orthostatic hypotension was 12% and 20% in the case and control groups, respectively. The corresponding values were 12% and 24% for the frequency distribution of postprandial hypotension and 40% and 56% for the frequency distribution of nocturnal hypertension. None of these frequency distributions were significantly different between the two groups. The severity of the disease was strongly related with the frequency distributions of orthostatic hypotension and postprandial hypotension (P < 0.001 and P = 0.015, respectively). However, it was not associated with the frequency distribution of nocturnal hypertension. Although the prevalence of orthostatic hypotension was different between the case and the control groups, the difference was not significant. On the other hand, the severity of the disease was strongly correlated with the prevalence of orthostatic hypotension and postprandial hypotension in patients with Parkinson's disease.

Multiple sclerosis (MS) is a chronic central nervous system disease with different types and symptoms. The most common type of MS is the relapsing-remitting MS whose relapses are treated using methylprednisolone pulse therapy. Our study was a descriptive study on 64 patients with MS who were selected based on McDonald criteria. The patients received methylprednisolone pulse therapy at Kashani Hospital (Isfahan, Iran). After treatment, we monitored the patients for 3 months. The required information was collected by history taking, physical examination, and filling a questionnaire. The type and percentage of minor and major side effects were specified. The major side effects were arrhythmia in 8 patients, hypertension in 3 patients, and aseptic necrosis in 1 patient. The minor side effects were palpitation in 47% of the patients, dyspepsia in 34%, and insomnia in 33%. The results of our study showed a direct relation between the type and severity of the side effects and the frequency of pulse therapy and the dosage of methylprednisolone. On the other hand, our study failed to establish relations between the type and severity of side effects and age, sex, and body mass index of the patients.