نوید کلانی

Pulmonary embolism (PE) occurs when a blood clot blocks a pulmonary artery or its branches. Complications after a hysterectomy can include bleeding, infection, thrombosis, damage to surrounding structures and bowel or bladder problems. This study reports a case of acute pulmonary embolism after hysterectomy surgery.

Case Presenetation:

 A 52-year-old woman who was a candidate for Total Abdominal Hysterectomy (TAH)+Bilateral Salpingo-Oophorectomy (BSO) due to vaginal bleeding for 3 weeks. During the surgery, the patient's hemodynamics were normal. The surgery lasted about one and a half hours. The patient's bleeding and urine output were normal. At the end of the surgery, the patient was released from muscle relaxation with neostigmine and atropine. The patient woke up and had stable hemodynamics during recovery and was transferred to the women's ward. The next day, the patient started walking in the ward when he suddenly had syncope. The cardiopulmonary resuscitation team immediately arrived at the patient's bedside. Due to the patient's poor breathing, the patient was quickly intubated and resuscitation with cardiac massage and appropriate medications was initiated. A cardiologist and radiologist were consulted urgently and they arrived at the patient's bedside. During cardiopulmonary resuscitation, echocardiography showed a clot in the proximal right and left pulmonary arteries, and an appropriate dose of Reteplase was administered with a diagnosis of extensive pulmonary embolism. Unfortunately, despite the medical team's efforts, the patient died.

Based on the results of the present study, patients who undergo hysterectomy with a history of previous bleeding are at risk of acute pulmonary embolism; therefore, these patients should be closely monitored after surgery and receive appropriate medications after surgery to prevent pulmonary embolism as ordered by the Physians.

With the onset of the COVID-19 pandemic, the world has faced new and different challenges. This pandemic has caused medical staff to face a wide range of ethical issues. One of the important challenges is the non-resuscitation order during the COVID-19 pandemic. Therefore, the purpose of this study is to investigate the attitudes of nurses, specialists, and medical students regarding the no-resuscitation order during the COVID-19 pandemic at Jahrom University of Medical Sciences.

This descriptive-cross-sectional study was conducted on 288 nurses, physicians, and medical students (Extern and Intern) at Jahrom University of Medical Sciences in 2023. The data collection tool in this study included two demographic information questionnaires and a questionnaire on attitudes towards no-resuscitation. Data analysis was performed using SPSS version 21 software and descriptive statistics and inferential statistical tests at a significance level of P<0.05.

The average score of the attitude of nurses, specialists and medical students regarding the do-not-resuscitate order during the Covid-19 pandemic was 3.52±0.39. Which is above the average level. Among the items of the questionnaire, the items "I want to have a better understanding of the legal consequences of DNR" and "I want to know more about advanced DNR orders" and "I want to know more about patients' rights in DNR" were the most important and the items were the least important. There is a relationship between the average score of the attitude of nurses, specialists and medical students regarding the do-not-resuscitate order with the level of education, occupation and employment status.

The results of the present study show that the nurses and doctors participating in the present study had a positive attitude towards do-not-resuscitate orders. This positive attitude was more pronounced in participants with a bachelor's degree, nurses and civil servants. This attitude is due to the attention to maintaining human dignity and the quality of life of patients, especially when continuing treatments leads to more suffering and pain. In addition, nurses and doctors emphasize the importance of legal consequences, advanced directives, and patients' rights regarding do-not-resuscitate orders, and consider it part of their ethical and humane principles.

Considering the importance of training competent physicians, medical education is a very serious and important matter, and this explains the need to use the most up-to-date and effective teaching methods. Among the effective teaching methods are active teaching methods, which we have explained in this study the students' experiences of using active learning methods in clinical medical education.

In this qualitative phenomenological study, the opinions of 11 extern and intern medical students of Jahrom University of Medical Sciences were collected through open-ended questions in the form of one-on-one interviews about active teaching methods and their experiences of using these methods, and they were coded and analyzed using MAXQDA software, and important concepts were extracted.

144 initial codes were categorized into 5 main themes and 18 subcategories, and in some cases, 31 subcategories. The main themes include; students' experiences of active learning, active learning contexts in clinical education, benefits of using active learning methods, active learning opportunities in the clinic, and active learning challenges in the clinic.

Based on what was obtained from the experiences of students and professors regarding active clinical education in the 5 main themes of experiences, contexts, benefits, opportunities, and challenges of active learning, active learning plays a significant role in consolidating the learned material and is a necessary and essential requirement for effective medical learning.

Breast cancer is the most common cancer diagnosed in women. Epidemiological studies have led to the hypothesis that vitamin D may reduce the risk of breast cancer. This study aimed to investigate the association between vitamin D deficiency and breast cancer.

This case-control study was conducted on 59 patients referred to Khatam Al-Anbia Comprehensive Cancer Clinic in Jahrom city between May 2021 and March 2022. Thirty patients with pathologically confirmed ductal or lobular breast cancer in situ or invasive in one or both breasts, with no previous history of the disease and within two months of their breast cancer diagnosis, were considered as the case group. Thirty women without breast cancer who had been referred for breast screening examination were considered as the control group. Both groups were matched for demographic characteristics and age. The data collection tools in this study included demographic information and clinical history of the patients and serum vitamin D levels. Data analysis was performed using SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) and descriptive statistics (mean, percentage, and standard deviation) and inferential statistical tests (logistic regression, Kolmogorov-Smirnov). The significance level was considered to be P<0.05.

The mean age of the patients participating in the case group was 52.17±10.6 and in the control group was 51.24±9.7. There was no statistically significant difference in age (P=0.654). There was also no significant difference between the two groups in terms of body mass index and different body index classifications, menopause age, and age of onset of menstruation. The number of months of breastfeeding in the control group was significantly higher than the case group (P=0.001). The results of logistic regression showed that, on the other hand, there was no significant relationship between the type of pathology of the disease and serum vitamin D levels.

The results of the present study showed that vitamin D deficiency can be a poor prognostic factor in the course of breast cancer.

The increase in medical errors has become a public concern among insurers, providers and health care professionals. Considering that errors occur in the operating room and emergency department, especially during the night shift; therefore, it is very important to study the causes and factors of errors in the operating room and the solutions to deal with them.

This study was conducted using a qualitative method with a phenomenological approach, which was used to obtain rich information from 11 members of the medical team active in the operating room complex, including specialists and technicians, who experienced errors. Data collection was done in a targeted manner with the help of semi-structured interviews, which were analyzed by the seven-step method of Claesi.

22 initial codes were extracted from the total number of interviews as factors and causes of medical errors in the operating room during the night shift, the main themes of which include; Individual and human factors, hardware and technical factors, managerial and organizational factors and team factors. 23 primary extraction codes were extracted as necessary solutions to prevent errors in the night shift of the operating room, the main themes of which include; Empowerment of operating room staff and development of operating room management.

The findings of this research showed that the conditions of the operating room in the night shift can be different from other departments and the day shift, which will increase the incidence of medical errors. The feeling of sleepiness, work pressure, fatigue and stress, insufficient information, lack of motivation and lack of relaxation were the most important human factors for the occurrence of errors in the night shift.

Diabetic retinopathy is one of the main causes of blindness in the world and one of the causes of disability in diabetic patients. However, no study has been conducted in Iran to Comparison of Quality of Life between Diabetic Patients With and Without Retinopathy.

This descriptive-analytical study was conducted on 183 diabetic patients referred to the Jahrom Honari Clinic from October to February 2023. The patients were divided into two groups: diabetic patients without retinopathy complications and diabetic patients with retinopathy complications. The data collection tool included two demographic information questionnaires and a quality of life questionnaire (DQOL-BCI). The data of the two groups and subgroups were compared and analyzed using SPSS version 21 software and descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistical tests (chi-square, t-test, ANOVA, Pearson correlation coefficient) at a significance level of P<0.05.

The majority of diabetic patients participating in the study in the group with retinopathy (70.3%) and the group without retinopathy (75%) were male. The groups of Diabetic Patients With and Without Retinopathy did not differ significantly from each other in terms of demographic variables and were similar. There was a significant difference between Diabetic Patients With and Without Retinopathy in terms of average quality of life (P>0.001). The mean quality of life in the group of diabetic patients with retinopathy (41.19±7.97) was higher than that of the group of diabetic patients without retinopathy (37.22±7.37). There was no significant difference between the mean quality of life and demographic variables in diabetic patients without retinopathy and diabetic patients with retinopathy (P<0.001).

That patients with retinopathy had a higher quality of life than the group without retinopathy. These results were obtained while none of the demographic variables such as age, gender, marital status, and education level had a significant relationship with the quality of life of these patients.

Recently, epinephrine is used to increase the depth and duration of local anesthetic pain, and it is widely used topically to reduce local anesthetic release and reduce bleeding caused by surgery.

This study was a randomized, double-blind clinical trial on 30 patients aged 18 to 85 years undergoing lower limb orthopedic surgery referred to Peymaniyeh Hospital in Jahrom from September to December 2022. Patients were randomly assigned to two groups, A (epinephrine+fentanyl+bupivacaine) and B (bupivacaine+fentanyl). Systolic blood pressure, diastolic pressure, mean arterial pressure, arterial blood oxygen saturation percentage, and pulse rate were measured and recorded before drug administration, before spinal anesthesia, after anesthesia, and then every half hour until the end of surgery (15, 45, 30, 60, 75, 90, 120) and during recovery. Data analysis was performed using SPSS version 21 software and descriptive (mean, standard deviation) and inferential statistics (t-test, chi-square, Mann-Whitney, Friedman) at a significance level of P<0.05.

Thirty patients aged 18 to 85 years (in two groups of 15) with anesthesia class I and II undergoing lower limb orthopedic surgery were evaluated. The study groups are matched in terms of age and gender variables. There was no significant difference in mean systolic, diastolic, mean arterial blood pressure, and heart rate before and after anesthesia, 15, 45, 30, 60, 75, 90, and 120 minutes after drug injection, and at entry and exit from recovery between the Epinephrine+Fentanyl+Bupivacaine and Fentanyl+Bupivacaine groups. There was a significant difference in mean O2SAT before anesthesia, 15, 30, and 75 minutes after drug injection between the epinephrine+fentanyl+bupivacaine and fentanyl+ bupivacaine groups (P<0.05).

The use of the combination of epinephrine+fentanyl+intrathecal bupivacaine compared to the combination of fentanyl+bupivacaine did not have a significant difference in the studied variables of patients' vital signs.

Rhinoplasty is a challenging and complex surgery because it is designed to meet the unique needs of the patient. In rhinoplasty surgery, many factors contribute to achieving the desired result. These factors include the surgeon's care and observation, analysis of the existing anatomy, choice of surgical technique, degree of soft tissue and cartilage trauma, amount of bleeding, quality of surgical instruments and anesthesia, and anything that helps reduce bleeding.

This double-blind study was conducted on 50 patients aged 18 to 45 years undergoing septorhinoplasty surgery referred to Motahari Hospital in Jahrom city in 2022. Patients were randomly divided into dexmedetomidine and control groups. The degree of sedation, bleeding and surgeon satisfaction were evaluated and recorded. Data analysis was performed using SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) and descriptive statistics (mean, standard deviation, percentage, number, frequency) and inferential statistical tests (Mann-Whitney U test, Kruskal-Wallis, t-test, chi-square test). The significance level in all tests was considered P<0.05.

The majority of patients in the study groups were female and the mean age of patients in the dexmedetomidine group was 34.36±7.33 years and in the control group was 36.60±9.59 years. The study groups were similar in terms of age and body mass index (P<0.05). The frequency of patient sedation in the dexmedetomidine group was lower than the control group, but it was not statistically significant (P<0.05). The results showed that at the beginning of the operation and 90 minutes later, the satisfaction level of the patient surgeon in the dexmedetomidine group was significantly better than the control group (P<0.001). In the dexmedetomidine group, the field of view of the surgeon was relatively clear and completely clear. The amount of bleeding in the dexmedetomidine group was lower than the control group, but it was not statistically significant (P<0.05).

Dexmedetomidine increased the surgeon's satisfaction by reducing bleeding and improving the surgeon's visual field. Therefore, this drug can be used as an anesthetic aid in surgery.

Cataract surgery is the most common surgery in the world. The prevalence of age-related cataract increases with age, and its prevalence increases with each decade of age after forty years. Various drugs are used to control analgesia and hemodynamics in patients undergoing cataract surgery. The purpose of this study is to compare dexmedetomidine and 2% lidocaine in the control of analgesia and hemodynamic changes in cataract surgery with local anesthesia.

In this double-blind clinical trial study, 52 patients with anesthesia class I and II underwent cataract surgery. Patients were randomly assigned to two groups: lidocaine (three cc) and dexmedomedin (five μg/kg + lidocaine). The information collection checklist in this study included: age, gender, history of aspirin use, systolic and diastolic blood pressure, heart rate, intraocular pressure, postoperative complications, and postoperative pain.

 The Mann-Whitney U test showed that the Dex-Metomedin group had less pain than the Lidocaine group in the first hour after the intervention (P=0.012). Two hours after the intervention, the dexmedemodin group had less pain than the lidocaine group (P=0.001). In the investigation of IOP after retrobulbar block in the dexmedetomidine group, we saw a significant increase in IOP from 16.56±3.12 to 17.96±2.68 mmHg compared to before the block (P=0.001). In the lidocaine group, we also saw a significant increase in IOP from 16.18±3.66 to 19.66±4.67 mm Hg compared to before the block (P=0.001). Before and after retrobulbar block, there was no significant difference between the two groups (P=0.694 and P=0.108, respectively). To investigate the effect of these interventions more precisely, the amount of IOP pressure change was also compared between the two groups, and we saw a greater increase in the lidocaine group than in the dexmedetomidine group (P=0.002).

The results of the present study showed that dexmedetomidine + lidocaine in retrobulbar form compared to lidocaine was able to control the pain level of patients after surgery and systolic and diastolic blood pressure during surgery. It is suggested to use this drug as local anesthesia in cataract surgery.

Currently, universities are considered as key places for the development of lifelong learning. This study aims to investigate the lifelong learning skills of medical students from Jahrom University of Medical Sciences (JUMS). 

This descriptive cross-sectional study was conducted in 2024 on 94 medical students, externs and interns at JUMS. The data collection tools included a demographic form and a lifelong learning scale. Analysis was done in SPSS software, version 21 using descriptive and inferential statistics. The significance level was set at P<0.05. 

The mean score of lifelong learning was 1.84±0.37, which is below the average level. Among the dimensions of lifelong learning, the dimensions of professors and facilities had the highest and lowest scores, respectively. The results showed that the mean total score of lifelong learning and the scores of its dimensions including professors, assessment methods, and facilities were significantly higher in in male students than female students (P<0.05). Regarding the dimensions of lifelong learning, it was found that students with higher grade point average had significantly higher goals (r=0.246, P=0.038).

The lifelong learning skills of the JUMS students in overall and in its dimensions (except for the dimensions of professors and goals) are lower than the average level.

Using radius hematoma block method can provide good anesthesia in distal radius fractures, but sometimes it is difficult to do it using anatomical landmarks. Performing the block procedure under ultrasound guidance can improve the success rate of the block and pain relief during delivery.

In this double-blind clinical trial study, 100 patients over 15 years of age with acute distal radius fracture were randomly assigned to two groups of hematoma block without ultrasound guidance and hematoma block with ultrasound guidance (47 people). Examining the amount of pain during block and insertion based on a Likert scale of 0 to 10 (0=no pain and 10=most pain) during insertion and half an hour after insertion was done and compared in two groups.

In this study, 69% of participating patients were women, the average age of patients in the group with ultrasound guidance was 47.25 years and in the group without ultrasound guidance was 55.16 years. The average number of VAS during descent in the group with ultrasound guidance and without ultrasound guidance was 5.42 and 5.81, respectively, and half an hour later, it was 1.91 and 2.33, respectively.

It seems that performing hematoma block under ultrasound guidance especially in cases where there are no suitable local landmarks or for reasons such as swelling of soft tissue, bone anatomy, crushing of fracture fragments, or the presence of interfering factors in diagnosing the exact location of the fracture. Hematoma block becomes complicated and difficult, it can be very helpful.

Complete intraspinal anesthesia is a rare but life-threatening complication and is characterized by decreased level of consciousness, drop in blood pressure, bradycardia and respiratory failure. The present study reported a case of complete spinal anesthesia in caesarean section surgery.

The patient, a 33-year-old woman with gravid 2, referred to Motahari Hospital in Jahrom city for a cesarean section. Spinal anesthesia was performed in a sitting position with a spinal needle size 25and with the first attempt at the L3-L4 level, and then the patient was placed in the supine position and with a brief Trendelenburg position, the level of anesthesia was increased to T4, and after ensuring the sensory block and Motor (T8), the patient's bed was placed in a flat state without position. The patient's blood pressure 3 minutes after spinal anesthesia was 103.72 mmHg and heart rate was 84 times per minute. At this moment and before making the surgical incision, suddenly the patient's level of consciousness dropped drastically; so that she did not respond to verbal commands and breathing stopped completely and respiratory apnea occurred and the patient's saturation decreased to about 78%, but the patient's blood pressure and heart rate did not decrease significantly. Immediately and without delay and without giving any anesthetic, the patient was intubated with a size 7 tracheal tube and connected to the anesthesia machine and saturation reached 98%. The operation started and the baby was born with fifth minute Apgar score of 9 and the patient woke up completely at the end of the operation and was extubated and transferred to recovery without any special complications.

The present study adds a special and uncommon case of complications of spinal anesthesia to the previously reported limited cases and shows the clinical characteristics and appropriate treatment performance in the face of complete spinal anesthesia during cesarean section. Therefore, by knowing the effective factors in reducing this complication, an effective step can be taken to reduce it as much as possible.

Pain after surgery is an unpleasant experience that occurs following various stimuli and people react to it. This process causes physiological disorders in all systems of the body.

In this three-way, randomized clinical trial, 59 patients with anesthesia classes 1 and 2 underwent lower limb orthopedic surgery with spinal anesthesia. Patients were divided into 4 groups: pethidine, ketorolac, placebo and a combination of ketorolac and pethidine. VAS criterion was used to measure patients' pain.

There was no statistically significant difference between ketorolac, pethidine, placebo and ketorolac + pethidine groups in terms of systolic and diastolic blood pressure and heart rate. Oxygen saturation percentage before and after spinal was significant 15 minutes after surgery (p <0.05). But at other times there was no significant difference (p> 0.05). There was a significant difference in terms of pain in recovery at 6 and 12 hours after surgery (p <0.05). But at other times, the difference was not significant. At 6 hours postoperatively, severe pain was observed in patients in the pethidine and placebo groups and in patients in the ketorolac + pethidine and ketorolac groups; However, at 12 hours postoperatively, severe pain was more common in patients in the pethidine group than in the other groups and was not present in patients in the ketorolac + pethidine group.

The results of this study showed that ketorolac and the combination of ketorolac + pethidine reduce analgesia in patients undergoing orthopedic lower limb surgery.

Complications of awakening from general anesthesia may increase the risk of serious complications. Various methods have been studied to suppress the occurrence of these complications. Intraoperative injection of dexmedetomidine can prevent complications of awakening from anesthesia by reducing irritation, cough and hemodynamic changes in children and adults. However, there are conflicting results regarding the effectiveness of dexmedetomidine and midazolam in suppressing cough and other complications during extubation. Therefore, the current study was designed with the aim of "comparing the effect of midazolam with intravenous dexmedetomidine before extubation on the reactions of coming out of anesthesia in patients after lumbar disc surgery".

This research was a double-blind randomized clinical trial on 90 patients aged 18 to 65 years with anesthesia class 1 and 2,  which included patients undergoing lumbar disc surgery under general anesthesia in Peymaniyeh Hospital, Jahrom (2023). Patients were randomly divided into three groups: A (receiver of midazolam with a dose of 0/2 mg/kg/h) and B (receiver of dexmedetomidine with a dose of 1 μg/kg) and C as a control group (placebo = normal saline). Data analysis was done by descriptive statistics and inferential statistical tests using spss software version 21.

This study was done to compare the effect of midazolam with intravenous dexmedomidine before extubation on the reactions of getting out of anesthesia in patients after lumbar disc surgery, in order to prevent the reactions of getting out of anesthesia and minimize its complications in patients undergoing lumbar disc surgery by examining the results of this study.

The academic promotion of faculty members is directly related to the promotion of universities, especially medical universities that are responsible for educating medical students. In this regard, this study aims to explore the barriers, solutions and effective motivational factors in the process of academic promotion for clinical faculty members in Iran.

This is a qualitative study with a phenomenological approach. Semi-structured interviews with 9 clinical professors from Jahrom University of Medical Sciences who were experienced the promotion process were used to collect data. The collected information was analyzed based on Colaizzi’s seven-step method.

Based on the analysis, 69 primary codes and semantic units were extracted which led to identifying 10 main themes and 23 sub-themes in three areas of barriers to promotion (lack of knowledge of professors regarding the promotion process, lack of human resources, structural challenges, regulation challenges, audit board challenges), solutions to overcome barriers (increasing professors’ awareness, developing facilities, modifying the evaluation system), and motivational factors (Intrinsic and extrinsic factors). 

The findings of the present research revealed a new perspective on the challenges of type 3 universities in Iran regarding the academic promotion process for clinical professors. To improve the process, it is recommended that, the awareness of professors about the promotion regulations and their indicators and clauses should be increased by holding workshops. Experts should be assigned to help them. The promotion regulations should be modified according to the status and characteristics of clinical professors. Intrinsic motivational factors including the salary and the reward system should be strengthened for them.

The term gossypiboma is used to describe surgical sponges or gauzes that remain in the patient's body after a surgery. The present study reports a case of a large multiloculated cyst following the retention of a long gas in an emergency cesarean section.

A 37-year-old female patient underwent a cesarean section at a gestational age of 38 weeks due to labor pains and rupture of the membranes, and the baby was delivered and the patient was discharged without any complications. About 5 months later, the patient referred because of right flank pain. In the ultrasound, a large multiloculate cyst was reported on the right side of the pelvis and slightly above it. The general surgeon requested a CT scan, which revealed a cyst-like mass on the right side of the abdominal cavity with fluid and gas accumulation. Finally, after months of waiting for various imaging, the X-ray image diagnosed the foreign body of long gauze after 11 months. For this reason, the patient was hospitalized and underwent surgery, and then the cyst, which consisted of long gas and a thick wall of ammentum around it, was released and removed. A week later, the patient had a general condition without problems.

Failure to prevent the occurrence of Gossypiboma is one of the most important issues that causes serious complications such as large cysts in patients. Therefore, all scrub and circular personnel in the operating room should use all their attention when performing instrument counts.

Educational grand rounds are a special form of clinical education that are used in many medical and academic centers in Iran. This study aims to survey the perceptions of faculty members, residents, interns, externs, and students of Jahrom University of Medical Sciences (JUMS) regarding the grand rounds held in the internal department  a hospital in Jahrom, Iran.

This analytical cross-sectional study was conducted on 83 people (faculty members, residents, interns, externs, students) in the internal department of Seyyed al-Shohada Hospital affiliated to JUMS  in 2023. The data collection tools included a demographic form and a standard Grand Round questionnaire. 

According to the majority of participants, the held grand rounds were at a good or very good level. Most of them perceived the presence of the intern in the grand rounds as useful and necessary. Moreover, 62% perceived that holding the Grand Round in a classroom and presentation by the professors was more efficient. Also, 58.9%  perceived the discussion about differential diagnoses as the best strategy for introducing the patient. 

The perceptions of the majority of faculty members, residents, externs and interns of JUMS regarding the held grand rounds are higher than perceptions of students.

A good educational environment is one of the most important factors in the quality of education. Medical education is important because of its direct impact on the health of patients. A quality educational environment can motivate students to learn better. Outpatient clinic experience is an important part of clinical education. Therefore, the present study aims to evaluate the status of educational environment in clinics of teaching hospitals affiliated to Jahrom University of Medical Sciences (JUMS) according to the medical students' point of view.

This is a descriptive cross-sectional study with the participation of 176  medical students who were selected using the census method. The data collection tool was the Ambulatory Care Learning Education Environment Measure (ACLEEM) questionnaire, which included two parts; the first part surveyed demographic information, and the second part was the main section with 50 items rated on a five-point scale. To assess the difference in the scores based on demographic factors, independent t-test was used. 

The mean overall ACLEEM score was 2.23±0.50, which was at a moderate level. In the domains of Clinical teachers, clinical activities & patient care, protected time for non-clinical activities, infrastructure, clinical skills, and assessment & feedback, the scores were at a moderate level, while in the domains of “Information. Communication & technology”, and “Clinical supervision”, the scores were lower than average level. The mean scores of ACLEEM were not significantly different in terms of students’ demographic characteristics.

According to medical students, the educational environment of clinics in hospitals affiliated to JUMS is at a moderate level. It is recommended that planners and experts in the field of medical education should identify the weaknesses and strengths of educational settings to increase the quality of outpatient clinical training.

For obtaining accreditation, in addition to creating infrastructures, there is a need to use new management methods and the managers who have the authority, knowledge, capability, motivation to take charge of these centers. The present study aims to investigate the knowledge and attitude of the executive management team of teaching hospitals in Jahrom, Iran, regarding accreditation. 

This descriptive cross-sectional study was conducted in 2023 on 61 members of the executive management team of teaching hospitals affiliated to Jahrom University of Medical Sciences. The data collection tool was a demographic form and the knowledge and attitude scale regarding hospital accreditation. Data analysis was done in SPSS software , version 21 using descriptive and inferential statistics.

The mean scores of knowledge and attitude were 49.57±16.02 and 66.62±21.53, respectively. According to the participants, “Knowledge and awareness about the requirements (infrastructure and necessary conditions)”,”Knowledge and awareness about accreditation standards”, and “Knowledge and awareness about the general principles and concepts of accreditation” had the highest importance. 

The awareness and attitude of the executive management team regarding hospital accreditation can be improved after the implementation of the accreditation process.

Despite the increasing progress in the construction and operation of the hospital, this project is still one of the major challenges in the country. This research is of a qualitative-descriptive type, with the method of contractual content analysis, with in-depth semi-structured interviews and open-ended questions, from the administrators and officials of Jahrom University of Medical Sciences, who play an important role in the construction and operation of the Seyed Al-Shohada Hospital project. Were done the interview was conducted in a quiet atmosphere away from interfering factors. The interviews continued until data saturation. The officials' experience of building the hospital was examined in the form of a general question, and then by entering into the depth of the subject, we tried to ask more questions and examine the depth of their experience. In total, after analyzing the interviews, the main classes are: 1- the process of operating the hospital; 2- Educational-therapeutic hospital; 3- Challenges; 4- The solutions provided to solve the challenges; 5- Documentation of documents and documents; 6- Proposals were extracted in the direction of similar projects. The results of this study showed that since health is one of the most important pillars in the development of any society and the health system of any country, especially hospitals, plays a key role in this field. have; Therefore, preparing all hospital infrastructures such as: the physical building of the hospital, provision of personnel and manpower,

Breast cancer is the most common cancer and one of the major causes of cancer deaths in women. The present study was conducted with aim to investigate the relationship between breast cancer and dietary patterns in women with breast cancer in Jahrom city.

This cross-sectional and analytical study was performed in 2021 on 107 women with breast cancer who referred to the Khatam Al-Anbia center in Jahrom city. The required information was collected through interviews and completing the food frequency questionnaire. Data analysis was done using SPSS software (version 21) and descriptive and inferential statistical tests. P<0.05 was considered statistically significant.

A significant inverse correlation was seen between the duration of receiving chemotherapy and the frequency of fast food consumption (r=-0.201, P=0.046). There was no significant difference in terms of disease pathology, disease stage, lymphatic involvement and cancer vascular involvement in food frequency in any of the foods (P>0.05), but people with breast cancer recurrence had a lower mean frequency of chocolate consumption than those who had no recurrence (P=0.025). People with breast cancer metastasis had a lower mean frequency of coffee consumption (P=0.009) and more fast food consumption (P=0.024) than those without cancer metastasis. The frequency of consumption of chocolate and fried foods was significantly higher in deceased people than in surviving persons (P<0.05).

In this study, there was a significant relationship between breast cancer and food patterns, including a positive correlation with tea and soda consumption, a negative correlation with fast food consumption, and a difference in chocolate and coffee consumption in people with cancer in terms of recurrence and metastasis. More studies are needed to compare the dietary patterns of these people with healthy ones in Jahrom city to find the causes between nutritional disorders and breast cancer.

Mammography has diagnostic value as a tool for the early detection of intangible breast cancers, both in screening and in the detection of disease. The present study was performed with aim to evaluate the findings related to focal asymmetry density of breast and their relationship with malignancy rate.

This descriptive analytical study was performed in 2019 on 150 patients with focal asymmetric density mammography referred to Khatam Al-Anbia Clinic of Jahrom city. Variables such as the appearance of the lesion on ultrasound, the presence or absence of a mass, the type of mass and the location of the lesion on ultrasound were examined and then hormonal and pathological evaluation was performed if necessary. Data analysis was done using SPSS software (version 19) and Chi-square and t-test. P<0.05 was considered statistically significant.

Out of 150 patients, 134 cases of focal asymmetry density (FAD) were observed on mammography. The age distribution of people whose mammographic findings showed the presence of FAD did not show a significant difference compared to patients without FAD (P=0.728). The outer upper quadrant or UOQ with 84 cases (56%) is the most common site of FAD involvement. Mammographic findings including normal, benign, suspected, borderline and malignant were significantly associated with the presence or absence of FAD (P=0.001). BI-RADS score was also significantly associated with the presence or absence of FAD in mammography (P=0.0001). The pathology was performed only for 21 cases. Based on this test, the sensitivity and specificity of focal asymmetry density for malignancy were determined as 63.64% and 20.00%.

Considering to the sensitivity and specificity of positive focal asymmetric density in mammography, for additional studies and to increase the diagnostic value, it is necessary to use other screening methods along with mammography for patients prone to focal asymmetric density.

Excessive bleeding during and after childbirth is a serious complication that can endanger the life of the mother. The present study reported a case of active arterial bleeding after normal delivery.

The patient is a 22-year-old woman, G2L1 (second pregnancy), who underwent natural childbirth due to labor pains, decreased fetal movements, and exceeding the due date. The baby girl was born naturally without any complications, with an Apgar score of 9 and a weight of 3050 grams, without dystocia or any specific abnormalities. Approximately three hours after delivery, the mother experienced dizziness and fainting while trying to get out of bed. At that time, the patient's pulse was 120 bpm, and she appeared pale. The patient's blood pressure was reported as 60/90, and there was no vaginal bleeding. The uterus was palpated in its normal position above the suprapubic area. The vagina and cervix were checked again and found to be without any abnormalities or bleeding. Due to the persistence of the patient's symptoms, an emergency abdominal and pelvic ultrasound was requested, which was performed after several hours of delay. Consultation with a urologist was requested, and it was suggested to perform a cystogram and abdominal ultrasound on the patient. The abdominal ultrasound reported a large hematoma measuring 3.14 x 7.5 x 17 cm in front of the uterus and behind the bladder. The patient was transferred to the operating room and underwent general anesthesia. The abdomen was opened through a wide incision. A large hematoma measuring 17 x 18 cm was found in the area behind the bladder and in front of the uterus, extending up to the fundus of the uterus and broad ligaments. The hematoma was drained and found to be located in the lower uterine segment, without any connection to the cervix or inside the uterus.

Active primary and secondary intra-abdominal hemorrhage is one of the surgical emergencies after delivery. The patient should undergo surgery immediately and the bleeding should be controlled.

Thalassemia is a common genetic blood disorder that is chronic and is associated with a wide range of serious psychological and clinical challenges, affecting an individual's psychological well-being similar to other chronic illnesses. This study aimed to determine the prevalence of depression in patients with thalassemia major and thalassemia intermedia related to blood disorders.

In this cross-sectional descriptive study, 61 patients with thalassemia major and nine patients with thalassemia intermedia from Jahrom city participated in the year 2019. Data collection tools included a demographic information questionnaire and the Beck Depression Inventory. Data analysis was performed using SPSS version 16, and descriptive and analytical statistics were applied.

The prevalence of depression in patients with thalassemia major was 42.6%. Eight individuals (1.13%) had mild depression, 13 individuals (3.21%) had moderate depression, and five individuals (2.8%) had severe depression. The average depression score did not differ between male and female thalassemia major patients (P > 0.05). This average score was 53.9 ±17.52 for patients with below diploma education, 29.7 ± 11.92 for diploma holders, and 51.3 ± 4.51 for bachelor's degree holders (P < 0.05). Additionally, the prevalence of depression in patients with blood-related intermediate thalassemia was 33.3%. Mild depression was present in 2.22%, and severe depression in 1.11% of these patients.

The prevalence of depression in patients with thalassemia major is higher than in those with thalassemia intermedia. It is recommended that healthcare and psychological services for patients with thalassemia major and intermedia be designed to improve their quality of life and reduce depression. Furthermore, providing education and increasing awareness about depression management and the importance of social support for these patients can be effective.

Clinical decision-making is done based on data collection, interpretation and evaluation to choose anevidence-based treatment plan from among different ways; Since the clinical environment has dynamic, variable, uncertain and unstable conditions, the clinical decision-making of assistants has different dimensions and is influenced by several factors; As a result, it is not possible to get a deep understanding of it with quantitative and cross-sectional studies; Therefore, the present study was carried out with the aim of explaining the experiences of internal department assistants on the factors and obstacles affecting clinical decision-making in hospitals affiliated to Jahrom University of Medical Sciences. This article is a contract content analysis study in which 8 assistants of the internal medicine department from hospitals affiliated to Jahrom University of Medical Sciences were selected and participated in thestudy by purposeful sampling. Semi-structured in-depth personal interview method was used to collect data. All interviews were recorded and then transcribed and analyzed using Granheim and Lundman's method. Data analysis revealed 4 main themes and 14 sub-categories, which main themes are: "criteria for clinical decision-making", "obstacles to clinical decision-making", "facilitators for clinical decision-making" and "the need for development" Training of assistants". Considering that clinical decision-making is based on the comprehensive benefit of the patient, ethicalprinciples and evidence, and the lack of theoretical knowledge, little experience and insufficient skills, lack of specialists, facilities and equipment along with the lack of amenities and work pressure can prevent correct decision-making, it is better to emphasize more on these matters in educational planning.