Abstract

Issue

Volume

Source title

Year

Title

Authors

Science and Engineering Ethics

2020

Bridging the Gap Between Ethical Theory and Practice in Medicine: A Constructivist Grounded Theory Study

Madani M., Vedadhir A.A., Larijani B., Khazaei Z., Gharamaleki A.F.

DARU, Journal of Pharmaceutical Sciences

2020

COVID-19 and off label use of drugs: an ethical viewpoint

Shojaei A., Salari P.

Background: Study aimed at assessing residents' cost awareness and their attitude about health care costs. Methods: Internal medicine residents at teaching hospitals of Tehran University of Medical Sciences were surveyed during August–December 2016 using a researcher-made questionnaire comprising attitude statements and cost estimation of diagnostic and treatment items. Results: Eighty-nine residents completed the survey (response rate = 56.6%). The results indicate that less than one quarter (23.69%) of cost estimates were in the range of correct answers. The mean (SD) for correct estimation of medications (out of 8 scores), lab tests (out of 20 scores), and total (out of 35 scores) were 1.25 (0.96), 4.92 (0.27), and 7.97 (0.34), respectively. An analysis of variance showed that the level of residency was positively correlated with residents’ correct cost estimation (F (3, 77)=9.98, p = 0.029). There was a significant positive correlation between age of residents with the correct estimate of medication prices (p = 0.018, r = 0.261). Conclusions: The internal medicine residents of Tehran University of Medical Sciences have poor knowledge of health care costs, including medications, diagnostic tests, and hospitalization costs. The results of this study explain the necessity of developing a training program for the transfer of cost information to physicians. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.

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Medical Teacher

2020

Cost-consciousness among Iranian internal medicine residents

Maghbouli N., Akbari Sari A., Asghari F.

The advances in science and technology in recent decades, especially in medical sciences, have raised new ethical challenges. Hence, professional organizations in the field of medical science are trying to develop regulations in the field of medical ethics to help medical science professionals in making the best decisions in different circumstances and moral dilemmas. The organizations also try to monitor their performance using those regulations. On the other hand, due to the specialization of medical science as well as the complexity of communication between these disciplines, there is a growing need for regulations to answer questions and resolve the challenges of each discipline. Certainly, scientific societies, due to benefit from relevant specialists, are the best reference for the development of specialized guidelines, one of which is the Iranian Society of Asthma and Allergy (ISAA). The aim of the current study was to develop codes of ethics for ISAA members, using a qualitative study.Generally, the ISAA codes of professional ethics consists of general and specific sections. In order to compile the general section, the upstream medical documents, including the patients' rights charter in Iran, the research ethics guidelines approved by the Ministry of Health and Medical Education (MOHME), ethical codes from the international societies of asthma and allergy, the general codes of professional ethics of the Iran Medical Council and the Islamic jurisprudential rules and the statute law of the country were used.To develop specific sections, we interviewed the experts in the field of Asthma and Allergy about the ethical challenges they had ever faced with.The ISAA codes of professional ethics developed in five chapters, entitled "Ethical Guidelines for the Mangers and Director of the Society, General Guidelines, Specific Guidelines, Ethical Guidelines for Research and Education, and Procedure for Supervision on the Professional Behavior of the ISAA Members", and approved by the board of directors of ISAA.

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IRANIAN JOURNAL OF ALLERGY ASTHMA AND IMMUNOLOGY

2020

Iranian Society of Asthma and Allergy Codes of Professional Ethics

Shamsi-Gooshki, Ehsan; Pishkuhi, Mahin Ahmadi; Mousavi, Maryam Sadat; Raoofi, Azam; Fazlollahi, Mohammad Reza; Parsapour, Alireza; Moin, Mostafa

Internationalization of higher education involves mutual exchanges as well as a consensus based. Political, economic, sociocultural, and scientific reasons recommend the need to move toward the internationalization of higher education. The current study highlights the strengths of the internationalization of Iran's medical sciences education. MATERIALS AND METHODS: This descriptive exploratory study was carried out in 2016-2017 in Iran. The techniques used for data collection included review of articles, interview with subject experts, and the focus group and the nominal technique group to explore the views of various stakeholders. The data were analyzed with the qualitative content analysis method. RESULTS: The inductive qualitative content analysis of all data generated 13 categories and 88 subcategories. The categories were geographical and geostrategic position of Iran; the historical, cultural, religious, and tourist attractions of Iran; the security of Iran; priority to internationalization policies and programs in Iran's macro plans; the existence of regulations, laws, and approvals for international activities; same language with neighboring and regional countries; the low cost of studying and living in Iran; the ability of Iranian faculty members and experts for internationalization; the background, reputation, and the progress of medical education, health, and care in Iran; the cheaper forces of Iran and their welcome to foreigners; the existence of motivation, zeal, and belief for internationalization; the existence of proper infrastructure; and the existence of a suitable capacity for internationalization. CONCLUSIONS: Iran has some positive points that can be used to promote international activities, provided it does some good advertising in this regard. It is suggested that the challenges, opportunities, and threats to Iran's internationalization should be collated from the perspective of the various stakeholders. © 2020 Journal of Education and Health Promotion | Published by Wolters Kluwer - Medknow.

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Journal of Education and Health Promotion

2020

Strengths of Iran for internationalization of medical sciences education

Rezaei H., Mosavi A., Yousefi A., Larijani B., Rezaei N., Dehnavieh R., Adibi P.

Medical errors are among the major challenges that threaten patients’ health worldwide. The aim of this study was to design a valid and reliable questionnaire to investigate the status of medical error disclosure by physicians. A preliminary questionnaire was developed based on the extracted results from 37 interviews with specialists. To test the validity of the questionnaire, 20 medical practitioners and medical ethics authorities were asked to evaluate the relevance and clarity of each item. To measure the instrument’s reliability (the intra-class correlation coefficient and Cronbach’s alpha), a test-retest study was conducted on 20 randomly selected physicians twice with a 2-week interval. Statistical analyses were performed using SPSS software version 20. The overall relevance and clarity of the instrument, with an average approach, were measured at 97.22 and 94.03 percent respectively. The Cronbach’s alpha, which presents the internal consistency was satisfactory (0.70 - 0.79) for various domains of the questionnaire. The range of intra-class correlation coefficients for the items in all domains of the questionnaire was 0.76 to 1.00. Regarding the validity and reliability of the questionnaire, it can be an appropriate instrument in the assessment and monitoring of the status of medical error disclosure by physicians. © 2019 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved

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Journal of Medical Ethics and History of Medicine

2019

A study of the validity and reliability of the questionnaire entitled "physicians' approach to and disclosure of medical errors and the related ethical issues"

Mohammadi M., Larijani B., Tabatabaei S.M., Nedjat S., Yunesian M., Nayeri F.S.

Iran, despite its size, geographic location and past cultural influence, has largely been a blind spot for human population genetic studies. With only sparse genetic information on the Iranian population available, we pursued its genome-wide and geographic characterization based on 1021 samples from eleven ethnic groups. We show that Iranians, while close to neighboring populations, present distinct genetic variation consistent with long-standing genetic continuity, harbor high heterogeneity and different levels of consanguinity, fall apart into a cluster of similar groups and several admixed ones and have experienced numerous language adoption events in the past. Our findings render Iran an important source for human genetic variation in Western and Central Asia, will guide adequate study sampling and assist the interpretation of putative disease-implicated genetic variation. Given Iran’s internal genetic heterogeneity, future studies will have to consider ethnic affiliations and possible admixture. © 2019 Mehrjoo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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PLoS Genetics

2019

Distinct genetic variation and heterogeneity of the Iranian population

Mehrjoo Z., Fattahi Z., Beheshtian M., Mohseni M., Poustchi H., Ardalani F., Jalalvand K., Arzhangi S., Mohammadi Z., Khoshbakht S., Najafi F., Nikuei P., Haddadi M., Zohrehvand E., Oladnabi M., Mohammadzadeh A., Jafari M.H., Akhtarkhavari T., Gooshki E.S., Haghdoost A., Najafipour R., Niestroj L.-M., Helwing B., Gossmann Y., Toliat M.R., Malekzadeh R., Nürnberg P., Kahrizi K., Najmabadi H., Nothnagel M.

BACKGROUND: Observing professional behavior in clinical settings encounters many obstacles. In this research, the effect of defects of the educational system in observing professional behavior in clinical settings of Tehran University of Medical Sciences (TUMS) has been investigated. MATERIALS AND METHODS: This qualitative content analysis study was conducted using focused group discussions in TUMS. Twenty-two focused group discussions with 182 faculty members, medical students, and clinical staff were conducted. Conventional content analysis was used to analyze the data. RESULTS: One hundred and sixty codes (90 codes from the viewpoint of clinical staff and 70 codes from the viewpoint of faculty members and medical students) were extracted. The codes are categorized into 4 categories and 17 subcategories. The categories include 'educators' imperfections,' 'inadequate initial training,' 'lack of attention to continuous professional education,' and 'lack of passion for professionalism education.' CONCLUSION: Greater efforts to empower educators, planning for the effectiveness of initial education, and motivating employees might play a role in promoting the observance of professional behavior in clinical settings. Professional behavior training should be considered at the entrance into the system. This education should be strengthened by continuing theoretical and practical training and addressed by proper supervision. It is also important to focus on attracting the attention of teachers to their own model role in observing professional behavior by others. © 2019 Journal of Education and Health Promotion.

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Journal of Education and Health Promotion

2019

Educational system defects and observing professional behavior: A qualitative study

Alipour F., Shahvari Z., Asghari F., Samadi S., Amini H.

Background: Some disasters, such as earthquake and flood make the majority of affected people homeless. The accommodation of these people in temporary shelters and camps requires some specific ethical issues. The aim of the present study was to discuss ethical issues regarding living in camps following natural disasters. Methods: This study is conducted utilizinga qualitative content analysis approach. The required data were collected from four Focus Group Discussions (FGDs). Subsequently, 11 in-depth interviews were completed using the individuals who had the experience of receiving care following natural disasters and continued until data saturation. Data were analyzed using Graham content analysis method. Results: According to the results obtained from affected people's views, the most important ethical issues that are not considered important in temporary shelters and camps include:1) the violation of privacy,2) the shortage of basic needs (e.g., food, water, and sanitation) and type and quality of services rendered,3) lack of attention to cultural and religious views of the affected people, 4) cause of evacuation, 5)lack of co-operation among disaster managers, 6)respecting the properties of the affected people, 7)conditions and geographic location of camps, 8)property care, and 9)community-based care. Conclusion: Without paying attention to ethical issues, living in temporary shelters (i.e., camps) violates the dignity of affected people and then the affected people will not have appropriate cooperation with the managers. All these issues expose them to more harm than before. Copyright © 2019 by The Archives of Bone and Joint Surgery.

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Archives of Bone and Joint Surgery

2019

Ethical considerations for living in temporary shelters (i.e., camps) following a natural disaster

Khaji A., Larijani B., Ghodsi S.M., Mohagheghi M.A., Khankeh H.R., Saadat S., Tabatabaei S.M.

The national guidelines for biomedical research ethics are approved by the “National Committee for Ethics in Biomedical Research” at the Iranian Ministry of Health and Medical Education as the regulatory body for biomedical research in the country. The focus of these guidelines should be on the ethical issues related to different stages of the research process, which would lead to increased research integrity and better supervision of research activities. The present study analyzed the contents of these national guidelines to clarify the ethical considerations connected to the five stages of a research process including 1) proposing, 2) approval, 3) operation, 4) documentation and 5) publishing. The findings showed that the assessed guidelines laid more emphasis on the ethical considerations related to the research operation stage rather than the proposal stage. In other words, activities such as identification of the research problem, formulation of hypotheses and questions, financial evaluation, data analysis and data interpretation did not receive adequate attention in these guidelines. Most of the guidelines presented subject categories such as the rights of participants and supervisory considerations in the “research operation stage”, ethical considerations in the “evaluation and approval procedure stage”, and editorial responsibilities in the “research review and publication stage”. In general, despite noticeable content for guiding researchers for ethical conduction of research the national guidelines are not adequately developed to cover comprehensive and sufficient ethical considerations regarding all the activities of research. © 2019 Medical Ethics and History of Medicine Research Center.

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Journal of Medical Ethics and History of Medicine

2019

Ethical considerations in the biomedical research: Analysis of national biomedical research ethics guidelines in iran

Mardani A., Nakhoda M., Noruzi A., Gooshki E.S.

Introduction: Triage is a dynamic and complex decision-making process in order to determine priority of access to medical care in a disaster situation. The elements which should govern an ethical decision-making in prioritizing of victims have been debated for a long time. This paper aims to identify ethical principles guiding patient prioritization during disaster triage. Method: Electronic databases were searched via structured search strategy from 1990 until July 2017. The studies investigating patients’ prioritization in disaster situation were eligible for inclusion. All types of articles and guidelines were included. Result: Of 7167 titles identified in the search, 35 studies were included. The important factors identified in patient prioritization were grouped into two categories: medical measures (medical need, likelihood of benefit and survivability) and Nonmedical measures (saving the most lives, youngest first, preserving function of society, protecting vulnerable groups, required resources and unbiased selection). Demographic characteristics, health status of patients, social value of patient, and unbiased selection are discriminatory factors in disaster triage. Conclusion: Various factors have been introduced to consider ethical patient prioritization in disaster triage. Providers’ engagement, public education, and ongoing training are required to reach a fair decision. © 2018 Elsevier Ltd

43

International Emergency Nursing

2019

Ethical prioritization of patients during disaster triage: A systematic review of current evidence

Ghanbari V., Ardalan A., Zareiyan A., Nejati A., Hanfling D., Bagheri A.

Background: Ensuring that countries have adequate research capacities is essential for an effective and efficient response to infectious disease outbreaks. The need for ethical principles and values embodied in international research ethics guidelines to be upheld during public health emergencies is widely recognized. Public health officials, researchers and other concerned stakeholders also have to carefully balance time and resources allocated to immediate treatment and control activities, with an approach that integrates research as part of the outbreak response. Under such circumstances, research "ethics preparedness" constitutes an important foundation for an effective response to infectious disease outbreaks and other health emergencies. Main text: A two-day workshop was convened in March 2018 by the World Health Organisation Global Health Ethics Team and the African coaLition for Epidemic Research, Response and Training, with representatives of National Ethics Committees, to identify practical processes and procedures related to ethics review preparedness. The workshop considered five areas where work might be undertaken to facilitate rapid and sound ethics review: preparing national ethics committees for outbreak response; pre-review of protocols; multi-country review; coordination between national ethics committees and other key stakeholders; data and benefit sharing; and export of samples to third countries. In this paper, we present the recommendations that resulted from the workshop. In particular, the participants recommended that Ethics Committees would develop a formal national standard operating procedure for emergency response ethical review; that there is a need to clarify the terminology and expectations of pre-review of generic protocols and agree upon specific terminology; that there is a need to explore mechanisms for multi-country emergency ethical consultation, and to establish procedures for communication between national ethics committees and other oversight bodies and public health authorities. In addition, it was suggested that ethics committees should request from researchers, at a minimum, a preliminary data sharing and sample sharing plan that outlines the benefit to the population from which data and samples are to be drawn. This should be followed in due time by a full plan. Conclusion: It is hoped that the national ethics committees, supported by the WHO, relevant collaborative research consortia and external funding agencies, will work towards bringing these recommendations into practice, for supporting the conduct of effective research during outbreaks. © 2019 The Author(s).

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BMC Medical Ethics

2019

Ethics preparedness: Facilitating ethics review during outbreaks - Recommendations from an expert panel

Saxena A., Horby P., Amuasi J., Aagaard N., Köhler J., Gooshki E.S., Denis E., Reis A.A., Gangbo F., Compaore G.M., Ngaba O.N., Komas N.P., Munday F., Aglanu L.M., Wellington K., Maiga-Ascofaré O., Bah-Sow O.Y., Diallo A.A., Souaré O., Penali L., Mason G.T., Mfutso-Bengo J., Doumbia A., Iliyasu Z., Folayan M.O., Mbaye E.H., Ndiaye B.P., Touré A., Touré P., Nyan O., Bouacha H., Seryazi I.S., Jahan M.U., Al-Atiyyat N.M.H., Shah A., Aasim A., De Castro L., Marodin G., Ascurra M., Rethymiotaki E., Peicius E., Farnon E.C., Taieb F.N., Taverne B., Moore C.E., De Almeida J.R., Whittall H., Saenz C., Sathiyamoorthy V., Ravinetto R.

Attitudes of physicians toward neonates with poor prognosis greatly influence their decisions regarding the course of treatment and care. The present study aimed to investigate factors contributing to attitudes of medical practitioners toward poor prognosis neonates. This was a cross-sectional, descriptive-analytic study. Questionnaires for assessing subjects' attitudes toward care of very poor prognosis neonates were administered to all neonatologists, pediatricians, neonatology assistants, and pediatric residents (a total of 88 individuals) working in the NICUs of Imam Khomeini Hospital. Participants' attitudes were determined through analysis of responses to seven questions on a 5-point Likert scale ranging from "strongly agree" to "strongly disagree". Presence of anomalies incompatible with an acceptable quality of life, birth weight, gestational age, responses to neonatal diagnostic tests, certain types of diseases, parental marital status and practitioner predictions about patient prognosis were the factors contributing to practitioners' attitude (P-value < 0.005). However, no significant relationship was found in connection with religious beliefs, socioeconomic status, opinions of consulting physicians, hospital treatment protocols, standards of the Association of Neonatal Physicians, and ethics committee expectations (P-value > 0.005). It can be concluded that the attitudes of practitioners toward intensive care of poor prognosis neonates is determined by the medical condition of the neonate rather than socio-demographic characteristics.

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JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2019

Factors influencing the attitudes of NICU physicians toward care of neonates with very poor prognosis

Nayeri, Fatemeh; Asghari, Fariba; Baser, Ali; Janani, Leila; Shariat, Mamak; Tanha, Kiarash; Eabrhim, Bita

Considering the application of human genome variation databases in precision medicine, population-specific genome projects are continuously being developed. However, the Middle Eastern population is underrepresented in current databases. Accordingly, we established Iranome database () by performing whole exome sequencing on 800 individuals from eight major Iranian ethnic groups representing the second largest population of Middle East. We identified 1,575,702 variants of which 308,311 were novel (19.6%). Also, by presenting higher frequency for 37,384 novel or known rare variants, Iranome database can improve the power of molecular diagnosis. Moreover, attainable clinical information makes this database a good resource for classifying pathogenicity of rare variants. Principal components analysis indicated that, apart from Iranian-Baluchs, Iranian-Turkmen, and Iranian-Persian Gulf Islanders, who form their own clusters, rest of the population were genetically linked, forming a super-population. Furthermore, only 0.6% of novel variants showed counterparts in "Greater Middle East Variome Project", emphasizing the value of Iranome at national level by releasing a comprehensive catalog of Iranian genomic variations and also filling another gap in the catalog of human genome variations at international level. We introduce Iranome as a resource which may also be applicable in other countries located in neighboring regions historically called Greater Iran (Persia).

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HUMAN MUTATION

2019

Iranome: A catalog of genomic variations in the Iranian population

Fattahi, Zohreh; Beheshtian, Maryam; Mohseni, Marzieh; Poustchi, Hossein; Sellars, Erin; Nezhadi, Sayyed Hossein; Amini, Amir; Arzhangi, Sanaz; Jalalvand, Khadijeh; Jamali, Peyman; Mohammadi, Zahra; Davarnia, Behzad; Nikuei, Pooneh; Oladnabi, Morteza; Mohammadzadeh, Akbar; Zohrehvand, Elham; Nejatizadeh, Azim; Shekari, Mohammad; Bagherzadeh, Maryam; Shamsi-Gooshki, Ehsan; Boerno, Stefan; Timmermann, Bernd; Haghdoost, Aliakbar; Najafipour, Reza; Khorshid, Hamid Reza Khorram; Kahrizi, Kimia; Malekzadeh, Reza; Akbari, Mohammad R.; Najmabadi, Hossein

Background: Forecasting is the process of predicting future behavior. In reviewing databases, no predicted value associated with international collaboration publications in Iran was found. Thus, the present study aimed at forecasting Iran's international collaborative articles in medical sciences. Methods: The number of Iran's articles and international collaborative articles in medical sciences written over 56 years was extracted from SCOPUS. Data were extracted from 1960 up to 2016. The time series method was used for forecasting using the Minitab software Version 17. Results: There was no increase in the number of medical articles from Iran from 1960 to 2001. However, the data showed incremental growth between 2001 and 2016. This was similar to Iran's medical sciences international collaboration articles. In 2016, the percentage of Iran's international collaboration articles was 15.2, which is expected to reach 19.9 in 2025. Conclusion: An investigation was performed on the number of international collaboration articles in the field of medical sciences in Iran. Future trends show an incremental growth. The number of Iran's articles can be increased with international cooperation. However, an increase or decrease in Iran's articles without international cooperation has to be investigated. © Iran University of Medical Sciences.

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Medical Journal of the Islamic Republic of Iran

2019

Iran's international collaborative articles in medical sciences

Rezaei H., Yousefi A., Larijani B., Dehnavieh R., Rezaei N., Kazemi M., Adibi P.

INTRODUCTION: Despite all efforts that have been made to promote professional behavior among medical trainees, unfortunately, reports from medical schools around the world confirm the prevalence of nonprofessional behaviors by medical students. Experts in the field of medical ethics and medical education in different countries have suggested several reasons for failing to minimize unprofessional performance among medical students. MATERIALS AND METHODS: This qualitative study aimed to promote our understanding from the challenges faced by Iranian medical students in providing professional behavior. The study was first conducted in the form of a semi-structured face-to-face interview with medical students and then completed with a focus group discussion (FGD) session. Forty-nine medical students participated in the interviews and 11 students participated in the FGD session. Qualitative conventional content analysis was used for examining the data. RESULTS: The participants classified the obstacles of professional behavior into the following three main categories: problems related to educational system, problems related to the society, and problems related to students themselves. CONCLUSION: Regarding the impact of various personal, social, and educational factors on the creation and expansion of unprofessional behaviors among medical students, it is essential to have a comprehensive approach for solving the problem. © 2019 International Journal of Preventive Medicine.

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Journal of Education and Health Promotion

2019

Obstacles of professional behavior among medical trainees: A qualitative study from Iran (2018)

Yavari N., Asghari F., Shahvari Z., Nedjat S., Larijani B.

Background: Respecting patients' privacy is an essential professional responsibility for physicians and other health team members. In this regard, this study investigates medical students' knowledge and attitude about confidentiality and disclosure of patients' information. Methods: In this cross-sectional study, 160 medical students of Iran University of Medical Sciences participated who were selected using stratified random sampling. Data were gathered using a valid and reliable self-report questionnaire. Student's knowledge and attitude toward medical confidentiality were assessed using self-administered and researcher-made questionnaires. Cronbach's alpha coefficients for knowledge and attitude levels were 79.7 and 82.2, respectively. Results: The average of medical students' responses to knowledge and attitude questions were 56.6% (9.6/ 17) and 55.3% (9.4 out of 17), respectively. On average, females had an acceptable attitude about 57.5% of the questions, whereas this was 50.9% for males. On average, females had an acceptable knowledge about 59.5% of the questions, whereas this was 50.6% for males. Therefore, female's attitudes and knowledge were more correct than their male counterparts (p < 0.001). Conclusion: The low level of knowledge and attitude of medical students towards medical confidentiality indicates that revision of Iranian medical education curriculum to reinforce attention and knowledge of medical students on this issue to render appropriate care to patients is a necessity. Medical students' knowledge and attitude towards patient's confidentiality rights is not fulfilling. © Iran University of Medical Sciences.

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Medical Journal of the Islamic Republic of Iran

2019

Patient privacy: Awareness and attitudes of Iran University of Medical Sciences medical students

Hosseini-Ghavam-Abad L., Asghari F., Bandehagh A., Najafipour S., Bigdeli S.

Background: Zika virus infection has recently attracted the attention of medical community. While clinical manifestations of the infection in adult cases are not severe and disease is not associated with high mortality rates, Zika virus infection can have an impact on fetal development and lead to severe neurodevelopmental abnormalities.Methods: To gain insight into different aspects of Zika virus infection, a comprehensive literature review was performed. With regard to epidemiology and geographical distribution of Zika virus infection, relevant information was extracted from CDC and WHO websites.Results: In this review, we discuss different basic and clinical aspects of Zika virus infection including virology, epidemiology and pathogenesis of disease. Laboratory methods required for the diagnosis of disease together with ethical issues associated with Zika virus infection will also be discussed in detail.Conclusion: Herein, we have tried to provide a multi-faceted view of Zika virus infection, with greater emphasis on disease status in Eastern Mediterranean Region.

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IRANIAN JOURNAL OF PUBLIC HEALTH

2019

Zika Virus Infection, Basic and Clinical Aspects: A Review Article

Noorbakhsh, Farshid; Abdolmohammadi, Kamal; Fatahi, Yousef; Dalili, Hossein; Rasoolinejad, Mehrnaz; Rezaei, Farshid; Salehi-Vaziri, Mostafa; Shafiei-Jandaghi, Nazanin Zahra; Gooshki, Ehsan Shamsi; Zaim, Morteza; Nicknam, Mohammad Hossein

Background: Considering that medical ethics is an applied subject providing systematic solutions to help physicians with moral issues, this research aimed to evaluate adherence to the principles of medical ethics among physicians on the basis of attitude of physicians of Mazandaran province. Methods: This cross-sectional study was conducted in Mazandaran province, Iran during 2015. A researcher-made questionnaire was used for data collection. The questionnaire was first completed by 40 physicians and its reliability was confirmed by obtaining a Cronbach’s alpha coefficient equal to 0.818. Its validity was confirmed by medical ethics experts. Therefore, the questionnaire was reliable and valid. Analytical and descriptive analysis were performed. Results: According to our findings, there is a significant correlation between some of variables of medical ethics principles. The results show that adherence to indicators of beneficence, non-maleficence and justice has been almost good; however, physicians’ ethical behaviors which pertain towards the principle of autonomy have not been acceptable. There was not any significant difference in adherence to the principles of autonomy, beneficence and non-maleficence, and justice on the basis of sex, residency, education and occupation. Conclusion: According to the present study, more training is required to improve physicians’ adherence to the principles of medical ethics‎. © 2018 The Author(s).

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Archives of Iranian Medicine

2018

Adherence to principles of medical ethics among physicians in mazandaran province, iran

Ghaderi A., Malek F., Mohammadi M., Maskopaii S.R., Hamta A., Madani S.A.

The "dead-donor rule" states that, in any case of vital organ donation, the potential donor should be determined to be dead before transplantation occurs. In many countries around the world, neurological criteria can be used to legally determine death (also referred to as brain death). Nevertheless, there is considerable controversy in the bioethics literature over whether brain death is the equivalent of biological death. This international legal review demonstrates that there is considerable variability in how different jurisdictions have evolved to justify the legal status of brain death and its relationship to the dead-donor rule. In this article, we chose to review approaches that are representative of many different jurisdictions-the United States takes an approach similar to that of many European countries; the United Kingdom's approach is followed by Canada, India, and influences many other Commonwealth countries; Islamic jurisprudence is applicable to several different national laws; the Israeli approach is similar to many Western countries, but incorporates noteworthy modifications; and Japan's relatively idiosyncratic approach has received some attention in the literature. Illuminating these different justifications may help develop respectful policies regarding organ donation within countries with diverse populations and allow for more informed debate about brain death and the dead-donor rule. © 2018 by The Journal of Clinical Ethics. All rights reserved.

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Journal of Clinical Ethics

2018

An international legal review of the relationship between brain death and organ transplantation

Aramesh K., Arima H., Gardiner D., Shah S.K.

Nowadays pharmacists should be involved in patients care and providing pharmaceutical care more than before, but still there is a gap between standard of care and pharmacy practice in pharmacies. In this study we aimed at evaluating the pharmacists experiences and attitudes about ethical professional practice in pharmacies. The study was conducted in the Tehran University of Medical Sciences, Tehran, Iran. This study performed as a mixed method study including 12 semi-structured interviews and two focus group discussions (FGDs). All interviews and FGDs were recorded verbatim. The study evaluates the pharmacy practice based on the Code of Ethics for National Pharmaceutical System requirements. Our study presents the pharmacists ethical challenges in 14 areas of practice such as lack of proper pharmacists-patients and inter and intra-professional relationship; poor management of medication error; lack of pharmacists awareness about their responsibilities, professional rules and regulations; non-OTC drug dispensing without prescription; no collaboration with custodian organizations; dissatisfaction from profession; financial problems; mismanagement in confronting with ads and offers of pharmaceutical companies, and conflict of interest; and uneven drug distribution during shortage. For providing standard pharmaceutical care modification of infra structures, educational system and regulations in pharmaceutical system is highly recommended. © 2018 by School of Pharmacy.

Special Issue

17

Iranian Journal of Pharmaceutical Research

2018

Assessment of pharmacists experiences and attitudes toward professionalism and its challenges in pharmacy practice

Javadi M., Ashrafi N., Salari P.

Background: Respecting patients confidentiality and privacy are considered as the patients’ rights. Confidentiality is the key virtue for trust building in physician-patient relationship. While law considers confidentiality as absolute except for legal situations, despite efforts to maintaining confidentiality, sometimes breaching confidentiality is unavoidable but not necessarily unethical. There is no Iranian unified ethical guideline to define clear approaches to patient confidentiality in clinical setting. To keep all medical data confidential it is necessary to identify the scope of the problem. In this study, we aimed at identifying the scope of the problem. Methods: This study was conducted in three phases including literature review, qualitative study (semi-structured interview) and focus group discussion. The literature review provided a framework for the second phase. Results: The content analysis of the interviews presented 3 main themes indicating problems in maintaining confidentiality in clinical setting including management issues, organizational ethics and physician-patient relationship. Conclusion: Based on the results a draft guideline in confidentiality in clinical setting was prepared and finalized in focus groups discussions. © 2018, Iranian Journal of Public Health. All rights reserved.

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Iranian Journal of Public Health

2018

Challenges of confidentiality in clinical settings: Compilation of an ethical guideline

Noroozi M., Zahedi L., Bathaei F.S., Salari P.

Background: Assessment of ethical issues in sexual health research around the world shows that published studies are scattered and limited and cannot be used as reliable sources for other studies. Objectives: This qualitative study aimed to explore the challenging experiences of sexual health researchers in Iran. Methods: This study was conducted using a conventional qualitative content analysis method. Data were collected through in-depth individual interviews. The interviews were written and coded through conventional content analysis to form the initial categories. Results: Based on the data analysis, three main categories, seven subcategories, and 14 second subcategories were extracted. The main categories included: 1- challenges related to biomedical research ethics committees, 2- challenges of sexual health researchers, and 3- challenges related to sexual health topics. Conclusions: This study was carried out to provide a better understanding of the challenges of sexual health researchers in their studies. The importance of detecting these challenges empowered researchers to cope with the challenges during their study. Copyright 2018, Author(s).

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Iranian Journal of Psychiatry and Behavioral Sciences

2018

Challenges of researchers in performing sexual health research in Iran: A qualitative study

Shirmohammadi M., Shahriari M., Gooshki E.S., Kohan S.

Privacy and confidentiality are among the inalienable rights of every human being that contribute to preservation of a sense of reverence and dignity. The present study was conducted to examine patients’ awareness of their entitlement to these important rights. This cross-sectional study was conducted on 200 patients in Tehran, Iran during the year 2010. Collected data included patients’ demographics (age, gender, marital status, place of residence, and educational level), type of hospital ward, frequency of hospitalization, duration of hospital stay, and patients’ awareness of privacy and confidentiality. Two trained interviewers gathered the data using a self-made questionnaire, which was specifically designed to assess patients’ awareness of privacy and confidentiality. Validity and reliability of the questionnaire were determined using content validity and Cronbach’s Coefficient Alpha (a = 0.7), respectively. To analyze data, patients were assigned to three categories of poor (0 ≤ scores ≤ 3), moderate (4 ≤ scores ≤ 7) and good (8 ≤ scores ≤ 10) levels of awareness. Statistical analysis was performed by SPSS software version 21. The results showed that 21% of the patients had poor, 72% moderate, and 7% good awareness of privacy and confidentiality, with a mean of 4.61 ± 1.63. In this study, 153 patients (76.5%) provided a correct definition of privacy, and 161 patients (80.5%) were aware of instances of privacy violation. In addition, a good level of awareness was found in 77 patients (38.5%) in terms of physician confidentiality, and in 158 patients (81.4%) regarding confidentiality of examination results and medical consultations. Our study results highlight the necessity to inform patients about the ethical and legal issues related to privacy and confidentiality, before or during admission. © 2018 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved.

11

Journal of Medical Ethics and History of Medicine

2018

Do patients know that physicians should be confidential? A study on patients’ awareness of privacy and confidentiality

Mohammadi M., Larijani B., Razavi S.H.E., Fotouhi A., Ghaderi A., Madani S.J., Shafiee M.N.

Background: Industrialization could bring risk of Technological Disaster (TD) such as happened in Chernobyl, Bhopal and Fukushima crisis. Little has been discussed about its related ethical issues. In this study, we aimed to investigate ethical issues have been stated for technological disasters.Methods: A systematic search was conducted on the main international literature databases including Pubmed, Embase, Scopus and ISI (Jan 1, 2000 to Jan 1, 2018). From 64articles were eligible for investigation of ethical issues in Natural disaster, 6 was related to Technological Disaster. The articles were in English language.Results: Our result show that there are seven articles discussing ethical issues during Technological disaster. All of them are related to nuclear crisis in Fukushima resulting from Japan tsunami 2011. These articles discussed mainly three ethical issues in providing medical care to victims of Technological Disasters as follow: 1-Duty of care 2-Mandatory evacuationand3-Resource Allocation.Conclusion: Victim health is the main factor for making decision and implementation of any programs during response to disasters. Mandatory Evacuation for reasons other than providing health to people (such as: maintain public order) and if bring health risk to people will be unjustified. Duty of health workers for providing care is based on General beneficence meanwhile it is necessary to provide facilities to protect them from dangers that treat them in the field. For act ethically, Health workers must have adequate preparedness for response to T-D meanwhile it is necessary to provide guidelines for individuals that participation in relief operation. It is necessary to discuss more about Technological Disaster Ethics especially in industrial countries and where there is especial industrial with potential of huge crises.Level of evidence: I

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6

ARCHIVES OF BONE AND JOINT SURGERY-ABJS

2018

Ethical Issues in Technological Disaster: A Systematic Review of Literature

Khaji, Ali; Larijani, Bagher; Ghodsi, Seyed Mohammad; Mohagheghi, Mohammad A.; Khankeh, Hammid R.; Saadat, Soheil; Tabatabaei, Seyed Mahmoud; Khorasani-Zavareh, Davoud

Scientists and researchers have examined spiritual health from different angles and proposed various definitions, but a comprehensive definition does not exist for the term as of now. The present study aimed to offer the definition, components and indicators of spiritual health from experts' perspective.This qualitative study utilized conventional content analysis and individual in-depth interviews with 22 experts in the area of spiritual health in various fields selected through purposeful sampling. Member check, credibility, reliability, transferability and allocation of adequate time for data collection were measured to increase the validity and reliability of the results.Conventional content analysis was performed in three main phases: preparation, organization and reporting, and the categories, subcategories and codes emerged accordingly.Participants defined spiritual health in three dimensions: religious, individualistic, and material world-oriented. The study revealed four types of connection in spiritual health: human connection with God, himself, others and the nature. The majority of participants stated that spiritual health and spirituality were different, and pointed out the following characteristics for spiritual health: it affects physical, mental, and social health; it dominates other aspects of health; there are religious and existential approaches to spiritual health; it is perceptible in people's behavior; and it can be enhanced and improved. Most experts recognized human connection with God as the most important part of the definition of spiritual health. In conclusion, the connection between humans and themselves, others and the nature was not seen as a component specific to spiritual health.

11

JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2018

Explanatory definition of the concept of spiritual health: a qualitative study in Iran

Ghaderi, Ahmad; Tabatabaei, Seyed Mahmoud; Nedjat, Saharnaz; Javadi, Mohsen; Larijani, Bagher

Objective To evaluate the knowledge and performance of surgical residents regarding the person from whom informed consent should be taken for surgery and from whom the consent is taken in practice.Materials and methods This study was done in 2013. The population of this study was all residents of urology, surgery, orthopaedic surgery and gynaecology of Tehran and Iran University of Medical Sciences. The study tool was a self-administered questionnaire, containing questions on their knowledge and performance regarding informed consent acquisition from patients with different conditions in terms of age, sex, marital status and their capacity to make treatment decisions.Results A total of 213 residents participated in the study (response rate=51.9%). The mean score of the participants' knowledge was 72.95 out of 100. There was no significant correlation between the residents' knowledge and performance. Regarding a competent married male patient, 98.2% of the residents knew that the person's consent was enough, but only 63.6% obtained informed consent only from the patient. These percentages were 69% and 19.7% for a competent married female patient, respectively. For a competent single male patient, 90.9% of the residents were aware that the patient's consent was enough, while only 40% of the residents obtained informed consent only from the patient. These percentages were 65.3% and 16% for a competent single female patient, respectively.Conclusion Despite the residents' average knowledge of patient autonomy, this right is not observed for female patients, and their treatment is subject to consent acquisition from other family members.

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44

JOURNAL OF MEDICAL ETHICS

2018

From whom do physicians obtain consent for surgery?

Jarayedi, Zahra; Asghari, Fariba

Islamic and non-religious ethics discourses have similarities and differences at the levels of meta-, normative, and applied ethics (e.g. biomedical ethics). Mainstream biomedical ethics (MBME) uses the language of contemporary, non-religious, Western ethics. Significant effort has been dedicated to comparing Islamic biomedical ethics (IBME) and MBME in terms of meta-and normative ethical positions, and final decisions on practical ethical issues have been reached. However, less attention has been given to comparing the general approaches of the two aforementioned discourses to ethical reasoning. Furthermore, IBME uses different languages to approach ethical reasoning, but identification and conceptualization of these approaches are among the important gaps in the literature. The aim of this study was to conceptualize general approaches to ethical reasoning in IBME. Through review and content analysis of the existing literature and the comparison between the languages employed by IBME and MBME, an inductive distinction have been made. The languages used in conceptualized approaches include the followings: (i) a language in common with the one employed by MBME; (ii) MBME language adjusted to the basic, common beliefs of Muslims; (iii) a language based on fatwas; and (iv) a language based on IBME principles. In the authors' opinion, major challenges of the above-mentioned four approaches include, respectively: identifying the lack of religious sensitivity or Islamic considerations regarding an issue; acknowledging specific beliefs as the basic, common beliefs of Muslims; diverse fatwas and relations between juridical soundness and ethical soundness; and agreement on the same principles and rules as well as who should apply them.

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JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2018

General approaches to ethical reasoning in Islamic biomedical ethics discourse

Moosapour, Hamideh; Mashayekhi, Jannat; Zahedi, Farzaneh; Soltani, Akbar; Larijani, Bagher

Part one of the present study presented practical Islamic jurisprudential rules and investigated their application to performing medical procedures on nearly dead patients. It was contended that a dying patient could be used in medical education in cases where there is no alternative method, provided the patient voluntarily consents and is not offended. Part two of the present study addresses the issue by referring to the opinions of Islamic jurisprudents to find an appropriate solution to a challenging question in medicine, namely, whether clinical training of medical students on the dying person is permissible. For this purpose, istiftas (petitions or requests for a fatwa) were sent to prominent contemporary Shiite jurisprudents to solicit their opinions on the use of dying patients for medical education. After exploring the existing views, it was finally concluded that the majority of the jurisprudents allowed the practice in cases of "necessity" and provided that the principles of "no harm" and "consent" were strictly observed. All these terms are found in jurisprudential rules, and we reached the conclusion that Shiite jurisprudents considered this type of training permissible under certain circumstances and in accordance with jurisprudential rules.

11

JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2018

Islamic jurisprudential and ethical considerations of practicing medical procedures on nearly dead patients: Part II (Shiite jurisprudents' viewpoints)

Ghasemzadeh, Nazafarin; Asghari, Fariba; Shirazi, Mandana; Razini, Fatemeh Faramarzi; Larijani, Bagher

Part one of the present study presented practical Islamic jurisprudential rules and investigated their application to performing medical procedures on nearly dead patients. It was contended that a dying patient could be used in medical education in cases where there is no alternative method, provided the patient voluntarily consents and is not offended. Part two of the present study addresses the issue by referring to the opinions of Islamic jurisprudents to find an appropriate solution to a challenging question in medicine, namely, whether clinical training of medical students on the dying person is permissible. For this purpose, istiftas (petitions or requests for a fatwa) were sent to prominent contemporary Shiite jurisprudents to solicit their opinions on the use of dying patients for medical education. After exploring the existing views, it was finally concluded that the majority of the jurisprudents allowed the practice in cases of “necessity” and provided that the principles of “no harm” and “consent” were strictly observed. All these terms are found in jurisprudential rules, and we reached the conclusion that Shiite jurisprudents considered this type of training permissible under certain circumstances and in accordance with jurisprudential rules. © 2018 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved.

11

Journal of Medical Ethics and History of Medicine

2018

Islamic jurisprudential and ethical considerations of practicing medical procedures on nearly dead patients: Part II (shiite jurisprudents’ viewpoints)

Ghasemzadeh N., Asghari F., Shirazi M., Razini F.F., Larijani B.

End-of-life care and protection of the patient in the near-death moments are part of a patient's rights and the duties of the medical staff. As the beginning and end of human life are most sensitive moments, there are various religious rules associated with them. The ethical issues regarding practicing medical procedures on nearly dead patients are of particular complexity and are consistent with invaluable and profoundly religious recommendations. In addition, the purpose of medical training is to provide physicians with the knowledge and skills necessary to practice appropriately and within legal and ethical frameworks. Therefore, respecting patients' cultural and religious beliefs is an ethically accepted principle in the health systems of different countries and is the basis of respect for human dignity. The present study used a qualitative content analysis to explain how to practice medical procedures on a dying or nearly dead patient in accordance with Islamic jurisprudential rules. It was finally concluded that according to the Islamic jurisprudential rules of "authority", "no harm", "necessity", and "public interest", procedures performed on a dying patient could be used for training purposes under certain circumstances. Nevertheless, such activities should only be done with the patient's permission and provided they cause no unnecessary harassment, and they may take place in the absence of alternative methods.

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JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2018

Islamic jurisprudential and ethical considerations of practicing medical procedures on nearly dead patients; Part I- the theoretical section

Ghasemzadeh, Nazafarin; Asghari, Fariba; Shirazi, Mandana; Razini, Fatemeh Faramarzi; Larijani, Bagher

Ethics is an essential element in the provision of healthcare services. Fundamental ethical values determine the manner in which the professional behavior is implemented in the healthcare area. These ethical principles find meaning in time and place and in the social context of ethical values and among children as vulnerable groups. So, this study examined the ethical principles of providing health care services for children and barriers to their application in Iran from key informants’ perspective. Therefore, qualitative content analysis method was used by means of semi-structured questionnaire to theoretical saturation scale with the participation of 20 key informants. Each interview underwent the process of implementation, evaluation, coding, and analysis, and then its findings were presented in two dimensions: desirable principles and barriers for its application, including 15 classes. Desirable principles include autonomy, beneficence, non-maleficence, justice, confidentiality, accent, consent, and participation. Obstacles to their compliance also included weakness of the policy landscape, weakness of the judicial system, cultural conservatism, socio-economic inequality, services commodification with unequal distribution, resource mismanagement (limitation), weakness of the professional education system, and the emergence of complex situations. From the key informants’ point of view, codes of ethics do not differ significantly from international principles, but their application is faced with difficulties, and they are likely to be improved through evidence-based policies according to the results of scientific studies. © 2018 Tehran University of Medical Sciences.

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56

Acta Medica Iranica

2018

Provision of healthcare services for children in Iran: Common ethical principles and obstacles to successful implementation

Bathaie F.S., Ardeshir Larijani B., Farzadfar F., Nedjat S., Emami-Razavi S.H., Kadivar M., Anaraki F.Z., Zinati P., Roshanfekr P., Olyaeimanesh A., Nezamoleslami D.

Awareness of the occurrence of medical errors is the right of patients and duty of the health service providers. This study was conducted to evaluate to what extent people want to know the occurrence of an error in their medical care, what they expect to be disclosed about medical error, and what are the influential factors in filing a lawsuit against physicians in disclosed medical errors from their point of view.In this cross-sectional survey, 1062 people residing in the city of Qom, Iran, were telephone interviewed using the random digit dialing method. The questionnaire used consisted of 4 demographic questions and 2 scenarios of major and minor medical error; the participants were asked if the physician should disclose the error in each scenario. The questionnaire also consisted of 16 questions about other issues related to error disclosure. Data were analyzed through descriptive and inferential statistics in SPSS software.About 99.1% of the study population believed that errors had to be disclosed to patients. They all wished to know that measures would be taken to prevent further errors. Moreover, 93.1% of the participants expected an explanation on the incident. As for the factors that decreased the likelihood of taking legal action against the physician from the viewpoint of the study population, treatment of the complications (96.1%) and honesty of the physician (95.8%) had the highest frequency.Based on the considerable preference of patients for error disclosure, it is recommended that physicians disclose all minor and major errors sympathetically and with transparency, honesty, and efforts to prevent future errors.

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JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2018

Public preferences and attitudes towards the disclosure of medical errors: a survey in Iran

Heidari, Akram; Razaghi, Masoomeh; Asghari, Fariba

The recent efforts for revitalizing traditional Iranian medicine (TIM) have shaped two main streams: The quackery traditional iranian medicine (QTIM) and the academic traditional iranian medicine (ATIM). The QTIM encompasses a wide range of practitioners with various backgrounds who work outside the academic arena and mostly address the public. These practitioners have no solid bases or limited boundaries for their claims. Instead, they rely on making misleading references to the Holy Islamic Scriptures, inducing false hope, claiming miraculous results, appealing to the conspiracy theories, and taking advantage of the public resentment toward some groups of unprofessional healthcare providers. The theories and practices of ATIM, however, can be categorized into two major categories: First, valid and scientific TIM that is aimed to conduct well-designed clinical trials and thereby, supply the evidence-based medicine with new treatments originated in or inspired by TIM. Second, a pseudoscientific part of the current TIM that is based on some obsolete medical theories, especially the medieval humoral medicine, and erroneous accounts of human anatomy, physiology, and physiopathology, mostly adopted from the ancient and medieval medical scripts. TIM has recently established some clinical centers for practicing humoral medicine that is partly pseudoscientific and involves significant risks. This paper suggests that the public health sector has a duty to act against the promulgation of medical superstitions by QTIM and the pseudoscientific medical practices of ATIM, and at the same time, support and promote the valid and potentially beneficial research pursued by ATIM aimed to explore the rich recourses of TIM and thereby enrich the evidence-based medicine.

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21

ARCHIVES OF IRANIAN MEDICINE

2018

Science and Pseudoscience in Traditional Iranian Medicine

Aramesh, Kiarash

According to Shiite perspective, the relative inviolability of the human embryo starts at the time of implantation and attains complete ethical status at ensoulment. Different paradigms of embryology have been influential on the understanding of Shiite jurists of the relevant Qur'anic verses. This paper provides a critical review of the process of issuing religious decrees on issues related to the early human life and concludes that Shiite jurisprudence needs to obtain consistency in its adopted account of embryology and adopt a proactive approach toward the bioethical new-emerging issues.

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57

JOURNAL OF RELIGION & HEALTH

2018

Shiite Perspective on the Moral Status of the Early Human Embryo: A Critical Review

Aramesh, Kiarash

[No abstract available]

11

Journal of Medical Ethics and History of Medicine

2018

Training professionalism trainers

Alipour, Fateme; Asghari, Fariba; Amini, Homayoun

Background: Humans have made various efforts to overcome infertility since ancient times. One of the modern assisted reproductive techniques is surrogacy which in this way; a woman agrees to become pregnant and carry a baby for another couple and give them the resulting offspring after birth so that they take paternal and maternal responsibility. The content of the contracts between the owner of the uterus and the applying couples is delivery of the baby to the intended couples that is usually determined by indicating the time “immediately after birth” or “as soon as birth” or “upon birth” when the nutritional status of the child by breastfeeding is not determined and even in other articles it has not even been considered. In Iran, according to the articles of the written surrogacy contract, surrogate has to deliver the baby to the intended couples immediately after birth, too. Therefore breastfeeding of newborn infant has been missed in surrogacy agreement. Objectives: In this study, we have attempted to defend the right to be breast-fed for the child of surrogacy and the right of the breast-feeding for the surrogate mother as rights that make others obligation in Iran. In addition, we propose an altruistic way and the acceptance of two motherly perspectives in surrogacy for the realization of this right. Methods: This study is a theoretical, review, library and content analysis study. First, a combination of key words such as Surrogacy Act, Ethics, Surrogacy Arrangement, andBreastfeedingwassearched in the valid databases. Dueto lack of thethemeof breastfeeding in surrogacy contracts, in the second part of the study, the importance of breast milk was investigated from the medical and Islamic perspectives by searching keywords in medical database, verses of Quran and valid juridical sources and the related extracted information were categorized and their content was analyzed. Then, the right to breastfeed the baby in surrogacy was examined from the rights perspective and how to exercise this right. Results: Consideration of the importance of breastfeeding from the medical, Islamic points of view and legal perspective, breastfeeding is recognized as a right of newborn and mother’s right or obligation. Surrogacy develops a mother-child relationship and is therefore liable to mother and child benefits. On the other hand, the breastfeeding right is not mentioned explicitly in surrogacy contract and this right has been missed. Conclusions: It is suggested that in surrogacy both the intended parentsandtheownerof thewombbe provided with the necessary information about the advantages of the breast milk for the child and for the mother at the time of consulting before signing the contract. In addition, the breastfeeding right should be given to the surrogate mother and it should be stated that this right is not considered as the custody right. © 2017, Iranian Journal of Pediatrics.

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27

Iranian Journal of Pediatrics

2017

Breast milk as the forgotten ethical right in surrogacy and suggestions for its recognition: Islamic perspective, Iranian experience

Ghasemzadeh N., Salehi S.-M., Faramarzi-Razini F.

The central role of the virtue of compassion in the shaping of the professional character of healthcare providers is a well-emphasized fact. On the other hand, the utmost obligation of physicians is to alleviate or eliminate human suffering. Traditionally, according to the Aristotelian understanding of virtues and virtue ethics, human virtues have been associated with masculinity. In recent decades, the founders of the ethics of care have introduced a set of virtues with feminine nature. This paper analyzes the notion of compassion as a common virtue between the traditional/masculine and care/feminine sets of virtues and shows that compassion is a reunion and merging point of both sets of human virtues. This role can be actualized through the development and promotion of compassion as an important part of the character of an ideal physician/healthcare provider. In addition, this paper argues that the notion of compassion can shed light on some important aspects of the contemporary debates on healthcare provider-patient relationship and medical futility. Despite the recent technological and scientific transformations in medicine, the interpersonal relationship between healthcare providers and patients still plays a vital role in pursuing the goals of healthcare. The virtue of compassion plays a central role in the establishment of a trust-based physician-patient relationship. This central role is discernible in the debate of medical futility in which making difficult decisions, depends largely on trust and rapport which are achievable by compassion in the physician and the recognition of this compassion by the patients and their surrogate decision makers. © 2017 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved.

10

Journal of Medical Ethics and History of Medicine

2017

Compassion as the Reunion of feminine and masculine virtues in medicine

Aramesh K.

Consanguineous marriage, which is common in many regions in the world, has absorbed much attention as a causative factor in raising the incidence of genetic diseases. The adverse effects may be attributed to the expression of the genes received from common ancestors and mortality and morbidity of the offspring. Iran has a high rate of consanguineous marriages. In recent years genetic counseling has come to be considered in health care services. This cross-sectional study was conducted in order to determine the prevalence and types of consanguineous marriages in the genetic clinics in Isfahan. We aimed to define the different types of marriages, specific categories of genetic disorders associated with consanguineous marriages, and mode of inheritance in the family tree. We also narratively reviewed the ethical aspects of the issue. The data were collected using a simple questionnaire. A total number of 1535 couples from urban and rural areas formed the study population. The marriages were classified according to the degree of the relationship between couples, including: double cousin, first cousin, first cousin once removed, second cousin and beyond second cousin. The SPSS software version 16 was used for data analysis. Data obtained through genetic counseling offered during a 5-year period revealed that 74.3% had consanguineous relationships, 62.3% were first cousins, 1% were double cousins and 7.8% were second cousins. In addition, 76% of the couples had at least one genetic disease in their family tree. Related ethical issues were also considered in this study, including autonomy and informed decision making, benefit and harm assessment, confidentiality, ethics in research, justice in access to counseling services, financial problems ethics, and the intellectual property of scientific success. © 2017 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved.

10

Journal of Medical Ethics and History of Medicine

2017

Consanguineous marriages in the genetic counseling centers of isfahan and the ethical issues of clinical consultations

Nouri N., Nouri N., Tirgar S., Soleimani E., Yazdani V., Zahedi F., Larijani B.

Introduction: Professional behavior is first learned at the university. One of the necessary considerations in maintaining the professional environment of the university is establishing a set of codes for the behavior of physicians and medical students. This paper describes the process of developing the professional code of conduct in Tehran University of Medical Sciences, Tehran, Iran. Methods: A review of Iranian and international literature was performed to develop the first draft of the guideline. In sessions of group discussion by the authors, the articles of the draft were evaluated for relevancy, clarity, and lack of repetition. The draft was sent for evaluation to all participants, including the medical faculty members, residents, and medical students, four times and necessary corrections were made according to the comments received. Results: The final guideline included 76 behavior codes in 6 categories, including altruism, honor and integrity, responsibility, respect, justice, and excellence. The codes of the guideline cover the physicians’ commitments in the physician-patient, physician-colleague, and instructor-student relationships in orderto improve the quality ofthe services. Conclusion: The Islamic and Iranian culture were taken into consideration in developing the guideline. Accordance with the administrative and educational conditions of the universities was ensured in developing the guideline and its acceptance was ensured through extensive surveys. Thus, it is expected that this guideline will be very effective in enhancing professional commitment in medical universities. © 2017, Academy of Medical Sciences of I.R. Iran. All rights reserved.

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20

Archives of Iranian Medicine

2017

Development of the first guideline for professional conduct in medical practice in Iran

Saeedi Tehrani S., Nayeri F., Parsapoor A., Jafarian A., Labaf A., Mirzazadeh A., Emadi Kouchak H., Shahi F., Ghasemzadeh N., Asghari F.

During medical training, students obtain enough skills and knowledge. However, medical ethics accomplishes its goals when, together with training medical courses, it guides students behavior towards morality so that ethics-oriented medical practice is internalized. Medical ethics is a branch of applied ethics which tries to introduce ethics into physicians’ practice and ethical decisions; thus, it necessitates the behavior to be ethical. Therefore, when students are being trained, they need to be supplied with those guidelines which turn ethical instructions into practice to the extent possible. The current text discusses the narrowing of the gap between ethical theory and practice, especially in the field of medical education. The current study was composed using analytical review procedures. Thus, classical ethics philosophy, psychology books, and related articles were used to select the relevant pieces of information about internalizing behavior and medical education. The aim of the present study was to propose a theory by analyzing the related articles and books. The attempt to fill the gap between medical theory and practice using external factors such as law has been faced with a great deal of limitations. Accordingly, the present article tries to investigate how and why medical training must take internalizing ethical instructions into consideration, and indicate the importance of influential internal factors. Virtue-centered education, education of moral emotions, changing and strengthening of attitudes through education, and the wise use of administrative regulations can be an effective way of teaching ethical practice in medicine. © 2017 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved.

10

Journal of Medical Ethics and History of Medicine

2017

Establishment of medical education upon internalization of virtue ethics: Bridging the gap between theory and practice

Madani M., Larijani B., Madani E., Ghasemzadeh N.

Since patient safety is multidimensional and grounded in ethical and legal imperatives, both ethical and legal challenges should be taken into account. In this regard, a falling incident case of a 12-day-old newborn was raised in the monthly ethics round in the Children’s Medical Center of Tehran University of Medical Sciences, Iran, and the ethical and legal dimensions of patient safety were discussed by experts in various fields. This report presents different aspects of patient safety in terms of root cause analysis (RCA) and risk management, the role of human resources, the role of professionalism, the necessity of informing the parents (disclosure of medical errors), and forensic medicine with focus on ethical aspects. © 2017 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences.

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Journal of Medical Ethics and History of Medicine

2017

Ethical and legal aspects of patient’s safety: A clinical case report

Kadivar M., Manookian A., Asghari F., Niknafs N., Okazi A., Zarvani A.

More than a decade ago, personalized medicine was presented in modern medicine. Personalized medicine means that the right drug should be prescribed for the right patient based on genetic data. No doubt is developing medical sciences, and its shift into personalized medicine complicates ethical challenges more than before. In this review, we categorized all probable ethical considerations of personalized medicine in research and development and service provision. Based on our review, extensive changes in healthcare system including ethical changes are needed to overcome the ethical obstacles including knowledge gap and informed consent, privacy and confidentiality and availability of healthcare services. Furthermore social benefit versus science development and individual benefit should be balanced. Therefore guidelines and regulations should be compiled to represent the ethical framework; also ethical decision making should be day-to-day and individualized. © 2017 Tehran University of Medical Sciences. All rights reserved.

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55

Acta Medica Iranica

2017

Ethical issues surrounding personalized medicine: A literature review

Salari P., Larijani B.

Introduction: Recent advances in pharmacy practice have created serious ethical challenges for the pharmacists. Pursuing a new philosophy of practice is required to overcome these challenges and optimize the standard of care. In this regard, the current ethics guideline in the Pharmacy curriculum used in Tehran University of Medical Sciences, does not provide a fully comprehensive understanding of the issue. Therefore, the aim of the present study was to revise the current curriculum based on a needs assessment study.Methods: In this study, a two-part questionnaire was presented to pharmacists to obtain their views on the importance of topics in their daily routine practice. Part one of the questionnaire consisted of demographic data and part two of 23 topics in pharmacy ethics.Results: Out of a total of 200 questionnaires, 158 questionnaires were returned. We reached consensus on 24 topics, of which 8 topics gained a score of higher than 4 (the highest score was considered to be 5) and the rest obtained a score of 3 and higher. The highest score pertained to the pharmacists' relationship with patients, awareness of the rules and regulations, and medication error.Conclusion: Based on the results, a revised curriculum was designed for ethics in pharmacy. It seems that the designed curriculum is context-based and will develop appropriate educational material regarding pharmacists' requirements in daily practice. Consideration of interactive methods for teaching the curriculum is highly recommended.

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ARCHIVES OF IRANIAN MEDICINE

2017

Ethics in Pharmacy Curriculum for Undergraduate Pharmacy Students: A Needs Assessment Study

Salari, Pooneh; Abdollahi, Mohammad

Background: There is not a valid Persian tool for measuring the decision-making competency of patients. The aim of this study is to evaluate the face and content validity of the MacArthur Competence Assessment Tool for the treatment of Iranian Persian-speaking patients. Methods: To assess the validity of the Persian version of the tool, a self-administrated questionnaire was designed. The Lawshe method was also used for assessing each item. Content validity ratio (CVR) and content validity index (CVI) were used to assess the content validity quantitatively. According to the experts' judgment, questions with a CVR >= 0.62 and CVR <0.62 were maintainable and unmaintainable, respectively. Results: The questions were designed in a manner to achieve the desirable result (CVR >= 0.62). The CVI scale (S-CVI) and CVI (S-CVI/Ave) were 0.94 (higher than 0.79). Thus, the content validity was confirmed. Conclusions: Since capacity assessments are usually based on physician's subjective judgment, they are likely to bias and therefore, with this suitably validated tool, we can improve judgment of physicians and health-care providers in out-and in-patient cases.

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INTERNATIONAL JOURNAL OF PREVENTIVE MEDICINE

2017

Face and Content Validity of the MacArthur Competence Assessment Tool for the Treatment of Iranian Patients

Saber, Ali; Tabatabaei, Seyed Mahmoud; Akasheh, Godarz; Sehat, Mojtaba; Zanjani, Zahra; Larijani, Bagher

Background: Prevalence of osteoporosis is increasing both in developed and developing countries. Due to rapid growth in the burden and cost of osteoporosis, worldwide, it seems reasonable to focus on the reduction of fractures as the main goal of treatment. Although, efficient pharmacological agents are available for the treatment of osteoporosis, there still remains a need to more specific drugs with less adverse effects.Main body: This review article provides a brief update on the pathogenesis, presenting current pharmacological products approved by the US Food and Drug Administration (FDA) or Europe, and also newer therapeutic agents to treat osteoporosis according to the clinical trial data available at PubMed, UpToDate, International Osteoporosis Foundation (IOF), and clinical practice guidelines. As well, the effect of combination therapy and recommendations for future research will be further discussed.Short conclusion: The use of current antiresorptive and anabolic agents alone or in combinations for the treatment of osteoporosis entails several limitations. Mainly, their efficacy on non-vertebral fracture reduction is lower than that observed on vertebral fracture. In addition, they have potential adverse events on long time usage. Development of newer agents such as cathepsin k inhibitor and strontium ranelate not only have increased the available options for treating osteoporosis, but also have opened doors of opportunity to improvements in the effective treatment. However, the high cost of new agents have restricted their usage in selective patients who are at high risk of fracture or whom failed response to first line treatment options. Thus, personalized medicine should be considered for future evaluation of genetic risk score and also for environmental exposure assessment. In addition to permanent attention to early diagnosis of osteoporosis and understanding of the pathophysiology of osteoporosis for novel approach in drug discovery, there seems a need to more well-designed clinical trials with larger sample sizes and longer duration on current as well as on newer agents. Also, continuous research on plant-derived components as the source of discovering new agents, and conducting more clinical trials with combination of two or more synthetic drugs, plants, or drug-plant for the treatment of osteoporosis are recommended.

25

DARU-JOURNAL OF PHARMACEUTICAL SCIENCES

2017

New horizons in treatment of osteoporosis

Tabatabaei-Malazy, Ozra; Salari, Pooneh; Khashayar, Patricia; Larijani, Bagher

Objective: Acute brain injury is one of the leading causes of morbidity and mortality worldwide. Phenytoin has been commonly used as an anticonvulsant agent for the treatment or prophylaxis of seizures following acute brain injury. After a severe head injury, several pharmacokinetic changes occur. The aim of this study is the comparative evaluation of phenytoin serum concentration in patients with traumatic and nontraumatic brain injury (TBI). Methods: This prospective observational study was performed on twenty adult brain injury patients who were admitted to an Intensive Care Unit and required phenytoin for the treatment or prophylaxis of postinjury seizures. For all the patients, phenytoin serum concentration was determined in three scheduled time points. Phenytoin serum concentration and pharmacokinetic parameters were compared between patients with TBI and cerebrovascular accident (CVA). Findings: The V-max and K-m were significantly higher in head trauma (HT) patients than the CVA group. The phenytoin concentration (C-p) and the C-p/dose ratio were significantly higher in the CVA group patients during the first sampling (P < 0.05). The Acute Physiology and Chronic Health Evaluation. (APACHE.) score was significantly lower than the baseline at the end of the study in each group of patients (P < 0.05). In addition, no significant correlation was observed between V-max, K-m, C-p, C-p/dose ratio, and APACHE II scores at the time of sampling. Conclusion: Due to significant differences in phenytoin plasma concentration and pharmacokinetic parameters between HT and CVA patients, close attention must be paid to the pharmacokinetic behavior of phenytoin in the efforts to improve the patient's outcome after a severe HT.

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6

JOURNAL OF RESEARCH IN PHARMACY PRACTICE

2017

Pharmacokinetic Behavior of Phenytoin in Head Trauma and Cerebrovascular Accident Patients in an Iranian Population

Alimardani, Shahnaz; Sadrai, Sima; Masoumi, Hamidreza Taghvaye; Salari, Pooneh; Najafi, Atabak; Eftekhar, Behzad; Mojtahedzadeh, Mojtaba

Air pollution is among the environmental problems that adversely affect people's health. There is a close relationship between medicine and environment, and as a consequence, there are ethical considerations surrounding the problem of air pollution. The present research aimed to determine physicians' attitude toward their ethical responsibility regarding air pollution, and their role in reducing it. This was a qualitative research using content analysis, conducted in Tehran University of Medical Sciences. The focus group included 21 physicians with specialties and subspecialties in pediatrics, infectious diseases, pulmonology, gynecology, and midwifery selected through predetermined sampling along with 13 personal in-depth interviews. A number of questions were asked regarding physicians' ethical responsibility to decrease environmental crises, particularly air pollution.As a result, 4 themes and 20 subthemes were extracted by assessing the focus group and interviews. These four general themes included the role of a physician as 1) an ordinary person, 2) a special citizen and a role model, 3) a professional person with special personal and social commitments, and 4) an administrator of the healthcare system.In the present research, physicians acquired a special attitude toward air pollution. The research population mentioned physicians' impact as role models for the society, as well as their educational, supervisory, informative, promotional, and administrative roles among their most important obligations regarding air pollution. It is recommended to conduct further studies on physicians' knowledge, attitude and practice regarding their responsibility toward environmental issues in order to investigate this important matter further.

10

JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2017

Physicians' attitude toward their ethical responsibility regarding air pollution: a qualitative research

Saeeditehrani, Saeedeh; Parsapour, Alireza; Nedjat, Saharnaz; Kadivar, Maliheh; Larijani, Bagher

Background: Wth the development of neonatal intensive care units (NICUs), new issues have emerged for physicians working in this area, including the ethical aspects of providing invasive and advanced care to neonates with extremely poor prognosis. This research was undertaken with the aim of investing the factors affecting physicians' practice in management of newborns in such complicated circumstances.Methods: A cross-sectional study was carried out over a period of 5 months (Jan 2012 to Jun 2012) in 9 different tertiary levels and academic NICUs affiliated to Tehran University of Medical Sciences in Tehran, Iran. Checklists related to management of 3 hypothetical cases with very poor prognosis and factors affecting pertinent decisions were administered to 88 neonatologists and pediatricians.Results: Totally, 81.4% of participants approved the use of advanced invasive methods of treatment in the premature neonate. Concerning the neonate with genetic malformations, 51.3% recommended advanced methods. In severe asphyxia, 42.1% disagreed with use of advanced invasive procedures. Overall, 34.2% of the target physicians approved the use of aggressive procedures in all 3 cases. Age, gender, marital status, parental status, and work experience were identified as influencing factors.Conclusions: With the prediction of acceptable levels of survivability in very premature infants, physicians are more inclined to treat this group. However, they do not favor aggressive measures in infants with severe asphyxia and advanced anomalies.

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20

ARCHIVES OF IRANIAN MEDICINE

2017

Views and Decisions of Physicians in Encountering Neonates with Poor Prognosis

Nayeri, Fatemeh; Asghari, Fariba; Baser, Ali; Janani, Leila; Shariat, Mamak; Eabrhim, Bita

Background: This study was done to determine the prevalence of publication misconduct among Iranian authors. Methods: Data were collected through an email survey of corresponding authors of papers published in Iranian journals indexed in Scopus during 2009-2011. Using the double list experiment, these individuals were indirectly questioned about committing one of the five misconducts including duplicate publication, falsification, guest authorship, plagiarism, and fabrication over the past year. Results: The survey was sent to 2321 individuals; 100 emails bounced, and of the remaining, 813 (36.60%) people responded to the questions. The prevalence rates were 4.15% for fabrication, 4.90% for plagiarism, 18.10% for guest authorship, 12.65% for falsification of the study methods, and -5.40% for duplicate publication. Among respondent 56.50% trusted the method and confidentiality of the survey and 6.50% did not trust the method or confidentiality at all. Conclusion: We found that the double list experiment method is simple and reliable for use in the academic community, and it can be conducted easily in an e-survey. According to our results, the most common misconducts among Iranian authors are guest authorship and falsification of the methodology. In light of the negative and maleficent impact of publication misconduct in the scientific society, we recommend raising awareness and educating authors and investigators in this regard. To determine the accuracy of the method used in this study, further studies on publication misconduct using a control group and direct questioning, as well as other indirect methods are suggested. © 2016, Iranian Journal of Public Health. All rights reserved.

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45

Iranian Journal of Public Health

2016

Assessing the prevalence of publication misconduct among Iranian authors using a double list experiment

Hadji M., Asghari F., Yunesian M., Kabiri P., Fotouhi A.

Objectives: Due to the lack of a standard tool for assessing patients' capacity to consent to medical treatment in Iran, the present study was carried out aiming to devise a Persian version of a cross-cultural adaptation of the MacArthur competence assessment tool.Patients and Methods: By reviewing different methods of cultural translation and adaptation for assessment tools, and due to the lack of consensus on its processes, we selected Wild's model as one of the most comprehensive methods in this regard. Wild's (2005) 10-stage model includes preparation, forward translation, reconciliation of the forward translation, back translation of reconciliation, back translation review, cognitive debriefing and cognitive review, and finalization, proofreading and final reporting. Using this model, we translated the MacArthur assessment tool and made it adaptable to Iranian patients.Results: The MacArthur assessment tool is not dependent on any specific culture and language. As a result, if translation and its scientific adaptation are done based on an integrated and detailed model, the tool can be used for every culture and language. In other words, this tool is not culture-specific; so, it is applicable in cases where a translation is needed, and it can be culturally adapted to suit different societies.Conclusions: In the present study, we are able to focus on and prove the efficacy and benefits of this measurement tool.

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5

ARCHIVES OF TRAUMA RESEARCH

2016

Cross-Cultural Adaptations of the MacArthur Competence Assessment Tool for Treatment in Iran

Saber, Ali; Tabatabaei, Seyed Mahmoud; Akasheh, Goodarz; Sehat, Mojtaba; Zanjani, Zahra; Larijani, Bagher

Background: Professionalism is a core competency of physicians. This study was conducted to design a model for formative assessment of professional commitment in medical students according to stages of change theory. M ethods: In this qualitative study, data were collected through literature review & focus group interviews in the Tehran University of Medical Sciences in 2013 and analyzed using content analysis approach. Results: Review of the literature and results of focus group interviews led to design a formative assessment model of professional commitment in three phases, including pre-contemplation, contemplation, and readiness for behavior change that each one has interventional and assessment components. In the second phase of the study, experts' opinion collected in two main categories: the educational environment (factors related to students, students' assessment and educational program); and administrative problems (factors related to subcultures, policymakers or managers and budget). Moreover, there was a section of recommendations for each category related to curriculum, professors, students, assessments, making culture, the staff and reinforcing administrative factors. Conclusion: This type of framework analysis made it possible to develop a conceptual model that could be effective on forming the professional commitment and behavioral change in medical students.

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30

Medical Journal of the Islamic Republic of Iran

2016

Design of formative assessment model for professional behavior using stages of change theory

Hashemi A., Mirzazadeh A., Shirazi M., Asghari F.

Background: Dealing with ethical considerations is a major component of Health Technology Assessment (HTA) definitions. Objectives: Present study aimed to explore and describe the manner of ethical analyses in HTA reports and the effects it had on HTA-related decision making around the world. Methods: By considering the contextual milieu of reports and searching for ethical themes and subjects in HTA full reports, a descriptive analysis of HTA reports' contents and related processes was conducted. The review focused on all English HTA reports issued in a year. All ethical aspects, criteria, approaches, and also decision- making related ethical issues were described and summarized in retrieved reports. The inclusion of ethical aspects in final decision-making criteria of HTA reports was also considered. Results: Eighty-nine HTA reports issued in one year were included in this review and analyzed for ethical considerations. There was no trace of any ethical issues in 60.7% of retrieved HTA reports. Dimensions of equity in resource distribution, stakeholder engagement, social values, essence and nature of technology, and ethical issues about the method of assessment for decision making, and physician-patient relationship were raised and discussed in 38.2%, 3.4%, 3.4%, 3.4%, 34.8% and 3.4% of reports respectively. Those issues were also included in 44.1, 5.9, 2.9, 2.9, 0 and 2.9% of final reports, respectively. In overall, only in 16 cases (17.9%) of all 89 reports, ethical issues were included in HTA decision-making orientations. Conclusion: This review shows that ethical issues are occasionally raised and discussed in HTA reports. More importantly, the inclusion of ethical concerns as a decision criterion in HTAs is few and insufficient.

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30

Medical Journal of the Islamic Republic of Iran

2016

Do ethical considerations influence any in HTA reports? A review of reports

Moattar A.S., Asghari F., Majdzadeh R.

In the last few years, medical education policy makers have expressed concern about changes in the ethical attitude and behavior of medical trainees during the course of their education. They claim that newly graduated physicians (MDs) are entering residency years with inappropriate habits and attitudes earned during their education. This allegation has been supported by numerous research on the changes in the attitude and morality of medical trainees. The aim of this paper was to investigate ethical erosion among medical trainees as a serious universal problem, and to urge the authorities to take urgent preventive and corrective action. A comparison with the course of moral development in ordinary people from Kohlberg’s and Gilligan’s points of view reveals that the growth of ethical attitudes and behaviors in medical students is stunted or even degraded in many medical schools. In the end, the article examines the feasibility of teaching ethics in medical schools and the best approach for this purpose. It concludes that there is considerable controversy among ethicists on whether teaching ethical virtues is plausible at all. Virtue-based ethics, principle-based ethics and ethics of care are approaches that have been considered as most applicable in this regard. © 2016 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved.

9

Journal of Medical Ethics and History of Medicine

2016

Does medical education erode medical trainees’ ethical attitude and behavior?

Yavari N.

Background: Fee splitting is a process whereby a physician refers a patient to another physician or a healthcare facility and receives a portion of the charge in return. This survey was conducted to study general practitioners' (GPs) attitudes toward fee splitting as well as the prevalence, causes, and consequences of this process.Methods: This is a cross-sectional study on 223 general practitioners in 2013. Concerning the causes and consequences of fee splitting, an unpublished qualitative study was conducted by interviewing a number of GPs and specialists and the questionnaire options were the results of the information obtained from this study.Results: Of the total 320 GPs, 247 returned the questionnaires. The response rate was 77.18%. Of the 247 returned questionnaires, 223 fulfilled the inclusion criteria. Among the participants, 69.1% considered fee splitting completely wrong and 23.2% (frequently or rarely) practiced fee splitting. The present study showed that the prevalence of fee splitting among physicians who, had positive attitudes toward fee splitting was 4.63 times higher than those who had negative attitudes. In addition, this study showed that, compared to private hospitals, fee splitting is less practiced in public hospitals. The major cause of fee splitting was found to be unrealistic/unfair tariffs and the main consequence of fee stplitting was thought to be an increase in the number of unnecessary patient referrals.Conclusion: Fee splitting is an unethical act, contradicts the goals of the medical profession, and undermines patient's best interest. In Iran, there is no cdde of ethics on fee splitting, but in this study, it was found that the majority of GPs considered it unethical. However, among those who had negative attitudes toward fee splitting, there were physicians who did practice fee splitting. The results of the study showed that physicians who had a positive attitude toward fee splitting practiced it more than others. Therefore, if physicians consider fee splitting unethical, its rate will certainly decrease. The study claims that to decrease such practice, the healthcare system has to revise the tariffs.

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19

ARCHIVES OF IRANIAN MEDICINE

2016

Fee Splitting among General Practitioners: A Cross-Sectional Study in Iran

Parsa, Mojtaba; Larijani, Bagher; Aramesh, Kiarash; Nedjat, Saharnaz; Fotouhi, Akbar; Yekaninejad, Mir Saeed; Ebrahimian, Nejatollah; Kandi, Mohamad Jafar

In his seminal book on the historical periods of Western attitudes toward death, Philippe Aries describes four consecutive periods through which these attitudes evolved and transformed. According to him, the historical attitudes of Western cultures have passed through four major parts described above: "Tamed Death," One's Own Death," "Thy Death," and " Forbidden Death." This paper, after exploring this concept through the lens of Persian Poetic Wisdom, concludes that he historical attitudes of Persian-speaking people toward death have generally passed through two major periods. The first period is an amalgamation of Aries' "Tamed Death" and "One's Own Death" periods, and the second period is an amalgamation of Aries' " Thy Death" and "Forbidden Death" periods.This paper explores the main differences and similarities of these two historical trends through a comparative review of the consecutive historical periods of attitudes toward death between the Western and Persian civilizations/cultures. Although both civilizations moved through broadly similar stages, some influential contextual factors have been very influential in shaping noteworthy differences between them. The concepts of after-death judgment and redemption/downfall dichotomy and practices like deathbed rituals and their evolution after enlightenment and modernity are almost common between the above two broad traditions. The chronology of events and some aspects of conceptual evolutions (such as the lack of the account of permanent death of nonbelievers in the Persian tradition) and ritualistic practices (such as the status of the tombs of Shiite Imams and the absolute lack of embalming and wake in the Persian/Shiite culture) are among the differences.

9

JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2016

History of attitudes toward death: a comparative study between Persian and Western cultures

Aramesh, Kiarash

Hospital ethics committees (HECs) help clinicians deal with the ethical challenges which have been raised during clinical practice. A comprehensive literature review was conducted to provide a historical background of the development of HECs internationally and describe their functions and practical challenges of their day to day work. This is the first part of a comprehensive literature review conducted between February 2014 and August 2016 by searching through scientific databases. The keyword ethics committee, combined with hospital, clinic, and institution, was used without a time limitation. All original and discussion articles, as well as other scientific documents were included. Of all the articles and theses found using these keywords, only 56 were consistent with the objectives of the study. Based on the review goals, the findings were divided into three main categories; the inception of HECs in the world, the function of HECs, and the challenges of HECs. According to the results, the Americas Region and European Region countries have been the most prominent considering the establishment of HECs. However, the majority of the Eastern Mediterranean Region and South-East Asia Region countries are only beginning to establish these committees in their hospitals. The results highlight the status and functions of HECs in different countries and may be used as a guide by health policymakers and managers who are at the inception of establishing these committees in their hospitals.

9

JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2016

Hospital/clinical ethics committees' notion: an overview

Hajibabaee, Fatemeh; Joolaee, Soodabeh; Cheraghi, Mohammad Ali; Salari, Pooneh; Rodney, Patricia

This paper presents a systematic literature review of studies that shed light on the health of migrants in Iran from the perspective of social justice. A systematic search was conducted in PubMed and Iranian databases, including IranMedex, Magiran, and SID, in June 2012. All studies that were published until June 2012 describing the health status of migrants - including refugees - in Iran were included. The search results were categorized according to an adapted version of the six dimensions of well-being in Madison Powers’ and Ruth Faden’s theory of social justice in health. They consisted of access to health care, health, respect, self-determination and attachment, personal security, and social determinants of health. The majority of papers mentioned issues related to infectious diseases (100 papers, 60.2%). Only a few papers mentioned socioeconomic status and access to health services, education, and work. Infectious diseases and high population growth among migrants and the problematic image of migrants as "threat" to the Iranian population’s health appear to be the most prominent results in our search. It is imperative to combat the high numbers of infectious diseases among migrants in Iran while simultaneously making efforts to change the public image of migrants as a health and social service threat to Iran. Data concerning social and ethical issues of migrants’ health in Iran is scarce, and thus, future research is necessary using other methods and sources. © 2016, Academy of Medical Sciences of I.R. Iran. All rights reserved.

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19

Archives of Iranian Medicine

2016

Migrants’ health in Iran from the perspective of social justice: A systematic literature review

Shamsi Gooshki E., Rezaei R., Wild V.

Introduction: One of the most important duties of hospital ethics committees is to provide medical ethics consultation to the staff and patients. This study was conducted with the aim of the needs assessment of the staff for optimal provision of medical ethics consultation services. Materials and methods: The data collection tool was a self-administered questionnaire. Hospital managers, chief nursing officers, ward managers, and head nurses of all hospitals affiliated with Tehran and Iran University of Medical Sciences entered the study. The questionnaire together with an invitation letter was sent to the samples. In the next stage, telephone follow-up of the incomplete forms was performed by the research team. Results: A total of 448 persons participated in this study (response rate: 54.2%). The mean frequency of the need for ethics consultation in each ward was 5.2 times in the last 3 months with a median of 3. The highest needs for consultation, which were common in all wards, were observed in treatment rejection by the patient, providing necessary information to obtain informed consent and obtaining consent to high risk procedures, conflict between the decisions made by the patient and the family members, decision making for the high risk patient, request for futile or inappropriate treatments, giving bad news, and decision making for the incompetent patient. Conclusion: The prevalence of ethical issues in clinical wards is variably high. The ethical issues in the clinical setting are mainly related to respect for the patient’s autonomy and competency for decision making. © The Author(s) 2015.

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11

Clinical Ethics

2016

Needs assessment for providing clinical ethics consultation services in Tehran

Asghari F., Parsapoor A., Vaskooi K., Tehrani S.S.

Implementation of patient feedback is considered as a critical part of effective and efficient management in developed countries. The main objectives of this study were to assess patient satisfaction with the services provided in hospitals affiliated to Tehran University of Medical Sciences, Iran, identify areas of patient dissatisfaction, and find ways to improve patient satisfaction with hospital services.This cross-sectional study was conducted in 3 phases. After 2 initial preparation phases, the valid instrument was applied through telephone interviews with 21476 participants from 26 hospitals during August, 2011 to February, 2013. Using the Satisfaction Survey tool, information of patient's demographic characteristics were collected and patient satisfaction with 15 areas of hospital services and the intent to return the same hospitals were assessed.The mean score of overall satisfaction with hospital services was 16.86 +/- 2.72 out of 20. It was found that 58% of participants were highly satisfied with the services provided. Comparison of mean scores showed physician and medical services (17.75 +/- 4.02), laboratory and radiology services (17.67 +/- 3.66), and privacy and religious issues (17.55 +/- 4.32) had the highest satisfaction. The patients were the most dissatisfied with the food services (15.50 +/- 5.54). It was also found that 83.7% of the participants intended to return to the same hospital in case of need, which supported the measured satisfaction level.Patient satisfaction in hospitals affiliated to Tehran University of Medical Sciences was high. It seems that the present study, with its large sample size, has sufficient reliability to express the patient satisfaction status. Moreover, appropriate measures should be taken in some areas (food, cost, and etc.) to increase patient satisfaction.

9

JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2016

Patients' satisfaction with inpatient services provided in hospitals affiliated to Tehran University of Medical Sciences, Iran, during 2011-2013

Makarem, Jalil; Larijani, Bagher; Joodaki, Kobra; Ghaderi, Sahar; Nayeri, Fatemeh; Mohammadpoor, Masoud

Despite the fact that the criteria for allocation of donated livers have been laid down for years, these criteria may not help to select a potential recipient from those with the same medical requirements. This study used conjoint analysis method to determine the importance of certain non-medical factors from the public’s point of view. Through a population based study, a sample of 899 randomly selected persons filled a questionnaire where in each question the respondents had to choose one out of two hypothetical patients as the recipients of a donor liver considering their expressed characteristics. The collected data were analyzed by means of conjoint analysis method, and the importance of each characteristic was determined. According to the respondents the important criteria for allocation of donated livers included younger age, being married or breadwinner of the family, more than 3-year survival after transplantation, and having no role in causing the illness. Among the selected criteria, financial ability to pay post-operation costs had the least value on the selection. The findings of this study indicate that the public may values certain social and individual factors in case of multiple potential recipients with equal medical need for liver transplant. © The Author(s) 2016.

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11

Clinical Ethics

2016

Public preferences for allocation of donated livers for transplantation: A conjoint analysis

Danesh A., Asghari F., Zeraati H., Yazdani K., Nedjat S., Mansournia M.-A., Jafarian A., Fotouhi A.

Obtaining informed consents is one of the most fundamental principles in conducting a clinical trial. In order for the consent to be informed, the patient must receive and comprehend the information appropriately. Complexity of the consent form is a common problem that has been shown to be a major barrier to comprehension for many patients. The objective of this study was to assess the readability of different templates of informed consent forms (ICFs) used in clinical trials in the Center for Research and Training in Skin Diseases and Leprosy (CRTSDL), Tehran, Iran.This study was conducted on ICFs of 45 clinical trials of the CRTSDL affiliated with Tehran University of Medical Sciences. ICFs were tested for reading difficulty, using the readability assessments formula adjusted for the Persian language including the Flesch-Kincaid reading ease score, Flesch-Kincaid grade level, and Gunning fog index. Mean readability score of the whole text of ICFs as well as their 7 main information parts were calculated.The mean +/- SD Flesch Reading Ease score for all ICFs was 31.96 +/- 5.62 that is in the difficult range. The mean +/- SD grade level was calculated as 10.71 +/- 1.8 (8.23-14.09) using the Flesch-Kincaid formula and 14.64 +/- 1.22 (12.67-18.27) using the Gunning fog index. These results indicate that the text is expected to be understandable for an average student in the 11th grade, while the ethics committee recommend grade level 8 as the standard readability level for ICFs.The results showed that the readability scores of ICFs assessed in our study were not in the acceptable range. This means they were too complex to be understood by the general population. Ethics committees must examine the simplicity and readability of ICFs used in clinical trials.

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JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2016

Readability of informed consent forms in clinical trials conducted in a skin research center

Samadi, Aniseh; Asghari, Fariba

Background: The early relationships between infant and care takers are significant and the emotional interactions of these relationships play an important role in forming personality and adulthood relationships. Objectives: The current study aimed to investigate the relationship of attachment styles (AS) and emotional intelligence (EI) with marital satisfaction (MS). Materials and Methods: In this cross-sectional research, 450 married people (226 male, 224 female) were selected using multistage sampling method in Mashhad, Iran, in 2011. Subjects completed the attachment styles questionnaire (ASQ), Bar-On emotional quotient inventory (EQ-i) and Enrich marital satisfaction questionnaire. Results: The results indicated that secure attachment style has positive significant relationship with marital satisfaction (r = 0.609, P< 0.001), also avoidant attachment style and ambivalent attachment style have negative significant relationship with marital satisfaction (r = -0.446, r = -0.564) (P < 0.001). Also, attachment styles can significantly predict marital satisfaction (P < 0.001). Therefore, emotional intelligence and its components have positive significant relationship with marital satisfaction; thus, emotional intelligence and intrapersonal, adaptability and general mood components can significantly predict marital satisfaction (P < 0.001). But, interpersonal and stress management components cannot significantly predict marital satisfaction (P > 0.05). Conclusions: According to the obtained results, attachment styles and emotional intelligence are the key factors in marital satisfaction that decrease marital disagreement and increase the positive interactions of the couples. © 2016, Mazandaran University of Medical Sciences.

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Iranian Journal of Psychiatry and Behavioral Sciences

2016

Relationship of attachment styles and emotional intelligence with marital satisfaction

Abbasi A.R.K., Tabatabaei S.M., Sharbaf H.A., Karshki H.

It has long been a common goal for both medical educators and ethicists to develop effective methods or programs for medical ethics education. The current lecture-based courses of medical ethics programs in medical schools are demonstrated as insufficient models for training "good doctors''.In this study, we introduce an innovative program for medical ethics education in an extra-curricular student-based design named Students' Medical Ethics Rounds (SMER). In SMER, a combination of educational methods, including theater-based case presentation, large group discussion, expert opinions, role playing and role modeling were employed. The pretest-posttest experimental design was used to assess the impact of interventions on the participants' knowledge and attitude regarding selected ethical topics.A total of 335 students participated in this study and 86.57% of them filled the pretest and posttest forms. We observed significant improvements in the knowledge (P < 0.0500) and attitude (P < 0.0001) of participants. Interestingly, 89.8% of participants declared that their confidence regarding how to deal with the ethical problems outlined in the sessions was increased. All of the applied educational methods were reported as helpful.We found that SMER might be an effective method of teaching medical ethics. We highly recommend the investigation of the advantages of SMER in larger studies and interdisciplinary settings.

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JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2016

Students' medical ethics rounds: a combinatorial program for medical ethics education

Beigy, Maani; Pishgahi, Ghasem; Moghaddas, Fateme; Maghbouli, Nastaran; Shirbache, Kamran; Asghari, Fariba; Zadeh, Navid Abolfat-h

The nature of the doctor-patient relationship as a keystone of care necessitates philosophical, psychological and sociological considerations. The present study investigates concepts related to these three critical views considered especially important. From the philosophical viewpoint, the three concepts of "the demands of ethics "," ethical phenomenology and " the philosophy of the relationship" are of particular importance. From a psychological point of view, the five concepts of " communication behavior patterns" (including submissiveness, dominance, aggression, and assertiveness), "psychic distance", "emotional quotient", "conflict between pain relief and truth-telling", and "body language" have received specific emphasis. Lastly, from the sociological perspective, the three notions of "instrumental action", "communicative action", and "reaching agreement in the light of communicative action" are the most significant concepts to reconsider in the doctor-patient relationship. It should be added, however, that from the sociological point of view, the doctor-patient relationship goes beyond a two-person interaction, as the moral principles of doctors and patients depend on medical and patient ethics respectively. The theoretical foundations of the doctor-patient relationship will finally help establish the different dimensions of medical interactions. This can contribute to the development of principles and multidisciplinary bases for establishing practical ethical codes and will eventually result in a more effective doctor-patient relationship.

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JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2016

The doctor-patient relationship: toward a conceptual re-examination

Namazi, Hamidreza; Aramesh, Kiarash; Larijani, Bagher

The right to information Act was implemented in the Iranian legal system through accession of the Merida Convention ensuring the right to information as a fundamental right for the public. One significant aspects of this subject is the ratification of the "Disclosure and Access to Information Act" by which it is recognized as a right of all Persian individuals and citizens to access state-held information in Iran administration.The Iranian legislature, with regard to the role of access to information and its significance, clarified the scope, permitted subjects of access, and exceptions of the right to state-held information. In this essay, we will discuss the legal aspects and scope of ensuring access to medical information in the Iranian statutes and their exceptions. It is argued that the Iranian legislation ensures the principle of maximum disclosure, while sensitive subjects', specially classified and private information, are exempted. Therefore, the related rules in Iran's statutes not only do not threaten patient's information, but also protect them by criminalizing the breaching of the mentioned right.

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JOURNAL OF MEDICAL ETHICS AND HISTORY OF MEDICINE

2016

The right to information and their exceptions in medical practices in the Iranian legal system

Sheykh-Talimi, Maysam; Shariati-Nasab, Sadegh; Zare, Mohammad Kazem; Omani-Samani, Reza

Embryo donation was one of the infertility treatment methods introduced to the Iranian legal system in 2003 (Act of Embryo Donation) and its by-law passed in 2005 after numerous discussions. Embryo donation is a new legal issue in Iran. No similar act has been previously legislated in the legal system; however, on the other hand, the importance of the judicial procedure in its execution cannot be ignored since during this treatment process the infertile couples must refer to the court. In this paper, we analyzed 80 court decisions that concerned permission for embryo donation during 2006-2011. The decisions were made for couples who requested this treatment and referred to Avicenna Fertility Center (Tehran, Iran). In this study, we analyzed the decisions and regulations for the demands, in addition to the medical and legal viewpoints of the judges. The differences among the judges’ decisions and in the ways of investigating were discussed. © 2015 Royan Institute (ACECR). All Rights Reserved.

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9

International Journal of Fertility and Sterility

2015

An evaluation of iranian judges’ decisions about the act of embryo donation

Milanifar A., Behjati Ardekani Z., Akhondi M.M.

Clinical education is an essential part of medical trainees’ education process, and curriculum planners agree that it should be based on ethical standards and principles in the medical field. Nevertheless, no explained and codified criteria have been developed for ethics in clinical teaching. This study was aimed to develop an ethical guideline for medical students and teachers as the first and most important step in respecting patients' rights in educational centers. The initial draft included the codes of ethics in clinical education and was developed based on library studies. Subsequently, it was improved through a qualitative study using semi-structured interviews and focus group sessions with medical students, patients, and medical teachers in educational hospitals affiliated to Tehran University of Medical Sciences. The improved draft was reviewed and validated by a medical expert panel to prepare the final draft. The codes derived from this study included patients’ choices and rights in purely educational procedures, and special considerations for a) obtaining informed consent for educational procedures; b) performing procedures on deceased persons, patients under anesthesia and those lacking decision making capacity; c) educational visual recordings of the patients; and d) safety monitoring in clinical education. The guideline developed in this study incorporates codes of ethics into clinical training. Therefore, in addition to providing efficient education, the interests of patients and their rights are respected, and the ethical sensitivity of learners in primacy of patients’ best interests will be preserved and enhanced. © 2015 Fariba Asghari et al.

2015

8

Journal of Medical Ethics and History of Medicine

2015

Developing an ethical guideline for clinical teaching in Tehran university of medical sciences

Hashemi A., Yeketaz H., Asghari F.

The challenging nature of neonatal medicine today is intensified by modern advances in intensive care and treatment of sicker neonates. These developments have caused numerous ethical issues and conflicts in ethical decision-making. The present study surveyed the challenges and dilemmas from the viewpoint of the neonatal intensive care personnel in the teaching hospitals of Tehran University of Medical Sciences (TUMS) in the capital of Iran. In this comparative cross-sectional study conducted between March 2013 and February 2014, the physicians’ and nurses’ perceptions of the ethical issues in neonatal intensive care units were compared. The physicians and nurses of the study hospitals were requested to complete a 36-item questionnaire after initial accommodations. The study samples consisted of 284 physicians (36%) and nurses (64%). Content validity and internal consistency calculations were used to examine the psychometric properties of the questionnaire. Data were analyzed by Pearson's correlation, t-test, ANOVA, and linear regression using SPSS v. 22. Respecting patients’ rights and interactions with parents were perceived as the most challenging aspects of neonatal care. There were significant differences between sexes in the domains of the perceived challenges. According to the linear regression model, the perceived score would be reduced 0.33 per each year on the job. The results of our study showed that the most challenging issues were related to patients’ rights, interactions with parents, communication and cooperation, and end of life considerations respectively. It can be concluded, therefore, that more attention should be paid to these issues in educational programs and ethics committees of hospitals. © 2015 Maliheh Kadivar et al.

8

Journal of Medical Ethics and History of Medicine

2015

Ethical challenges in the neonatal intensive care units: Perceptions of physicians and nurses; an iranian experience

Kadivar M., Mosayebi Z., Asghari F., Zarrini P.

The number of patients with diabetes has been expected around 300 million by 2025 and 366 million by 2030 by WHO. On the other hand, diabetic wounds as one of the common complications of diabetes represent major health challenges. Recently, wound care biological products have been proposed for treatment of chronic wounds such as the diabetic wound. Accordingly, tissue-engineered skin substitutes have demonstrated promising effects. Some of these products have used adult skin and neonatal foreskin fibroblasts to produce a tissue-engineered skin substitute. Although adult skin and neonatal foreskin fibroblasts have demonstrated promising effects, but fetal skin fibroblasts and keratinocytes have depicted some unique and considerable properties over adult and neonatal skin cells for instance, skin regeneration with no inflammation and scar formation, low immunogenicity, more VEGF-A secretion than their adult counterparts, immunomodulatory effect by the expression of Indoleamine 2,3 dioxygenase, more resistance to oxidative and physical stresses, etc. On the other hand fetal dermal cells with intrinsic IOU-dependent immunosuppressive activity have introduced them as an allogeneic alternative for treatment of chronic wounds. Therefore, based on the mentioned advantages they are ideal skin substitutes. Accordingly, we suggest that using these cells alone or in combination with biocompatible scaffolds for treatment of different types of ulcers such as diabetic wounds. (c) 2015 Elsevier Ltd. All rights reserved.

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84

MEDICAL HYPOTHESES

2015

Human fetal skin fibroblasts: Extremely potent and allogenic candidates for treatment of diabetic wounds

Larijani, Bagher; Ghahari, Aziz; Warnock, Garth L.; Aghayan, Hamid Reza; Goodarzi, Parisa; Falahzadeh, Khadijeh; Arjmand, Babak

Background: Informal payments to health care providers have been reported in many African, Asian and European countries. This study aimed to investigate different aspects of these payments that are also known as under-the-table payments in Iran.Methods: This is an in-depth interview-based qualitative study conducted on 12 purposively chosen clinical specialists. The interviewees answered 9 questions including the ones about, definitions of informal payments, the specialties and hospitals mostly involved with the problem, how they are paid, factors involved, motivation of patients for the payments, impact of the payments on the health care system and physician-patient relationship and the ways to face up with the problem. The findings of the study were analyzed using qualitative content analysis method.Results: Six topics were extracted from the interviews including definitions, commonness, varieties, motivations, outcomes and preventive measures. It was revealed that under-the-table payments are the money taken (either in private or public portions) from patients in addition to what formally is determined. This problem is mostly seen in surgical services and the most important reason for it is unrealistic tariffs.Conclusion: Regarding the soaring commonness of informal payments rooted in underpayments of health expenditures in some specialties, which deeply affect the poor, the government has to boost the capitation and to invest on health sectors through supporting the health insurance companies and actualizing the health care costs in accord with the real price of the health care delivered.

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44

IRANIAN JOURNAL OF PUBLIC HEALTH

2015

Informal Payments for Health Care in Iran: Results of a Qualitative Study

Parsa, Mojtaba; Aramesh, Kiarash; Nedjat, Saharnaz; Kandi, Mohammad Jafar; Larijani, Bagher

[No abstract available]

59

Organ Transplantation in Times of Donor Shortage: Challenges and Solutions

2015

Iran's experience on living and brain-dead organ donation: A critical review

Aramesh K.

Physicians’ knowledge of therapy and counseling stands among the most important issues in the viewpoints of clients who refer to psychiatric centers. Transsexual patients are very important in this regard. The goal of this research is to study their attitude toward doctors’ empathy. A group of transsexual patients who referred to the Tehran Institute of Psychiatry, Iran, answered the Jefferson Scale of Empathy. The relationship of the patients’ age, gender, education level, and lifestyle with their attitude was measured. This study was conducted on 40 patients, including 16 women (40%) and 24 men (60%). In terms of education, 8 patients had a degree below high school diploma (20%), 9 had high school diploma (22.5%), and 23 patients were university students or of higher education level (57.5%). Among these patients, 6 were unemployed (15%), 10 were students (25%), and the rest were employed. Moreover, 8 participants lived alone (20%), 5 lived with their friends (12.5%), and 27 lived with their family (67.5%). Gender had no influence on the average score of the questionnaires, yet level of education had some influence. Lifestyle also had a significant influence on the patients’ attitude. On the other hand, patients whose problems began before the age of 12 had lower score than others. Experienced psychologists in referential centers can express greater levels of empathy to specific diseases and this trend is very effective on the patients’ cooperation level. In order to create an effective relationship between physicians and patients, the efficiency of the health system and increasing satisfaction of specific patients should be considered. © 2015 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved.

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Journal of Medical Ethics and History of Medicine

2015

Surveying the attitudes of transsexual patients referring to Tehran institute of psychiatry toward doctors’ empathy, Iran, 2011-2012

Jazi G.A., Eftekhar M., Mobasher P., Tehrani S.S., Ahmadi K., Fahim M.R.

Tissue and organ transplantation is one of the most promising treatments for some incurable diseases. Nowadays, transplantation is the common therapy in many countries. Unfortunately, availability of donated tissues and organs is limited. There are several factors which may affect donation rate for instance; social factors, culture, religion, and family decision. Accordingly, religious beliefs have a crucial role in tissue and organ donation and transplantation. Islam as a code of life has a comprehensive road map to lead mankind. Spiritual view of human life is considered to be much more valuable in Islam. Therefore, saving a human life is one of the most important Islamic teachings. In Iran as a Muslim country, tissue and organ transplantation program was established based on religious scholars’ permission which has an essential role towards considerable development of the program in Iran. © 2014, Springer Science+Business Media Dordrecht.

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16

Cell and Tissue Banking

2015

Tissue and organ donation and transplantation in Iran

Goodarzi P., Aghayan H.R., Larijani B., Rafiee A.B., Falahzadeh K., Sahebjam M., Ghaderi F., Arjmand B.

In Western literatures, "conflict" is a general term that refers to discord between two or more entities. In Islamic jurisprudence, however, in addition to the term "conflict" (Taāruz), there is another term which is called tazāhum. The two terms, however, have different definitions. Conflict between two concepts, for instance, indicates that one is right and the other is wrong, while tazāhum does not necessarily have to be between right and wrong, and may appear between two equally right concepts. Moreover, conflict exists on a legislative level, while tazāhum is a matter of obedience and adherence, meaning that in practice, both sides cannot continue to coexist. Conflict of interest is a known term in Western literatures, and according to D.F. Thompson, it refers to a situation where professional judgment regarding a primary interest is improperly and unjustifiably influenced by a secondary interest. Taking into account Thompson's definition and the distinction between "conflict" (Taāruz) and "tazāhum", the English term "conflict of interest" translates to "tazāhum of interest" in Islamic jurisprudence as it refers to a person's action without reflecting right or wrong, and simply concerns priority of one interest over another. The resolution to tazāhum in Islamic jurisprudence lies in two principles: the principle of significance and the principle of choice. For instance, in case of conflict (the Western term) or tazāhum (the Islamic term) between the interests of patient and physician, the patient's interest should be the main concern based on the principle of significance. Although Western literatures propose methods such as disclosure or prohibition in order to resolve conflict of interest, the foundation for these solutions seems to have been the principle of significance. © 2014 Mojtaba Parsa et al.

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Journal of Medical Ethics and History of Medicine

2014

A comparison between conflict of interest in Western and Islamic literatures in the realm of medicine

Parsa M., Aramesh K., Larijani B.

Autonomy is usually considered as a main principle in making decisions about individuals' health. Children and particularly adolescents have the capacity to take part in medical decision-making to some extent. For the most part the parent-doctor-child/adolescent triangle sides are essentially in agreement, but this may not be true in some cases, causing physicians to face problems attempting to determine their professional duties. According to Islamic jurisprudent upon reaching the age of Taklif (15 full lunar years for boys and 9 full lunar years for girls) no one can be treated as incompetent based on mental immaturity unless his or her insanity or mental immaturity is provend Moreover the Islamic Sharia, decrees that parents should lose their authority to make medical decisions for their children, if their bad faith or imprudence is proven, in which case a fit and proper person or an institution will be appointed to make decisions in this respect based on the child's best interests. © 2014 by Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, All rights reserved.

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24

Iranian Journal of Pediatrics

2014

Autonomy of children and adolescents in consent to treatment: Ethical, jurisprudential and legal considerations

Parsapoor A., Parsapoor M.-B., Rezaei N., Asghari F.

Patient's preoccupations with perceived defect in appearance or excessive concern about minimal flaws are among diagnostic criteria of body dysmorphic disorder (BDD). Sufferers usually seek cosmetic procedures such as orthodontic treatment. This study was conducted to estimate the prevalence of BDD among a sample of Iranian orthodontic patients. A total of 270 orthodontic patients were evaluated with BDD-YBOCS questionnaire for the diagnosis of BDD. Fifteen patients (5.5%) were screened positive for BDD. BDD was more frequent among females, singles and in younger patients. Most of the BDD patients experienced multiple previous orthodontic evaluations. The relative high prevalence of BDD among orthodontic patients in Iran offers that orthodontists should take psychologically based problems such as BDD into account while evaluating patient's orthodontic problems. © 2014 Tehran University of Medical Sciences. All rights reserved.

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52

Acta Medica Iranica

2014

Body dysmorphic disorder in Iranian orthodontic patients

Yassaei S., Goldani Moghadam M., Aghili H., Mahmoud Tabatabaei S.

Medical ethics is a realm where four important subjects of philosophy, medicine, theology and law are covered. Physicians and philosophers cooperation in this area will have great efficiency in the respective ethical rules formation. In addition to respect the autonomy of the patient, physician's obligation is to ensure that the medical intervention has benefit for the patient and the harm is minimal. There is an obvious conflict between duty of confidentiality and duty of mandatory reporting. Professional confidentiality is one of the basic components in building a constant physician-patient relationship which nowadays, beside the novelty, it is the subject of discussion. Legal obligation of confidentiality is not absolute. In physician-patient relationship, keeping patient's secrets and maintaining confidentiality is a legal and ethical duty, and disclosure of such secrets is mainly through specific statutes. Thus, there are a number of situations where breach of confidentiality is permitted in different legal systems. One of the situations where breaching confidentiality is permitted is the medical mandatory reporting to the relevant authority which is in accordance with many countries' legal systems. Some situations are considered in many countries legal systems' such as notification of births and deaths, infectious diseases, child abuse, sport and relevant events, medical errors, drug side effects and dangerous pregnancies. In this paper, we will examine and discuss medical mandatory reporting and its ethical and legal aspects in the judicial and legal system of Iran and few other countries. Finally we will suggest making Medical Mandatory Reporting Law in Iran. © 2014 Bagher Larijani et al.

7

Journal of Medical Ethics and History of Medicine

2014

Breaching confidentiality: Medical mandatory reporting laws in Iran

Milanifar A., Larijani B., Paykarzadeh P., Ashtari G., Akhondi M.M.

In recent years, notable measures have been taken to protect the rights of participants in biomedical research in Iran. The present study examines possible trends in adherence to ethical codes regarding informed consent after the development of the National Code of Ethics in Biomedical Research (NCEBR) and establishment of research ethics committees. In this retrospective study, 126 dissertations from Tehran University of Medical Sciences were evaluated for adherence to ethical codes. These dissertations were all in clinical trial design and had been presented in the years 1999 and 2009, that is, precisely before and after the development of the NCEBR. A checklist was developed to evaluate the ethical issues associated with informed consent. A single investigator retrieved and evaluated the consent forms from the dissertations. Borderline cases were discussed with other investigators to reach a consensus decision. Based on the checklist, the Standardized Ethical Score (SES) was calculated for each consent form. The mean SES and the rate of consent form attachment were compared between the two years. In total, 70 dissertations had reported obtaining informed consent from study participants, whereas consent forms were attached in only 22 dissertations (17.50%). The percentage of dissertations with the consent form attached increased over time from 12.2% in 1999 to 20.8% in 2009 (P > 0.05), but the majority still did not include a consent form. Moreover, the mean SES of consent forms was significantly higher in 1999 (0.746) than in 2009 (0.428), highlighting the need for more training of researchers and improved surveillance by the ethics committees. A great amount of effort is still needed to make the consent process more ethical, especially for dissertations as a less visible part of academic research. As for students, more systematic training focused on research ethics should be implemented prior to thesis submission. © 2014 Fariba Asghari et al.; licensee Tehran Univ. Med. Sci.

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Journal of Medical Ethics and History of Medicine

2014

Continuing review of ethics in clinical trials: A surveillance study in Iran

Mohamadi A., Asghari F., Rashidian A.

Despite the existence of a large variety of competency frameworks for medical graduates, there is no agreement on a single set of outcomes. Different countries have attempted to define their own set of competencies to respond to their local situations. This article reports the process of developing medical graduates’ competency framework as the first step in the curriculum reform in Tehran University of Medical Sciences (TUMS). A participatory approach was applied to develop a competency framework in Tehran University of Medical Sciences (TUMS). Following literature review, nominal group meetings with students and faculty members were held to generate the initial list of expectations, and 9 domains was proposed. Then, domains were reviewed, and one of the domains was removed. The competency framework was sent to Curriculum Reform Committee for consideration and approval, where it was decided to distribute electronic and paper forms among all faculty members and ask them for their comments. Following incorporating some of the modifications, the document was approved by the committee. The TUMS competency framework consists of 8 domains: Clinical skills; Communication skills; Patient management; Health promotion and disease prevention; Personal development; Professionalism, medical ethics and law; Decision making, reasoning and problemsolving; and Health system and the corresponding role of physicians. Development of a competency framework through a participatory approach was the first step towards curriculum reform in TUMS, aligned with local needs and conditions. The lessons learned through the process may be useful for similar projects in the future. © 2014 Tehran University of Medical Sciences. All rights reserved.

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52

Acta Medica Iranica

2014

Defining a competency framework: The first step toward competency-based medical education

Mirzazadeh A., Hejri S.M., Jalili M., Asghari F., Labaf A., Siyahkal M.S., Afshari A., Saleh N.

Research shows that ancient Iranians were among the pioneers of medical science, and are therefore admired and praised by non-Iranian scholars for their efforts and accomplishments in this field. Investigations of medical and historical texts indicate that between the 10th and the 18th century A.D., ancient Iran experienced a golden age of medicine. Great physicians such as Rhazes, al-Ahwazi, Avicenna and others reviewed the medical textbooks of civilizations such as Greece and India, Theories were scientifically criticized, superstitious beliefs were discarded, valuable innovations were added to pre-existing knowledge and the ultimate achievements were compiled as precious textbooks. Alhawi by Rhazes, Cannon by Avicenna, and Kamil al-Sina'ah by al-Ahwazi are among the works that were treasured by domestic and foreign scientists alike, as well as future generations who continued to appreciate them for centuries. The above-mentioned textbooks discuss diseases and conditions related to neurosurgery, ophthalmology, ear, nose and throat, gastroenterology, urology, skeletomuscular system and other specialties, as well as cancer and similar subjects. One of the richest texts on the description, diagnosis, differential diagnosis, and prognosis of cancer and therapeutic approaches is Alhawi by Mohammad ibn Zakarya al Razi (Rhazes). This article presents a brief summary of Rhazes’ views about the definition of cancer, types, signs and symptoms, prevalence, complications, medical care, treatment and even surgical indications and contraindications. Moreover, his opinions are compared against the views of other physicians and theories of modern medicine. It is also recommended to review the medical heritage of Iran and evaluate the proposed treatments based on modern methodologies and scientific approaches. © 2014 Seyed Mahmoud Tabatabaei et al.; licensee Tehran Univ. Med. Sci.

7

Journal of Medical Ethics and History of Medicine

2014

Diagnosis and treatment of cancer in medical textbooks of ancient Iran

Tabatabaei S.M., Tabatabaei S.M.A.

Background: In spite of several studies, the impact of homocysteine level and folic acid supplementation on bone metabolism is yet to be recognized. In this registered clinical trial (IRCT2014042217385N1), we aimed to find out the power of 6-month folic acid supplementation on homocysteine level and bone metabolism. Methods: Forty postmenopausal osteoporotic women (50 to 87 years) were enrolled in the study. All participants were randomized to receive folic acid 1 mg (n = 17) or placebo (n = 14). At baseline, 3 months, and finally 6 months post intervention, the level of homocysteine, vitamin B12, and bone biomarkers were measured. Results: Both groups were similar at baseline. The homocysteine decreased in both groups but statistically non-significant (P > 0.05). The changes of the serum level of vitamin B12, osteocalcin, and β cross laps were significant between groups after 6 months (P ≤ 0.05). Conclusion: The trend of changes of bone biomarkers after 6 months folic acid supplementation shows that homocysteine concentration and/or folic acid supplementation have impact on the rate of bone metabolism. However, further investigations by larger sample size and differentiating age and gender are still needed to clarify the exact role of folate, homocysteine and vitamin B12. © 2014 Salari et al.; licensee BioMed Central Ltd.

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22

DARU, Journal of Pharmaceutical Sciences

2014

Effect of folic acid on bone metabolism: A randomized double blind clinical trial in postmenopausal osteoporotic women

Salari P., Abdollahi M., Heshmat R., Aghaei Meybodi H., Razi F.

Recent advances in life-sustaining treatments and technologies, have given rise to newly-emerged, critical and sometimes, controversial questions regarding different aspects of end-of-life decision-making and care. Since religious values are among the most influential factors in these decisions, the present study aimed to examine the Islamic scholars' views on end-of-life care. A structured interview based on six main questions on ethical decision-making in end-of-life care was conducted with eight Shiite experts in Islamic studies, and was analyzed through deductive content analysis. Analysis revealed certain points in Islamic views on the definition of death and the persons making decisions about end-of-life care. According to the participants, in addition to conventional criteria ('urf) such as absence of heartbeat and respiration, the irreversible cessation of human voluntary acts (as a sign that the soul has control over the body and the faculty of thinking) are considered to be the criteria in establishing death. The participants also recognized physicians as the main authorities in verifying signs of death. Furthermore, it was emphasized that life preservation and continuation of care must be sensible, and the patient can request not to have death-prolonging procedures started or continued. In the view of participants, patient's autonomy cannot be the sole basis for all measures, but Islamic ethical and jurisprudential principles should be relied upon to make correct and sensible decisions whether to continue or stop terminal patients' care. Final decisions should be made by a team of experts, and physicians must be at the center of such a team. Finally, we suggest that a guideline in keeping with Islamic norms on human life and death, purpose of life, God's will, boundaries of man's authority, and the physician's ethical duties and obligations should be developed. © 2014 Bagher Larijani et al.

7

Journal of Medical Ethics and History of Medicine

2014

End-of-life care ethical decision-making: Shiite scholars' views

Mobasher M., Aramesh K., Zahedi F., Nakhaee N., Tahmasebi M., Larijani B.

Objective: The aim of our study is to compare the prevalence of illicit drug use estimated through a technique referred to as the "crosswise model" (CM) with the results from conventional direct questioning (DQ). Method: About 1,500 students from Tehran University of Medical Sciences 2009-2010 were first interviewed by DQ and, then three months later, by the CM. Result: The CM yielded significantly higher estimates than DQ for lifetime prevalence of use of any illicit drug (CM = 20.2%,DQ = 3.0%, p < .001) and for lifetime prevalence of use of opium or its residue (CM = 13.6%, DQ = 1.0%, p < .001). Also, for use of any illicit drug in the last month and use of opium or its residue in the last month, the CM yielded higher point estimates than DQ, although these differences were not significant (any drug: CM = 1.5%, DQ = 0.2%, p = .66; opium: CM = 3.8%, DQ = 0.0%, p = .21). Conclusion: Our findings suggest that the CM is a fruitful data collection method for sensitive topics such as substance abuse. © 2014 Informa Healthcare USA, Inc.

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49

Substance Use and Misuse

2014

Estimating the prevalence of illicit drug use among students using the crosswise model

Shamsipour M., Yunesian M., Fotouhi A., Jann B., Rahimi-Movaghar A., Asghari F., Akhlaghi A.A.

Background: The nature of community-based participatory research (CBPR) poses distinctive ethical challenges. In the absence of organized guidelines, a remarkable amount of researchers’ time and energy will be spent tackling these ethical challenges. The study aimed to explore ethical issues and principles potentially arising when conducting CBPR.Methods: This qualitative study conducted in CBPR Center of Tehran University of Medical Sciences. Required data were gathered through systematic literature review and semi-structured interviews. Representatives of community, academia, and nongovernmental organizations (NGOs) participated in our study. Ten interviews with representatives of partner organizations, four group interviews with academic staff, and four with representatives of community were conducted. Repeated thematic analysis was used to elicit ethics-related overarching themes from transcribed interviews. As recommendations, these themes were then organized into a set of CBPR-related ethical issues and principles.Results: Four CBPR ethical guidelines (including 173 articles) were selected from a systematic review. Overarching themes relating to ethical principles which emerged from interviews were as follows: Trust, transparency and accountability, equity and inclusion, power imbalance, tolerance and conflict management, and attention to cultural sensitivity. Practical principles that emerged included: Consensus rather than informed consent, ownership of data and research achievements, and sustainability and maintenance of relationships. According to findings and in comparison to international guidelines, the present study put more emphasis on cultural sensitivity and sustainability as CBPR ethical tangles.Conclusions: Community-based participatory research ethical challenges are of the same kind in most parts of the world. However, some discrepancies exist that calls for local scrutiny. Future use and critic of current explored ethical issues and principles are highly encouraged. © 2014, Isfahan University of Medical Sciences(IUMS). All rights reserved.

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5

International Journal of Preventive Medicine

2014

Ethical considerations of community-based participatory research: Contextual underpinnings for developing countries

Jamshidi E., Morasae E.K., Shahandeh K., Majdzadeh R., Seydali E., Aramesh K., Abknar N.L.

Advancements in different field of medicine have given rise to complex ethical dilemmas in clinical practice. The more the clinicians are sensitized to ethical problems and familiar with ethical decision-making, the more they can value professionalism in their practice. The current paper is designed to emphasize physicians to think ethically in the field of internal medicine and endocrinology. Being aware of the ethical issues and being sensi-tive to them are the first steps for ethical conduct. So, some important ethical issues will be described in brief, and an overview of professionalism and the principles of ethical decision making will be provided. Three ethical cases are included in order to make the discussion more practical.

SUPPL. 1

43

Iranian Journal of Public Health

2014

Ethical issues in clinical practice in endocrinology - Review article

Larijani B., Zahedi F.

One of the most important applications of transgenic animals for medical purposes is to transplant their organs into human's body, an issue which has caused a lot of ethical and scientific discussions. we can divide the ethical arguments to two comprehensive groups; the first group which is known as deontological critiques (related to the action itself regardless of any results pointing the human or animal) and the second group, called the consequentialist critiques (which are directly pointing the consequences of the action).The latter arguments also can be divided to two subgroups. In the first one which named anthropocentrism, just humankind has inherent value in the moral society, and it studies the problem just from a human-based point of view while in second named, biocentrism all the living organism have this value and it deals specially with the problem from the animal-based viewpoint. In this descriptive-analytic study, ethical issues were retrieved from books, papers, international guidelines, thesis, declarations and instructions, and even some weekly journals using keywords related to transgenic animals, organ, and transplantation. According to the precautionary principle with the strong legal and ethical background, due to lack of accepted scientific certainties about the safety of the procedure, in this phase, transplanting animal's organs into human beings have the potential harm and danger for both human and animals, and application of this procedure is unethical until the safety to human will be proven.

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16

Cell Journal

2014

Ethical issues of transplanting organs from transgenic animals into human beings

Manesh S.B., Samani R.O., Manesh S.B.

Monetary compensation for human eggs used in research is a controversial issue and raises major concerns about women's health and rights, including the potential of exploitation and undue inducement. Human eggs are needed for various types of studies and without payment, it would be impossible to procure sufficient eggs for vital research. Therefore, a solution seems necessary to prevent exploitation and resolve other ethical concerns while ensuring sufficient supplies of human eggs for research. A brief review of legislation in different countries shows the existing diversity and controversy over compensating human egg donation for research purposes. While in more economically developed countries procreative liberty and consumer orientation seem to be defensible, in some developing countries, where concerns about exploitation exist, adopting a more regulated approach to assisted reproduction is more prudent and wise. Egg sharing is a program that has been proposed to solve both the ethical problems of purchasing eggs and the shortage of human egg supply for research. In developing countries, however, regardless of whether the egg sharing or the monetary compensation model is adopted, some steps should be taken to guarantee the ethical nature of this practice. These steps include ensuring the existence of independent institutional review boards (IRBs), confirming the validity of all steps in the process of obtaining informed consent, and ensuring the existence and viability of independent supervising and auditing bodies. © 2013 Kiarash Aramesh; licensee Tehran Univ. Med. Sci.

7

Journal of Medical Ethics and History of Medicine

2014

Journal of medical ethics and history of medicine

Aramesh K.

Nowadays, scientific findings in the field of regeneration of nervous system have revealed the possibility of stem cell based therapies for damaged brain tissue related disorders like stroke. Furthermore, to achieve desirable outcomes from cellular therapies, one needs to monitor the migration, engraftment, viability, and also functional fate of transplanted stem cells. Magnetic resonance imaging is an extremely versatile technique for this purpose, which has been broadly used to study stroke and assessment of therapeutic role of stem cells. In this review we searched in PubMed search engine by using following keywords; "Stem Cells", "Cell Tracking", "Stroke", "Stem Cell Transplantation", "Nanoparticles", and "Magnetic Resonance Imaging" as entry terms and based on the mentioned key words, the search period was set from 1976 to 2012. The main purpose of this article is describing various advantages of molecular and magnetic resonance imaging of stem cells, with focus on translation of stem cell research to clinical research.

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JOURNAL OF RESEARCH IN MEDICAL SCIENCES

2014

Magnetic resonance imaging of transplanted stem cell fate in stroke

Aghayan, Hamid Reza; Soleimani, Masoud; Goodarzi, Parisa; Norouzi-Javidan, Abbas; Emami-Razavi, Seyed Hasan; Larijani, Bagher; Arjmand, Babak

Despite the fact that ophthalmology is one of the foremost branches of medicine, conceptualization of the structure and function of the eye barely advanced in ancient Western civilizations. At the early recovery of Persian civilization (9(th) century AD) after the extinction of the Sassanid Empire (7(th) century AD), translations of Greek medical textbooks played an important role in the development of medicine and the emergence of great Persian physicians such as Rhazes, Avicenna and others. Rhazes was a leading Persian physician whose medical teachings have as yet not been thoroughly explored. In addition to numerous books and articles in various fields, he authored a great medical Encyclopedia (al-Hawi al-Kabir) in 25 volumes. In this article, we are going to compare Rhazes' particular viewpoints about ophthalmology with those of other famous Persian physicians and some recent essays and textbooks. For this purpose we reviewed Rhazes' second volume of al-Hawi that is dedicated exclusively to ophthalmology and contains some major topics of ophthalmology including anatomy, physiology, pathology, diseases, disorders and treatments. Important themes were carefully extracted and compared with the tenets of modern ophthalmology. After collating Rhazes' viewpoints with the latest findings in this field, it was concluded that he had brilliantly written about the signs and symptoms, etiology and treatment of many eye disorders more than a thousand years ago. The amazing point is that there was no accurate equipment at the time to help him in his investigations. This study proved that Rhazes' theories conform to recent knowledge about ophthalmology in many aspects, and could therefore be the subject of further investigations.

7

Journal of medical ethics and history of medicine

2014

Ophthalmology in Persian medicine

Tabatabaei, Seyed Mahmoud; Sabetkish, Nastaran; Tabatabaei, Seyed Mohammad Ali

[No abstract available]

10

14

American Journal of Bioethics

2014

Paid Living Kidney Transplantation in Iran: Rethinking the Challenges

Pajouhi A., Zahedi F., Pajouhi Z., Larijani B.

Given the importance of patient's rights in healthcare, special attention has been given to the concept of patient's rights by the Ministry of Health and Medical Education in Iran. Iranian patient's rights charter has been compiled with a novel and comprehensive approach. This charter aims to elucidate rights of recipients of health services as well as observing ethical standards in medicine. This paper presents the Iranian patient's rights charter. Based on a study done from 2007 to 2009, the charter has been finalized through an extensive consultation involving all stakeholders, patients, physicians, nurses, lawyers, patient associations and health policy makers. The developed charter was adopted by the Ministry of Health in December 2009. Iranian patient's rights charter has been formulated in the framework of 5 chapters and 37 articles including vision and an explanatory note. The five chapters concern right to receiving appropriate services, right to access desired and enough information, right to choose and decide freely about receiving healthcare, right to privacy and confidentiality, and finally right to access an efficient system of dealing with complaints which have been explained in 14, 9, 7, 4 and 3 articles, respectively. The paper concludes that, adopting the patient's rights charter is a valuable measure to meet patient's rights; however, a serious challenge is how to implement and acculturate observing patient's rights in practice in our healthcare system in Iran. © 2014 Tehran University of Medical Sciences. All rights reserved.

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52

Acta Medica Iranica

2014

Patient's rights charter in Iran

Parsapoor A., Bagheri A., Larijani B.

Epilepsy as one of the most common neurological disorders affects more than 50 million people worldwide with a higher prevalence rate in low-income countries. Excessive electrical discharges in neurons following neural cell damage or loss cause recurrent seizures. One of the most common and difficult to treat types of epilepsy is temporal lobe epilepsy (TLE) which results from hippocampal sclerosis. Nowadays, similar to other diseases, epilepsy also is a candidate for treatment with different types of stem cells. Various stem cell types were used for treatment of epilepsy in basic and experimental researches. Two major roles of stem cell therapy in epilepsy are prophylaxis against chronic epilepsy and amelioration cognitive function after the occurrence of TLE. Several animal studies have supported the use of these cells for treating drugresistant TLE. Although stem cell therapy seems like a promising approach for treatment of epilepsy in the future however, there are some serious safety and ethical concerns that are needed to be eliminated before clinical application. © 2014 Tehran University of Medical Sciences. All rights reserved.

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52

Acta Medica Iranica

2014

Stem cell therapy for treatment of epilepsy

Goodarzi P., Aghayan H.R., Soleimani M., Norouzi-Javidan A., Mohamadi-Jahani F., Jahangiri S., Emami-Razavi S.H., Larijani B., Arjmand B.

This study was done to explore the views of patients and their companions concerning endotracheal intubation training on newly deceased patients and the necessity of obtaining their consent in this regard. In this cross-sectional descriptive analytical study, we used a questionnaire to collect data through structured interviews conducted by the researcher on patient discharge day. A convenient sample of over 18 year old patients hospitalized at a teaching hospital were enrolled, and after receiving patient consent, one of each patient's companions was enrolled in the study as well. In this study, 150 of the approached patients agreed to participate (response rate = 85.0%); of those, 92 (61.3%) allowed their companions to be enrolled as well. Eighty-three persons (55.3%) in the patient group and 68 persons (73.9%) in the companion group agreed to have endotracheal intubation training on their own bodies after death. Among these consenting patients and companions, 75.9% (n = 63) and 91.2% (n = 62) believed it was necessary to acquire patient consent for this procedure. Obtaining relatives' consent was thought to be necessary by 69.9% (n = 72) of the patients and 72.1% (n = 49) of the companions, even when there was patient prior consent. Therefore it seems that asking the patient's consent for doing educational procedures on their dead body is crucial.

7

Journal of medical ethics and history of medicine

2014

Teaching endotracheal intubation on the recently deceased: opinion of patients and families.

Mirzazadeh, Azim; Ostadrahimi, Nima; Ghalandarpoorattar, Seyedeh Mojgan; Asghari, Fariba

The use of donated embryos has offered hope for infertile couples who have no other means to have children. In Iran, fertility centers use fertile couples as embryo donors. In this paper, the advantages and disadvantages of this procedure will be discussed. We conclude that embryo-donation should be performed with frozen embryos thus preventing healthy donors from being harmed by fertility drugs. There must be guidelines for choosing the appropriate donor families. In countries where commercial egg donation is acceptable, fertile couples can be procured as embryo donors thus fulfilling the possible shortage of good quality embryos. Using frozen embryos seems to have less ethical, religious and legal problems when compared to the use of fertile embryo donors. © 2014, Research and Clinical Center for Infertitlity. All rights reserved.

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12

Iranian Journal of Reproductive Medicine

2014

Using fertile couples as embryo donors: An ethical dilemma

Alizadeh L., Samani R.O.

Introduction The efficacy of statin treatment in chronic kidney disease (CKD) patients remains controversial. Therefore, we performed a meta-analysis to investigate whether statins modulate renal function in patients with CKD. Methods Data from Scopus, PubMed, Web of Science, and the Cochrane Central Register of randomized controlled trials for years 1966-December 2012 were searched for appropriate studies. Results Twenty trials with 6452 CKD subjects randomized to receive either statin or placebo were included. Statin therapy significantly influenced high sensitivity C-reactive protein levels in patients on or off dialysis [- 0.28 mg/dl, 95%CI: - 0.93 to - 0.37; p &lt; 0.05 and - 0.46 mg/dl, 95%CI: - 0.87 to - 0.05; p = 0.03], respectively], urinary protein (- 0.77 g/24 h, 95%CI: - 1.24 to - 0.29, p &lt; 0.02; this effect persisted for treatment ≤ 12 months), and serum creatinine but only for long-term therapy (3 years) (- 0.65 mg/dl, 95%CI: - 1.00 to - 0.30; p = 0.0003). The summary for standardized effect size of mean differences of glomerular filtration rate was 0.29 ml/min/1.73 m2 (95%CI: 0.01 to 0.58; p = 0.04), and depended on treatment duration - a significant increase was observed for between 1 and 3 years of statin therapy (0.50 ml/min/1.73 m2, 95%CI: 0.40 to 0.60; p &lt; 0.0001), with no significant increase for both ≤ 1 and &gt; 3 years of the therapy. Conclusion Statins might exert significant renoprotective effects in CKD patients; however, benefit may depend on the duration of treatment. This is an issue that warrants more definitive investigation. More studies are necessary in dialysis patients to credibly evaluate the renal effects of statin therapy. © 2013 Elsevier Ireland Ltd © 2013 Published by Elsevier Ireland Ltd.

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168

International Journal of Cardiology

2013

A meta-analysis of the role of statins on renal outcomes in patients with chronic kidney disease. Is the duration of therapy important?

Nikolic D., Banach M., Nikfar S., Salari P., Mikhailidis D.P., Toth P.P., Abdollahi M., Ray K.K., Pencina M.J., Malyszko J., Rysz J., Rizzo M.

Objectives Medical students, as tomorrow's doctors, are responsible for their patients' health; cheating may affect their academic knowledge and clinical skills. The main purpose of this study was to investigate the frequency of and attitudes towards academic disintegrity among medical students at Tehran University of Medical Sciences (TUMS). Methods Anonymous questionnaires including questions about various types of academic disintegrity were distributed among medical students during the clerkship and internship phases of the curriculum. Randomised response technique (RRT) was used to maintain the responders' privacy. Because the study design guaranteed the confidentiality of respondents, the TUMS Institutional Review Board declared that formal ethical approval was not required. Results A total of 124 students were enrolled in this study, of whom 63 were in the clerkship phase and 61 were in the internship phase. Of these respondents, 29% (n=36) were male. The most frequently reported type of academic disintegrity was found to be 'impersonating an absent student in a class' (93%) and the least frequent to be 'legitimising absences by using bribes' (5%). Only a small number of interns considered 'buying hospital shifts', 'selling hospital shifts', 'impersonating an absent student' and 'helping others to cheat in examinations' as representing academic disintegrity. Approximately one third of participants stated that the RRT increased their confidence in anonymity and 90% of students found the use of RRT not difficult. Conclusions Academic integrity is widely disrespected in different ways among medical students. Effective policies and interventions are required to control these misbehaviours in future doctors in order to optimise medical practice. Almost all respondents found it not difficult to use the RRT; the technique proved to be an effective and easily applied method of eliciting truthful responses to sensitive questions and represents an alternative to conventional anonymising techniques. Discuss ideas arising from this article at 'discuss' © Blackwell Publishing Ltd 2013.

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47

Medical Education

2013

Academic disintegrity among medical students: A randomised response technique study

Mortaz Hejri S., Zendehdel K., Asghari F., Fotouhi A., Rashidian A.

[No abstract available]

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39

Journal of Medical Ethics

2013

Attitude towards plagiarism among Iranian medical students

Ghajarzadeh M., Hassanpour K., Fereshtehnejad S.-M., Jamali A., Nedjat S., Aramesh K.

[No abstract available]

6

Journal of Medical Ethics and History of Medicine

2013

Brief report: The third annual medical ethics congress in Iran

Salari P., Zahedi F., Aramesh K., Larijani B.

Pharmacists as one of health-care providers face ethical issues in terms of pharmaceutical care, relationship with patients and cooperation with the health-care team. Other than pharmacy, there are pharmaceutical companies in various fields of manufacturing, importing or distributing that have their own ethical issues. Therefore, pharmacy practice is vulnerable to ethical challenges and needs special code of conducts. On feeling the need, based on a shared project between experts of the ethics from relevant research centers, all the needs were fully recognized and then specified code of conduct for each was written. The code of conduct was subject to comments of all experts involved in the pharmaceutical sector and thus criticized in several meetings. The prepared code of conduct is comprised of professional code of ethics for pharmacists, ethics guideline for pharmaceutical manufacturers, ethics guideline for pharmaceutical importers, ethics guideline for pharmaceutical distributors, and ethics guideline for policy makers. The document was compiled based on the principles of bioethics and professionalism. The compiling the code of ethics for the national pharmaceutical system is the first step in implementing ethics in pharmacy practice and further attempts into teaching the professionalism and the ethical code as the necessary and complementary effort are highly recommended.

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Journal of Research in Medical Sciences

2013

Code of ethics for the national pharmaceutical system: Codifying and compilation

Salari P., Namazi H., Abdollahi M., Khansari F., Nikfar S., Larijani B., Araminia B.

This study was conducted to examine adherence to ethical principles during research and the necessity to conduct systematic and continuing review of ongoing research in Iran. All clinical trials approved by the Research Ethics Committee of Tehran University of Medical Sciences (TUMS) ongoing in 2007 (n = 21) were reviewed through receiving principal investigators' (PIs) reports, as well as reviewing patient consent forms. Two questionnaires were sent to PIs, one to collect information about the study and the other to evaluate PIs' perception and awareness about ethical codes of clinical trials. A representative of the TUMS research ethics committee was sent to the research site to fill a checklist by reviewing the obtained informed consent and fill the other checklist by interviewing a sample of participants regarding their perception of their volunteer participation in the clinical trial and receiving adequate information. Only in 66.7% of the surveyed trials the objectives of the trial had been explained in the informed consent, and in 38.6% of the trials it was mentioned in informed consent that participation is voluntary. Among participants, 34.7% (n = 26) were not aware they were enrolled in a research project, 29.3% (n = 22) had not understood the information they had received, 74.7% (n = 56) did not know they could refuse to participate and still receive care from their physician, and 58.7% did not realize they were free to drop out of the study at any time. The results point to the need for continuing review of clinical research, especially clinical trials, and the necessity for thorough assessment of patient consent forms during the process of approval in terms of their contents and their understandability. © 2013 Fariba Asghari et al.

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Journal of Medical Ethics and History of Medicine

2013

Continuing review of ethics in clinical trials: A surveillance study in Iran

Asghari F., Ghalandarpoorattar S.M.

Objective:The available data on statin effects in chronic kidney disease (CKD) patients are still conflicting. We investigated the impact of short- and long-term statin therapy on lipid profiles in CKD patients requiring or not requiring dialysis. Research design and methods:Data from Scopus, PubMed, Web of Science, and the Cochrane Library from 1966 to May 2012 were searched for studies that investigated this effect. We included all randomized controlled clinical trials that investigated the impact of statin therapy on lipids and lipoproteins. Results:The final analysis included 16 trials with 3594 subjects. In CKD patients, statin therapy significantly reduced total cholesterol (TC), triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) (p<0.003 for all comparisons), and the effect insignificantly intensified with duration of statin therapy (56.3 vs 66.8, 22.5 vs 24.1, and 53 vs 56.1mg/dl, respectively). Comparing statin therapy for ≤3 and >3 months in CKD patients on dialysis, the magnitude of TC and LDL-C decreased (26.3 vs 25.9, and 42.2 vs 29.8mg/dl, respectively, p>0.05 for both), while TG increased modestly (4.5 vs 13.4mg/dl). Short-term statin therapy increased high density lipoprotein cholesterol by a mean 0.7mg/dl (p=0.04), and long-term therapy was associated with a mean reduction of 2.4mg/dL. Conclusions:Statin therapy significantly modifies the lipid profile in CKD patients not on dialysis therapy (with the trend to be more effective with longer therapy), and have less beneficial effect in patients on dialysis with the trend to be less effective with longer duration of therapy. © 2013 Informa UK Ltd All rights reserved.

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29

Current Medical Research and Opinion

2013

Effects of statins on lipid profile in chronic kidney disease patients: A meta-analysis of randomized controlled trials

Nikolic D., Nikfar S., Salari P., Rizzo M., Ray K.K., Pencina M.J., Mikhailidis D.P., Toth P.P., Nicholls S.J., Rysz J., Abdollahi M., Banach M.

Background: In the recent years, advances in medical technologies for end stage cancer patients' care have affected the end-of-life decision-making in clinical practice and exposed oncologists to serious ethical dilemmas. But little is known about oncologists' viewpoints in our country regarding their ethical problems in this mention. We aimed to clarify the ethical dilemmas which Iranian oncologists may face in our health care setting and to determine factors influencing decision-making process. Methods: In this qualitative study, a phenomenological approach was used. We interviewed 8 cancer specialists in teaching hospitals in Iran and used content analysis to identify codes and categorize themes in the data. Results: During the process of analysis, three main themes emerged about ethical dilemmas in end of life care for advanced cancer patients: illness factors, socio-cultural context and patient-physician relationship. Cancer specialists identified ethical problems on several main issues, the most important of which were telling the truth in Iranian cultural context, uncertainty in end stage definition, multidisciplinary team working and cost consideration in Iranian health care system. Conclusion: Health care and insurance system in Iran face to end of life care challenges; therefore, health care providers and policy makers need to allocate appropriate resources and programs to improve quality of care in terminal stages. Appropriate physicians' communication skills training, multidisciplinary team working and supplementary insurance services that provide essential health care can improve the quality of care of patients with end stages of cancer. The findings of this study can help us to provide ethical policies for decision-making in end-of-life care.

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42

Iranian Journal of Public Health

2013

Ethical issues in the end of life care for cancer patients in Iran

Mobasher M., Nakhaee N., Tahmasebi M., Zahedi F., Larijani B.

At the aim of explaining the rights of health care recipients and upgrading ethical observance in the field of treatment the most important field of health care-, the Patient's Rights Charter was declared by Ministry of Health and Medical Education to all medical universities in September 2009. This paper provides a report of strategic planning for implementation of Patient's Rights Charter and a summary of other projects.

1 SUPPL 1

42

Iranian Journal of Public Health

2013

Implementation of patient's rights charter: A report from Ministry of Health and Medical Education, Iran

Parsapoor A.R., Salari P., Larijani B.

Education needs assessment is one of the essential components of curriculum development. In this study, we aimed to assess the educational needs of general physicians for medical ethics. We conducted a three-stage Delphi study of general physicians' views on important ethical issues in their practice. In the item generation stage we retrieved 45 important educational items from a survey of general physicians, patients, well known ethical clinicians, and a review of other universities' curricula and international literature. The questionnaire was designed to ask the importance of each generated item. We then sent the questionnaire to general physicians. Items scored as highly important by more than 80% of the respondents in the first or second consensus development surveys were considered as educational priorities. Four academic medical ethics teachers reviewed and commented on the findings. The response rate to the first consensus development survey was 38%, of whom 77% also responded to the second survey. We developed consensus on 24 medical ethics items for inclusion in medical ethics curriculum. All items were also considered important by medical ethics teachers, and they added four further items to the list. Despite the attention given to ethical issues originating from technological advances, the most important educational needs of general physicians in medical ethics are still the traditional issues concerning the doctor-patient relationship and professionalism.

6

Journal of medical ethics and history of medicine

2013

Medical ethics course for undergraduate medical students: a needs assessment study.

Asghari, Fariba; Samadi, Aniseh; Rashidian, Arash

Patient-centred system of care is essential in managing many disorders such as diabetes mellitus. The cultural and religious context can influence the involvement of patients and their families in such a care. We intend to discuss patient-centred care in diabetology in view of Islam. For more clarification, we will take into consideration a few illustrative lines of argument in detail about situation in Iran. In conclusion, dynamic spirit of Islamic jurisprudence is reflected in its adaptability to change in medical practice. In recent decades, Iranian religious scholars have provided scientists in new fields of science and research with appropriate directions and guidelines. Decree issued by Iranian religious leaders permitting research on stem cells for therapeutic purposes in many disorders including diabetes mellitus is one example. Understanding of the nature of Islam is importance for communication with patients in Islamic countries. © 2013 Larijani and Zahedi; licensee BioMed Central Ltd.

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12

Journal of Diabetes and Metabolic Disorders

2013

Patient centred care in diabetology: An Islamic perspective from Iran

Larijani B., Zahedi F.

IntroductionFair allocation of donor organs is essential to maintain public trust in a public healthcare system. A study of the public's views and opinions of this could clarify non-medical prioritization criteria. We report our survey of public opinion of criteria for donor kidney allocation.MethodsThis was a cross-sectional study using random digit dialing to phone interview 706 Tehran residents. Patient scenarios were presented to determine interviewee opinions on nine recipient criteria: probability for survival, previous transplant history, time on the waiting list, age, an individual's role in developing their kidney failure, gender, marital status, social status, and financial situation. Each scenario introduced two patients and interviewees then chose the better candidate for transplantation.ResultsMore than 50% of the participants chose length of waiting time, a patient's role in causing their disease, age, and survival time after transplantation as important allograft allocation criteria.ConclusionThis study disclosed other criteria in addition to the likelihood for successful transplantationthe patient's role in the development of their disease and patient agewhich should be prioritization considerations.

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27

CLINICAL TRANSPLANTATION

2013

Public preferences for donor kidney allocation: a study in Iran

Asghari, Fariba; Broumand, Mohammadali; Heidari, Akram

Context: Nocturnal enuresis has undoubtedly occurred since man's earliest days and the first references are found in the Ebers papyri of 1550 BC. The purpose of this study is to review of Rhazes opinion about diagnosis and treatment of nocturnal enuresis and compare his belief and clinical methods with modern medical practice.Evidence Acquisition: In the review study we searched all available and reliable electronic and paper sources using appropriate keywords about the views of Rhazes, and compared them with recent medical evidence about diagnosis and treatment of nocturnal in medication.Results: Our findings proved that Rhazes described the symptoms, signs, and the treatment of nocturnal enuresis in accordance with contemporary medicine.Conclusions: A review of opinion Rhazes and other ancient Islamic medical textbooks on nocturnal enuresis reveals that medical practice in those days was comparable to modern medicine yet avoiding the side effects that are commonly experienced with the modern medical approach.

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15

IRANIAN RED CRESCENT MEDICAL JOURNAL

2013

Rhazes, a Genius Physician in the Diagnosis and Treatment of Nocturnal Enuresis in Medical History

Ashtiyani, Saeed Changizi; Shamsi, Mohsen; Cyrus, Ali; Tabatabayei, Seyed Mohammad

The available studies have reported the benefits of statins on all-cause and cardiovascular mortality in chronic kidney disease (CKD) patients. However studies in end-stage renal disease patients on dialysis yielded conflicting results. Therefore, we performed a meta-analysis and provide the most reliable trial data to date on the impact of statin therapy on cardiovascular events and death from all causes in CKD patients. Data from PubMed, Web of Science, Cochrane Library, and Scopus for the years 1966 to October 2012 were searched. The final meta-analysis included 11 randomized controlled trials involving 21,295 participants with CKD. Among them 6857 were on dialysis. The use of statins in subjects with non-dialysis-dependent CKD resulted in a marked reduction in death from all causes (relative risk [RR]: 0.66; 95% confidence interval [CI]: 0.55-0.79; p < 0.0001), cardiac causes (RR: 0.69; 95%CI: 0.55-0.68; p = 0.0012), cardiovascular events (RR: 0.55; 95%CI: 0.4-0.75; p = 0.0001) and stroke (RR: 0.66; 95%CI: 0.5-0.88; p = 0.0022). The use of statins in dialysis-dependent CKD patients resulted in a non-significant effect on death from all causes (RR: 0.99; 95%CI: 0.88-1.11; p = 0.85) and stroke (RR: 1.31; 95%CI: 0.9-1.89; p > 0.05), but had the effect of reducing death from cardiac causes (RR: 0.79; 95%CI: 0.64-0.98; p < 0.05) and cardiovascular events (RR: 0.81; 95%CI: 0.7-0.94; p < 0.05). In conclusion, the use of statins should be indicated in cardiovascular disease prevention especially in patients with non-dialysis-dependent CKD. According to the very limited data the obtained results suggest caution in expecting a reduction in cardiovascular events in patients on dialysis. © 2013 Elsevier Ltd. All rights reserved.

72

Pharmacological Research

2013

Statins decrease all-cause mortality only in CKD patients not requiring dialysis therapy - A meta-analysis of 11 randomized controlled trials involving 21,295 participants

Barylski M., Nikfar S., Mikhailidis D.P., Toth P.P., Salari P., Ray K.K., Pencina M.J., Rizzo M., Rysz J., Abdollahi M., Nicholls S.J., Banach M.

Nurses are ever-increasingly confronted with complex concerns in their practice. Codes of ethics are fundamental guidance for nursing as many other professions. Although there are authentic international codes of ethics for nurses, the national code would be the additional assistance provided for clinical nurses in their complex roles in care of patients, education, research and management of some parts of health care system in the country. A national code can provide nurses with culturally adapted guidance and help them to make ethical decisions more closely to the Iranian-Islamic background. Given the general acknowledgement of the need, the National Code of Ethics for Nurses was compiled as a joint project (2009-2011). The Code was approved by the Health Policy Council of the Ministry of Health and Medical Education and communicated to all universities, healthcare centers, hospitals and research centers early in 2011. The focus of this article is on the course of action through which the Code was compiled, amended and approved. The main concepts of the code will be also presented here. No doubt, development of the codes should be considered as an ongoing process. This is an overall responsibility to keep the codes current, updated with the new progresses of science and emerging challenges, and pertinent to the nursing practice.

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42

Iranian Journal of Public Health

2013

The code of ethics for nurses

Zahedi F., Sanjari M., Aala M., Peymani M., Aramesh K., Parsapour A., Bagher Maddah S.S., Cheraghi M.A., Mirzabeigi G.H., Larijani B., Vahid Dastgerdi M.

Objectives: Diarrhea the second leading cause of death in childhood is caused by a variety of organisms. Rehydration reduces the risk of death but it is not effective in shortening duration of disease. Recently, probiotics have been recommended for prevention or treatment of gastrointestinal disorders including diarrhea. Considering existing documents from different aspects, it seems that results are somehow controversial or non-conclusive. Thus, we aimed to meta-analyze clinical trials to show actual benefit of probiotics in treatment of diarrhea. Methodology: The literature search provided 1228 articles while only 19 articles focusing on the analyses performed on children were eligible to be included in the meta-analysis with a total of 3867 patients enrolled in the study. Studies in adults' diarrhea, HIV patients, diarrhea induced by Clostridium difficile, radiation and chemotherapy were also systematically reviewed. Results: The meta-analysis showed that probiotics decrease the duration of diarrhea and fever significantly in children while their effects on the duration of hospitalization, vomiting and number of stools per day were not significant. The results of systematic review on adults' diarrhea, amoebiasis, clostridium difficile-associated diarrhea, diarrhea in HIV positive patients, radiation-induced diarrhea, and chemotherapy-induced diarrhea did not support efficacy of probiotics in acute diarrhea. Conclusion: Probiotics may reduce duration of diarrhea and fever in children but their exact efficacy in treatment of diarrhea is not obvious yet. © 2012 Bentham Science Publishers.

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11

Inflammation and Allergy - Drug Targets

2012

A meta-analysis and systematic review on the effect of probiotics in acute diarrhea

Salari P., Nikfar S., Abdollahi M.

The purpose of this study was to examine how ethical approval and competing interests are addressed by medical journals in Iran. In a cross-sectional study, 151 journals accredited by the Publications Commission of the Ministry of Health and Medical Education were reviewed. Data collection was carried out by assessing journal guidelines and conducting structured phone interviews with journal managers, focusing on how ethical considerations and conflicts of interest (COI) are addressed. Overall, 135 of the 151 journals (89. 4 percent) examined some aspect of ethical considerations of submitted articles. Authors were required to disclose their financial sponsors by 98 journals (64. 9 percent), while COI disclosure was required by 67 journals (44. 4 percent). We conclude that the rate of addressing ethical considerations is not far from ideal, but the requirement for COI disclosure needs more attention. © 2012 Springer Science+Business Media B.V.

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9

Journal of Bioethical Inquiry

2012

Addressing Ethical Considerations and Authors' Conflict of Interest Disclosure in Medical Journals in Iran

Heidari A., Adeli S.H., Mehravaran S., Asghari F.

The goal of this study was to assess attitude towards plagiarism in faculty members of Medical School at Tehran University of Medical Sciences. One hundred and twenty medical faculty members of Tehran University of Medical Sciences were enrolled in this cross-sectional study. They were asked to answer to valid and reliable Persian version of attitude towards plagiarism questionnaire. Attitude toward plagiarism, positive attitude toward self-plagiarism and plagiarism acceptance were assessed. Eighty seven filled-up questionnaires were collected. Mean total number of correct answers was 11.6 ± 3.1. Mean number of correct answers to questions evaluating self-plagiarism was 1.7 ± 0.4 and mean number of correct answers to questions evaluating plagiarism acceptance was 1.4 ± 0.2. There was no significant correlation between plagiarism acceptance and self-plagiarism (r=0.17, P=0.1). It is essential to provide materials (such as workshops, leaflets and mandatory courses) to make Iranian medical faculty members familiar with medical research ethics issues such as plagiarism. © 2012 Tehran University of Medical Sciences.

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50

Acta Medica Iranica

2012

Attitude toward plagiarism among iranian medical faculty members

Ghajarzadeh M., Norouzi-Javidan A., Hassanpour K., Aramesh K., Emami-Razavi S.H.

Objective: To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war. Methods: Data were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war. Results: During 52 days, Tehran was stroked by 118 Al-Hussein missiles (a modified version of Scud missile). Eighty-six missiles landed in populated areas. During Iraqi missile attacks, 422 civilians died and 1 579 injured (4.9 deaths and 18.3 injuries per missile). During 52 days, 8.1 of the civilians died and 30.4 injured daily. Of the cases that died, 101 persons (24%) were excluded due to the lack of information. Among the remainders, 179 (55.8%) were male and 142 (44.2%) were female. The mean age of the victims was 25.3 years±19.9 years. Our results show that the high accuracy of modified Scud missiles landed in crowded areas is the major cause of high mortality in Tehran. The presence of suitable warning system and shelters could reduce civilian casualties. Conclusion: The awareness and readiness of civilian defense forces, rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile attacks are necessary.

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15

Chinese Journal of Traumatology - English Edition

2012

Civilian casualties of Iraqi ballistic missile attack to Tehran, capital of Iran

Khaji A., Fallahdoost S., Soroush M.R., Rahimi-Movaghar V.

[No abstract available]

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8

Archives of Medical Science

2012

Current opinion on treatment of inflammatory bowel disease in pregnant women

Salari P., Nikfar S., Abdollahi M.

Background: Reporting the professional errors for improving patient safety is considered essential not only in hospitals, but also in ambulatory care centers. Unfortunately, a great number of nurses, similar to most clinicians, do not report their errors. Therefore, the present study aimed to clarify the factors associated with reporting the nursing errors through the experiences of clinical nurses and nursing managers.Methods: A total of 115 nurses working in the hospitals and specialized clinics affiliated to Tehran and Shiraz Universities of Medical Sciences, Iran participated in this qualitative study. The study data were collected through a semi-structured group discussion conducted in 17 sessions and analyzed by inductive content analysis approach.Results: The main categories emerged in this study were: a) general approaches of the nurses towards errors, b) barriers in reporting the nursing errors, and c) motivators in error reporting.Conclusion: Error reporting provides extremely valuable information for preventing future errors and improving the patient safety. Overall, regarding motivators and barriers in reporting the nursing errors, it is necessary to enact regulations in which the ways of reporting the error and its constituent elements, such as the notion of the error, are clearly identified. © 2012 Hashemi et al.; licensee BioMed Central Ltd.

11

BMC Nursing

2012

Factors associated with reporting nursing errors in Iran: A qualitative study

Hashemi F., Nasrabadi A.N., Asghari F.

Background Revealing an error to a patient is an important ethical consideration. The present study was designed to explore nurses' perceived concerns regarding error disclosure. Method Information obtained from 80 experienced nurses regarding their error disclosure using focused group discussion method. Data were then analyzed using inductive content analysis method. Results patient's reactions, managers' responses and job insecurities were obtained results. Conclusion Health care systems need to address nurses' concerns in order to prepare a safe ground for error disclosure. Nurses should have access to planned education about nursing errors and the benefits of error disclosure. Also rules on error disclosure should be developed to be implemented by all health organizations. © IDOSI Publications, 2012.

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17

World Applied Sciences Journal

2012

Iranian nurses' concerns regarding error disclosure: A qualitative study

Hashemi F., Nasrabadi A.N., Asghari F.

Objective: The importance of pediatric research especially in the ethically proven trials resulted in considerable legislative attempts in association with compiling ethical guidelines. Because of children's vulnerability conducting pediatric research raises different ethical issues; the two most important of which are informed consent and risk-benefit assessment. Differences in religious and socio-cultural context limit implication of ethical standards.Methods: At the aim of finding a solution we critically reviewed guidelines, and literatures as well as Islamic points in addition to comparing different viewpoints in application of ethical standards in pediatric research.Findings: The literature review showed that pediatric research guidelines and authors' viewpoints have the same basic ethical core, but there are some variations; depend on cultural, religious, and social differences. Furthermore, these standards have some limitations in defining informed consent according to child's age and capacity upon applicationConclusion: In this regard Islamic approach and definition about growth development and puberty sheds light and clarifies a clearer and more rational address to the issue.

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22

IRANIAN JOURNAL OF PEDIATRICS

2012

Key Ethical Issues in Pediatric Research: Islamic Perspective, Iranian Experience

Mobasher, Mina; Salari, Pooneh; Larijani, Bagher

Purpose. Bisphosphonates are the main class of drugs widely used in prevention and treatment of osteoporosis. Along with the beneficial effects, recent studies point to the harms of long-term treatment with bisphosphonates. Methods. The most relevant articles reporting serious adverse effects of bisphosphonates were selected and reviewed with the aim of assessing the risk-benefit of bisphosphonates. We searched PubMed, Web of Science, and Scopus using keywords bisphosphonates, risk of fracture, atrial fibrillation, osteonecrosis jaw, esophageal cancer, and adverse effects with no time limitation. We limited our s research to English articles. Results. Our review shows that bisphosphonates reduce vertebral fractures in short term use while in long-term can cause osteonecrosis jaw, esophageal cancer, atrial fibrillation, and increase the risk of atypical fractures and probably adynamic bone disease. There is no consensus on the time limitation of bisphosphonate usage or its long term adverse effects. Thus, more studies on long-term side effects of bisphosphonates are highly recommended. In addition, new approaches for prevention and treatment of osteoporosis seem necessary. Conclusion. Prescribers should act cautionary and consider full assessment of risk-benefit and the duration of treatment.

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15

JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

2012

Long Term Bisphosphonate Use in Osteoporotic Patients; A Step Forward, Two Steps Back

Salari, Pooneh; Abdollahi, Mohammad

Background This study aims to evaluate the attending surgeons' and residents' attitudes towards error disclosure and factors that can potentially affect these tendencies in major academic hospitals affiliated with Tehran University of Medical Sciences (TUMS). Methods and material In a cross-sectional study, self-administered questionnaires were delivered to all attending surgeons and second to fourth year surgical residents of TUMS during October and November 2009. The questionnaire contained two clinical scenarios and questions regarding physicians' attitudes towards disclosing medical error and their actual practice in the case of their last error. Of the 63 distributed questionnaires, 53 (84.1%) were completed and returned. Results Participants were less likely to disclose minor (39.6%; 21/53) than major (49.1%; 29/53) medical errors. Participants believed that their most important concerns for not disclosing errors were fear of a malpractice lawsuit (71.7%, n=38), losing patients' trust (62.3%, n=33), and emotional reactions of the patients and their relatives (56.6%, n=30). Although most physicians indicated they would disclose errors in minor and major scenarios, only 16.7% (n=8) had disclosed their last medical errors to their patients, two of which had resulted in patients taking legal action. Conclusion There was an obvious gap between surgeons' intentions and actual practices concerning disclosure of medical error. Education in medical error management to professionally support error disclosure might help reduce the gap.

1037

88

Postgraduate Medical Journal

2012

Medical error disclosure: The gap between attitude and practice

Ghalandarpoorattar S.M., Kaviani A., Asghari F.

Studying the situation of observance of patients' rights and interaction of those individuals who provide and/or receive health services are regarded as the most significant and salient parameters of qualitative evaluation of health services. The main aim of this study is to compare the attitudes of patients as recipients of healthcare services with those of physicians and nurses as representatives of healthcare providers regarding the necessity of observance of various aspects of patients' rights in three hospitals selected as representing the three models of providing medical service (teaching, private and public). This was a cross-sectional descriptive analytical study and the data were gathered using a questionnaire. Researchers helped the patients to fill in the questionnaire through interviewing and the physicians and nurses filled in their own questionnaires. The field consisted of three hospitals (a teaching general hospital, a private hospital and a public general one) all located in Tehran. The questionnaires included a set of general questions regarding demographic information and 21 questions about the necessity of observance of patients' rights. They were filled in by the interviewer for 143 patients and, after being sent to other groups, 143 nurses (response rate = 61.3%) and 82 physicians (response rate = 27.5%) filled them in. The criterion for necessity of each right was measured according to the Likert Scale [from 0 (not necessary) to 10 (absolutely necessary]. The data were analyzed using SPSS 11.5 software. Given the abnormal distribution of the data, non-parametrical tests were used. The results of this study showed that all of the study groups agreed with the necessity of almost all aspects of patients' rights and the highest level of disagreement between groups was related to patients' right of access to information and right of choosing provision provider and deciding on treatment plan. However, these disagreements were not significant altogether. According to the results, it seems that healthcare providers, especially physicians, should be better familiarized with patients' right of access to information and right of choosing and deciding. Based on the disagreement between the attitudes of the patients and physicians in this study, it seems that the patients had a higher level of expectations concerning their rights compared to physicians.

5

Journal of medical ethics and history of medicine

2012

Necessity of Observing Patient's Rights: A Survey on the Attitudes of Patients, Nurses and Physicians.

Parsapoor, A; Mohammad, K; Malek Afzali, H; Ala'eddini, F; Larijani, B

Assessment of patients' views about the observance of patients' rights in the health system is of great importance for evaluation of such systems. Comparing views of patients (recipients of health services) and physicians and nurses (health care providers) regarding the observance of various aspects of patients' rights at three hospitals representing three models of medical service provision (teaching, private, and public) is the main objective of this study. This was a cross-sectional descriptive and analytical study, and the information needed was gathered through questionnaires. They were filled out by an interviewer for patients, but self administered by physicians and nurses. The field of study consisted of three hospitals including a general teaching hospital, a private hospital, and a public hospital, all located in Tehran. The questionnaires contained some general questions regarding demographic information and 21 questions concerning the necessity of observing patient's rights. The questionnaires were initially filled out by a total of 143 patients, and then consigned to 143 nurses (response rate = 61.3%) and 82 physicians (response rate = 27.5%) to be completed. The rate of observance of each right was measured on a Likert scale ranging from zero (non-observance) to 10 (full observance). Considering abnormal distribution of the information, it was analyzed with non-parametrical tests using SPSS 11.5 software package. The results of this study showed that the study groups had different views about how well different aspects of patients' rights were observed. The highest level of disagreement was related to the right of choosing and deciding by the patients, which was not satisfactory in the teaching hospital. According to the results, it seems that healthcare providers, especially physicians, should be better informed of patients' right of access to information and right of choosing and deciding. Based on the observed disagreement between the views of the patients and those of the physicians in the present study, it can be asserted that the patients thought that the level of observance of these rights was lower in comparison with what the physicians thought.

5

Journal of medical ethics and history of medicine

2012

Observance of Patient's Rights: A Survey on the Views of Patients, Nurses, and Physicians.

Parsapoor, A; Mohammad, K; Malek Afzali, H; Ala'eddini, F; Larijani, B

Background: Although liver transplantation is the last resort for treating end stage liver diseases, this medical procedure is not available for all needful patients because of inadequate organ supply. Therefore, guidelines have been developed by medical experts to regulate the process. Some professionals believe that medical criteria are inadequate for organ allocation in all situations and may not secure fairness of organ allocation. Objectives: The current study has been designed to identify decision criteria about allocation of donated liver to potential recipients from public points of view. Patients and Methods: This is a qualitative study that was conducted through individual interviews and Focus Group Discussions. Individual interviews were conducted among patients' companions and nurses in one of the two liver transplant centers in Iran. Group discussions were conducted among groups of ordinary people who had not dealt previously with the subject. Data was analyzed by Thematic Analysis method. Results: Most of the participants in this study believe that in equal medical conditions, some individual and societal criteria could be used to prioritize patients for receiving donated livers. The criteria include psychological acceptance, ability to pay post-operative care costs, being breadwinner of the family, family support, being socially valued, ability to be instructed, lack of mental disorders, young age of the recipient, being on waiting list for a long time, lack of patient's role in causing the illness, first time transplant recipient, critical medical condition, high success rate of transplantation, lack of concurrent medical illnesses, not being an inmate at the time of receiving transplant, and bearing Iranian nationality. Conclusions: Taking public opinion into consideration may smooth the process of organ allocation to needful patients with equal medical conditions. It seems that considering these viewpoints in drafting organ allocation guidelines may increase confidence of the society to the equity of organ allocation in the country. This strategy may also persuade people to donate organs particularly after death. © 2012 Baqiyatallah Research Center for Gastroentrology and liver diseases; Published by Kowsar Corp.

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12

Hepatitis Monthly

2012

Organ allocation for liver transplantation according to the public opinion

Danesh A., Nedjat S., Asghari F., Jafarian A., Fotouhi A.

Inflammatory bowel disease (IBD) is fundamentally a relapsing and remitting disease appearing in forms of ulcerative colitis (UC) or Crohn's disease (CD) with a non-well-known etiology. With the hope to prevent adverse drug events and to increase the efficacy of therapies for IBD, in the recent years, other than new monoclonal antibodies such as infliximab, the novel phosphodiesterase inhibitors (PDEIs) have been introduced. Among PDE4Is, rolipram, OPC-6535, mesopram, roflumilast and tetomilast have shown beneficial effects in experimental colitis. Unfortunately until now, human studies have not been successful in showing significant superiority of PDE4Is in the treatment of IBD. Parallel with discovery of PDE4Is and their anti-inflammatory properties, inhibiting other PDE isoenzymes in immune and proinflammatory cells is on the way. PDE7Is have shown synergistic effect with PDE4Is and they may act similar to PDE3Is in experimental settings. Sildenafil as the PDE5I has shown good effects in experimental colitis by balancing oxidantantioxidant status. Although the present data about PDE superfamily and their specific roles in gastrointestinal tract is limited but inhibitors of PDE4, PDE5 and PDE7 seem good candidates as the next generation of effective drugs. The synergistic anti-inflammatory effect of PDE4Is and PDE7Is is also important. © 2012 Informa UK, Ltd.

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21

Expert Opinion on Investigational Drugs

2012

Phosphodiesterase inhibitors in inflammatory bowel disease

Salari P., Abdollahi M.

Introduction: The objective of this study was to assess the views of Tehran citizens in regard to donating their organs in case of brain death. Methods: In this cross-sectional study, conducted between February 2009 and November 2010, two interviewers contacted 1379 people through random digit dialing for phone interviews. Phone calls were made between 6 and 9 pmon a workday, and those reaching companies or organizations were excluded. The interviewee was selected randomly from among the household members, and those 18 yr and older were included in the study. Results: Of the 1379 people eligible for entering the study, 706 consented to have the interview (response rate = 51%). Among the respondents, 84.6% were willing to donate. Of these, 94.6% were willing to complete a donor card as well, but only 10.7% of them already had one. Conclusion: There should be simple processes for the public to declare their decision about organ donation in case of brain death. People should be encouraged to communicate their wishes with others so that family members can decide about their organ donation more easily. © 2012 John Wiley & Sons A/S.

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Clinical Transplantation

2012

Public opinion of organ donation: A survey in Iran

Broumand M., Parsapoor A., Asghari F.

Gout, a medical condition of acute inflammatory joint disorders, has been recognized from the antiquity. However, the name of Rhazes, a Persian historic physician who has described the etiology, signs, symptoms, epidemiology, treatment and prevention of this malady more than a thousand year ago, hasn't been taken into consideration appropriately. In this article, we studied and reported several chapters of Alhawi which is considered the most important Rhazes's medical textbook, focussing on his hypotheses because he has described this disease more manifestly. His original manuscripts are originally written in Arabic and they hadn't been translated to Persian until 1998. We intend to compare Rhazes opinions about gout with those of the literature in the area of rheumatology. According to our findings, Rhazes documented the symptoms of gout and categorized them scientifically. His insights about the treatment of gout, side effects of pharmacotherapy and management of the patients are so interesting and wonderful. Generally most of Rhazes viewpoints about gout are correct and compatible with recent findings. More investigation on Rhazes' viewpoints can guide us to propose more reliable hypothesis and schematize cost effective studies by delving into past medical records.

5

Journal of medical ethics and history of medicine

2012

Rhazes viewpoints about causes, diagnosis, treatment and prognosis of gout.

Tabatabaei, Seyed Mahmoud; Tabatabaei, Seyed Mohammad Ali; Zamani, Mohammad Mahdi; Sabetkish, Nastaran; Roshani, Farnaz

In this study, the prevalence of attention-deficit hyperactivity disorder (ADHD) in kindergarten children in northeast Iran was investigated, and the criterion validity of Conners' parent-teacher questionnaire was evaluated through the use of clinical interviews. This study was a cross-sectional descriptive research project with children in kindergartens that was supported by the Behzisti Organization, which included 155 kindergartens and 4143 children. To study the prevalence of ADHD, cluster random sampling was used; 1083 children were chosen as a reference, and random sampling was used to determine the criterion validity. Twenty-two children scoring below a specified cut-off score and 32 children scoring above the cut-off score were interviewed. In the first stage, ADHD was assessed using Conners' parent-teacher questionnaire, and in the second stage, it was assessed with a clinical interview based on DSM-IV-TR criteria. Finally, the prevalence rate was evaluated with descriptive parameters, and the criterion validity was assessed using the tetracoric correlation coefficient. The prevalence of ADHD was estimated at 12.3% ± 2.12%. Moreover, test sensitivity and specificity were evaluated at 90.3% and 81.2%, respectively. Therefore, the criterion validity with α= 0.05 is 90.3%. The prevalence of ADHD among children was high, suggesting a need to screen all children for ADHD before school age. The Conners' questionnaire proved to be a good test for the primary screening of ADHD among kindergarten children. © 2011 Elsevier Ltd.

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33

Research in Developmental Disabilities

2012

The investigation of ADHD prevalence in kindergarten children in northeast Iran and a determination of the criterion validity of Conners' questionnaire via clinical interview

Abdekhodaie Z., Tabatabaei S.M., Gholizadeh M.

Neglecting patients' rights in a health care system can give rise to a challenging situation between health care providers and patients. The purpose of this study was to compare the views of patients as recipients of healthcare services and physicians and nurses, as healthcare providers, regarding the unsatisfied demands of different aspects of patients' rights in 3 hospitals representing three types of settings (teaching, private, and public). This was a cross-sectional descriptive analytical study. Data were gathered using a questionnaire which was filled out by an interviewer for the patients and self administered for nurses and physicians. The research venues were one general teaching hospital, one first class private hospital, and one non-teaching public hospital, and all 3 were in Tehran. The questionnaire consisted of some general questions about respondents' demographics, and 21 questions concerning the importance of patients' rights, and how well patients' rights were observed. Overall, 143 patients, 143 nurses (response rate: 61%) and 82 physicians (response rate: 27.5%) completed the questionnaire. The degrees of unsatisfied demands were different depending on the various views within each group regarding the degree of importance and observance of each right, which was measured by the Likert's scale ranging from 0.0 (no importance, no observance) to 10.0 (absolutely important, full observance). Concerning the non-normal distribution, the collected data were analyzed by non-parametric tests using the SPSS software (ver. 11.5). Results showed that the studied groups had significantly different views. The most prominent issue concerned patients' to make an informed decision, which was particularly unsatisfactory in the teaching hospital. The results of this research indicate that healthcare providers, especially physicians, need to be informed to show more respect for patients' rights in terms of access to clinical information and making decisions. The results demonstrated that there was a significant difference between the opinions of patients and health care providers regarding the extent of unsatisfied demands of patients' rights. According to the patients, the level of unsatisfied demands of these rights is far higher than that expressed by physicians.

5

Journal of medical ethics and history of medicine

2012

Unsatisfied patient's rights: A survey on the views of patients, nurses and physicians.

Parsapoor, Alireza; Mohammad, Kazem; Afzali, Hussein Malek; Ala'eddini, Farshid; Larijani, Bagher

The relationship between cardiovascular diseases (CVD) and osteoporosis two common disease in aged people has been theorized since several years ago but many controversies exist yet. In this study, the role of inflammatory cytokines in both diseases has been studied in depth. In the pathophysiology of diseases, estrogen deficiency (in women), oxidative stress, vitamin K deficiency, vitamin D overload, secondary hyperparathyroidism, hyperhomocysteinemia and inflammation play substantial role. Meanwhile, drug therapy of each disease may affect the other one, a spectacle potentiating the common inflammatory link theory. Results of this review indicate that cytokines or proteins such as interleukin (IL)-1, IL-6, IL-11, IL-12, IL-15, IL-17, tumor necrosis factor-α (TNF-α), interferons, macrophage colony stimulating factor (M-CSF), granulocyte M-CSF (GM-CSF), receptor activator of nuclear factor KB ligand (RANKL), osteoprotegerin (OPG), osteopontin (OPN), osteonectin, bone morphogenic proteins (BMPs), bone morphogenic protein-2 (BMP-2), transcription factor for osteoblasts differentiation (Runx2), C-reactive protein (CRP), cyclooxygenase (COX), oxidized LDL, paraoxonase, lysosomal cysteine protease cathepsin K and platelets are shared in the pathophysiology of both diseases. Accordingly, drugs such as bisphosphonates, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors known as statins, non-steroidal anti-inflammatory drugs (NSAIDs), anti-platelet drugs such as clopidogrel or ticlopidine and phytoesteroges affect conditions of both diseases. The inflammatory elements sharing in pathogenesis of both CVD and osteoporosis lead us to revise developments of new drugs in this specific area of science that is much relevant to the health of elderly people who are increasing in developed world. © 2011 Asian Network for Scientific Information.

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7

International Journal of Pharmacology

2011

A comprehensive review of the shared roles of inflammatory cytokines in osteoporosis and cardiovascular diseases as two common old people problem; actions toward development of new drugs

Salari P., Abdollahi M.

The association between cardiovascular diseases and senile chronic diseases has been thought from many years ago. Osteoporosis is one of the major senile and chronic disease which accounts for high morbidity and mortality as well as high cost among elderly patients. Concerning the importance of prevention and treatment of cardiovascular disease as well as osteoporosis, and the pleiotropic effects of statins, the theory of the beneficial effects of statins on bone was proposed from different aspects such as the effect of statins on bone formation, bone resorption, bone mineral density and fracture risk. The probable link between cholesterol synthesis and bone metabolism has been also suggested. Regarding the link between cardiovascular disease and osteoporosis, in vitro studies show beneficial effects of statins on bone formation, however, most of clinical trials do not completely confirm the issue. Meanwhile, some investigators believe in the impact of statins on bone turnover. However, there is no conclusive data and agreement yet to recommend use of statins neither as a treatment nor prevention of osteoporosis. More longitudinal studies in different ethnicities with large sample sizes are suggested. © 2011 Asian Network for Scientific Information.

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International Journal of Pharmacology

2011

A systematic review on the relation between use of statins and osteoporosis

Sharif P.S., Abdollahi M.

Aim This study was conducted to assess interns' level of exposure to different aspects of professional attitude and behaviour among faculty and residents.Methods In this descriptive study, 218 interns in surgery and internal medicine wards at four teaching hospitals of Tehran University of Medical Sciences were enrolled during the first semester of the 2007/2008 academic year. Each intern completed one questionnaire for faculty and one for residents in their ward.Results The questionnaire was completed by 150 students (68.8%) for faculty and by 139 students (63.7%) for residents. In terms of overall aspects of professionalism, the mean (+/- SD) score on observing professionalism was 52.9 +/- 10 and 49.26 +/- 7.9 points out of 70 for faculty and residents, respectively. Students agreed that responsibility was observed better than other aspects of professionalism (119/150 (79.3%) and 115/139 (82.8%) students stated it was often or always observed by faculty and residents, respectively). In both groups, commitment to honour and integrity and excellence was less compared with other areas.Conclusion Medical faculty and residents should be more aware of their behaviour and attitudes in practice, especially their interaction with colleagues so that students' professional behaviour can be improved.

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87

POSTGRADUATE MEDICAL JOURNAL

2011

Are we proper role models for students? Interns' perception of faculty and residents' professional behaviour

Asghari, Fariba; Fard, Nazila Nikravan; Atabaki, Arash

In the recent years, the role of a pharmacist has been significantly changed. Traditionally, in the late 20th century, a pharmacist's role was considered as merely dispensing medication to patients. This view however, has been significantly altered, and, today, a pharmacist is supposed to provide patients with information regarding the medication they are to take, as well as on different aspects of their disease. Therefore, one can suggest that some other factors have recently come into play in the daily tasks of a pharmacist such as accountability and authority. The current cross-sectional survey is conducted on a cohort of community pharmacists attending a continuing education program. A questionnaire comprised of 26 Likert-type scale questions was designed to assess pharmacists' attitude towards professionalism and its subscales which are defined later in detail. A total number of 1000 pharmacists were surveyed and 560 of them filled and returned the questionnaires. On a scale from 1-5 on which 1 was corresponded with strongly agree and 5 with strongly disagree, the total score of pharmacists professionalism was 92.9 ± 10.4 out of 130. As regards the subscales, in the subscale of accountability 46.8% of participants, in the subscale of altruism 90.1% of participants, in the theme of duty 85.7% of participants, and in the subscale of working relationship with physicians 84% of pharmacist achieved more than two third of the total score. Only in term of conflict of interest 67.9% of participants scored less than two third (17-25) of the total score. Women obtained significantly higher scores in altruism (P&gt;0.05). Furthermore, there was a correlation between age and the score of accountability and working relationship with physicians; and, the same was observed in regards with work experience with the score of working relationship with physicians. The employment position affected neither our participants' response to the whole questionnaire nor any of subscales. Although the total score for professionalism was not dramatically decreased, the significantly low results are alarming and they should be considered more seriously. In order to enhance the level of pharmacists' professionalism, especially in some special aspects, it seems necessary to conduct similar surveys on pharmacy students and registered pharmacists with a more comprehensive questionnaire. Overall, it can be concluded that designing a proper teaching course in professionalism for pharmacy students is of paramount importance if we are to promote professionalism in future pharmacists. © 2011 Hossein Dargahi.

4

Journal of Medical Ethics and History of Medicine

2011

Assessment of professionalism in Iranian pharmacists

Javadi M., Asghari F., Salari P.

[No abstract available]

4

7

Archives of Medical Science

2011

Behind the pathogenesis of osteoporosis and cardiovascular diseases

Salari P., Abdollahi M.

Osteoporosis as a common chronic disease is challenging human health. Although different therapeutic options are routinely used for prevention/treatment of osteoporosis, their side effects and benefits are under question. Increasing our knowledge about signaling pathways in bone and osteocytes as well as osteoblasts and osteoclasts will help us in designing new therapeutic modalities for osteoporosis. In the present study, all new therapeutic measures of osteoporosis have been reviewed. For this purpose, search engines like Pubmed, Web of Science, Scopus, Google Scholar were searched and all relevant articles were found. The study was limited to the year 1998-2010. Bisphosphonates are the cornerstone of osteoporosis treatment, but there are not enough relevant studies that investigated their equivalencies in comparison with each other or the other medications. Therefore, medication selection is empirical and subjective. Furthermore, no eminent study has compared certain combinations. There are new hopes for treatment of osteoporosis, which are more specific with less harm. Our results show that new and emerging therapies are more potent and target specified which more individualize osteoporosis treatment; however, more investigations on their safety and efficacy in comparison with current medications are highly recommended. © 2010 Springer-Verlag.

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31

Rheumatology International

2011

Current, new and future treatments of osteoporosis

Salari Sharif P., Abdollahi M., Larijani B.

Introduction: Golestan, a province located north of Persian Gulf in northeastern part of Iran is a well known area for high risk of esophageal cancer (EC) in the world. There is no information about healthcare utilization in populations residing in the area. This study was conducted to assess utilization of healthcare and its associated factors among esophageal cancer patients in this region as well as to address ethical implication of this utilization. Methods: All new cases of EC in Golestan province during year of 2007 were recruited. Seven diagnostic and five therapeutic services were used to assess diagnostic utilization index (DUI), and therapeutic utilization index (TUI), respectively. Multivariate regression analysis was used to assess the relationship between variables and DUI or TUI. P-value of less than 0.05 was considered as statistically significant. Results: Tow hundred twenty three, patients were enrolled with mean (Standard Deviation) age of 64.3 (12.5) years with 57.8% male. We observed that occupation (P<0.01), ethnicity (P<0.01) and sex (P=0.03) were strongly associated with DUI. Insurance coverage (P<0.01), place of residency (P<0.01), and occupation (P=0.01) were associated with TUI. Conclusion: We concluded that several factors contribute to disparity in healthcare utilization in the studied population.

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12

Asian Pacific Journal of Cancer Prevention

2011

Healthcare utilization in patients with esophageal cancer in a high risk area in northeast of Iran

Roshandel G., Majdzadeh R., Keshtkar A., Aramesh K., Sedaghat S.M., Semnani S.

[No abstract available]

6

7

International Journal of Pharmacology

2011

New horizons in management of inflammatory bowel disease

Salari P.

Recently, exenatide as an incretin mimetic was approved by FDA as an adjunct to diet and exercise in treating type 2 diabetes. Therefore comparing every new medication with insulin can provide more clues about the real benefit of paying extra budget for new drugs. In this meta-analysis we compared the efficacy and tolerability of exenatide to insulin. The literature search provided 1016 articles while only 5 articles were eligible to be included in the meta-analysis with a total of 1404 patients enrolled in the study. The results show that there is no superiority for exenatide over insulin even in its weight reduction advantage. However, the high risk of gastrointestinal side effects including nausea and vomiting is of major concern. Current evidence does not support the advantage of exenatide over insulin but more clinical trials are needed to reach a convincing conclusion. © 2011 Asian Network for Scientific Information.

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7

International Journal of Pharmacology

2011

No Superiority of exenatide over insulin in diabetic patients in Terms of Weight Reduction or Incidence of Adverse Effects: A Meta-analysis

Salari P., Nikfar S., Abdollahi M.

Introduction: Substitute decision making on behalf of incapable patients is based on the ethical principle of 'respect for autonomy'. This study was conducted to assess patients' wishes and preferences in terms of a substitute decision maker and determinants of such preferences. Methods: The authors conducted a cross-sectional study and selected samples randomly from patients presenting at Farabi Eye Hospital clinics who were 18 years of age or older. Questionnaires were completed through interviews. Results: 200 patients between the ages of 18 and 83 years were interviewed. About 52% (N=105) were men and 73% (N=77) were married. Among married patients, the spouse was chosen as the substitute decision maker in only 51% of cases. Single men preferred their father first in 36% (N=9) of cases, while single girls chose their father in 5.6% (N=1) of cases and their most prevalent choice was other unmentioned people (33.3%, N=6). Most patients (93.5%) wished to be asked about their substitute decision maker when hospitalised. Conclusion: The results of this study show that the people we usually consult for decisions concerning patient treatment are significantly different from the patients' preferred substitute decision makers. The authors suggest patients be allowed to choose their substitute decision maker while conscious.

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Journal of Medical Ethics

2011

Patients' perspectives of the substitute decision maker: Who makes better decisions?

Mirzaei K., Milanifar A., Asghari F.

Alterations in pharmacy practice from prescription dispensing to more patient-centered relationship intensifies the necessity of clinical decision-making. Pharmacists' knowledge as well as ethical reasoning affects their clinical decision-making. Unfortunately in Iran pharmacy ethics did not develop along with medical ethics and special considerations are of major importance. The study was designed to evaluate pharmacists' attitude toward some principles of bioethics. A cross-sectional survey was performed on a sample of Iranian pharmacists attended in continuous education programs in 2010. Based on the pharmacists' attitude toward common ethical problems, 9 Likert-type scale scenarios were designed. A thousand pharmacists were surveyed and 505 questionnaires were filled. For the whole questionnaire the strongly disagree answer was the most ethical answer. On a scale from 1-5 on which 5=strongly disagree, the total score of pharmacists ethical attitude was 17.69 ± 3.57. For easier analysis we considered the score of 1 for agree and strongly agree answers, score of 2 for neutral answers and score of 3 for disagree and strongly disagree answers. The total score in confidentiality for all participants was 4.15 ± 1.45 out of 9, in autonomy 6.25 ± 1.85 out of 9, in non-maleficence 5.14 ± 1.17 out of 6 and in justice was 2.27 ± 0.89 out of 3, however there was no significant difference between men and women in the total score and the score of each theme. The older participants (> 40 years) significantly had lower total score (P< 0.05) as well as the score of each theme (P< 0.05), except for non-maleficence. The work experience showed impact on the pharmacists' attitude toward autonomy and the participants with more than 5 years work experience significantly obtained lower score in this theme. Compiling ethical guidelines and improving pharmacy ethics curriculum is highly critical to provide the best pharmaceutical care and to make clinical decisions in critical situations. Therefore further quantitative and qualitative investigations into finding pitfalls and challenges in this issue are highly recommended.

4

Journal of medical ethics and history of medicine

2011

Pharmacy ethics: evaluation pharmacists' ethical attitude.

Sharif, Pooneh Salari; Javadi, Mohammadreza; Asghari, Fariba

Phytoestrogens as selective estrogen receptor modulators like compounds may consider as a therapeutic option in osteoporosis. In this regard, the effect of phytoestrogens on bone biomarkers was examined in several trials which their results are controversial. We aimed this meta-analysis to evaluate the net effect of phytoestrogens on bone markers. A thorough search was conducted from 2000 to 2010 in English articles. All randomized clinical trials were reviewed, and finally, 11 eligible randomized clinical trials were selected for meta-analysis. Totally 1,252 postmenopausal women were enrolled in the study by considering the changes of pyridinoline (Pyd), desoxypyridinoline (Dpyd), bone alkaline phosphatase, and osteocalcin concentrations in urine and serum after phytoestrogens consumption. The urine Pyd and Dpyd levels decreased significantly in phytoestrogens consumers. Effect size and effect size for weighted mean difference of urine Pyd levels showed -1.229171 (95% confidence interval (CI) = -1.927639 to -0.530703) and -9.780623 (95% CI = -14.240401 to -5.320845), respectively, a significant results in comparison to control group and significant results for Dpyd -0.520132 (95% CI = -0.871988 to -0.168275) and -0.818582 (95% CI = -1.247758 to -0.389407), respectively. Meta-analysis indicates that phytoestrogens intake can prevent bone resorption, but its benefits on bone formation are not significant. This favorable effect was observed in low doses and in at least 3 weeks of phytoestrogens intake.

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33

AGE

2011

Prevention of bone resorption by intake of phytoestrogens in postmenopausal women: a meta-analysis

Sharif, Pooneh Salari; Nikfar, Shekoufeh; Abdollahi, Mohammad

In this project, we aimed to revise the medical ethics curriculum at the School of Medicine, Tehran University of Medical Sciences, in order to promote the level of students' ethical awareness and enable them to make ethical decisions. Ideal and long term educational objectives were set to determine directions for future reforms and to provide a baseline for future evaluation of the project. However, based on limited available recourses, the first stage of the reform was planned and implemented with a 3 years scope. In revising the curriculum, which was done according to the Harden's ten questions, we focused on moral attitude and ethical reasoning skill in addition to academic knowledge base by using methods such as case discussions, portfolio, and clinical ethics rounds. The revised curriculum was implemented during the first semester of the 2006-2007 academic year for the first time. The student feedback indicated that the new curriculum was successful in increasing the students' awareness of ethical issues and enabled them to understand and accept their professional obligations. Revising the curriculum and its evaluation should be considered as an ongoing process. The present project was a successful experience that motivated faculty members to pursue the next steps of improving the curriculum on medical ethics and proved to be convincing for the authorities and policy makers to support it.

4

Journal of medical ethics and history of medicine

2011

Reform in medical ethics curriculum: a step by step approach based on available resources.

Asghari, Fariba; Mirzazadeh, Azim; Samadi, Aniseh; Safa, Aliakbar Nejati; Jafarian, Ali; Farahani, Ali Vasheghani; Razavi, Seyed Hasan Emami

[No abstract available]

6

7

International Journal of Pharmacology

2011

Successes in understanding pathophysiology of osteoporosis

Salari P.

Several drugs are used in the treatment of irritable bowel syndrome (IBS) but all have side effects and variable efficacy. Considering the role of the gut-brain axis, immune, neural, and endocrine pathways in the pathogenesis of IBS and possible beneficial effects of benzodiazepines (BZD) in this axis, the present systematic review focuses on the efficacy of BZD receptor modulators in human IBS. For the years 1966 to February 2011, all literature was searched for any articles on the use of BZD receptor modulators and IBS. After thorough evaluation and omission of duplicate data, 10 out of 69 articles were included. BZD receptor modulators can be helpful, especially in the diarrhea-dominant form of IBS, by affecting the inflammatory, neural, and psychologic pathways, however, controversies still exist. Recently, a new BZD receptor modulator, dextofisopam was synthesized and studied in human subjects, but the studies are limited to phase II b clinical trials. None of the existing trials considered the neuroimmunomodulatory effect of BZDs in IBS, but bearing in mind the concentration-dependent effect of BZDs on cytokines and cell proliferation, future studies using pharmacodynamic and pharmacokinetic approaches are highly recommended. (C) 2011 Baishideng. All rights reserved.

38

17

WORLD JOURNAL OF GASTROENTEROLOGY

2011

Systematic review of modulators of benzodiazepine receptors in irritable bowel syndrome: Is there hope?

Salari, Pooneh; Abdollahi, Mohammad

Accompanied with various opinions across cultures, truth telling is a major debate in bioethics. Many studies have focused on attitudes toward truth disclosure. We intend to review several relevant research studies, and discuss the issue through a clinical case consultation. It seems that while the right to know is emphasized in bioethics, in some cultural contexts, health professionals fear communicating bad news. The patients may not receive information directly, because it is believed that the truth may make the patient feel hopeless and unable to cope with the problem. Nevertheless, some believe that sharing information may strengthen a trusting relationship between patients and medical professionals. Extensive efforts are in process in some societies to make patient rights to know the truth as a natural part of medical practice. However, in some cases, the principles of respect for patient autonomy require us to accept patient's refusal to know the truth, with the provision that he assigns someone to receive information and make medical decisions on his behalf. In conclusion, it is suggested that healthcare professionals should not act on a unique presumption in all cases and they should explore what the real interest of patient is, in order to respect individual autonomy. © 2012 Farzaneh Zahedi; licensee Tehran Univ. Med. Sci.

4

Journal of Medical Ethics and History of Medicine

2011

The challenge of truth telling across cultures: A case study

Zahedi F.

Recent investigations in finding new drugs in the treatment of diabetes have led to the discovery of several pathological pathways involved in diabetes. Exenatide a drug with incretin mimetic activity was studied in several in vivo and in vitro as well as human studies. It has shown promising results in controlling metabolic indices in type-2 diabetes and was approved by FDA but still there is an active safety alert on it. In this study we aimed to meta-analyze all placebo-controlled clinical trials on the efficacy or tolerability of exenatide in type 2 diabetes. The literature search provided 1016 articles while only 14 articles were eligible to be included in the metaanalysis with a total of 2583 patients enrolled in the study. According to the wide variation in design of various studies, the study duration of 16 weeks and less or more and dose (5 μg bid versus 10 μg bid) were considered and analyzed. The results of this meta-analysis show that exenatide decreases fasting plasma glucose and HbA1C significantly regardless of dose and study duration. The effect of exenatide on weight reduction was more prominent at the dose of 10 μg bid regardless of the study duration, however at the dose of 5 μg bid, significant results were observed after drug administration for more than 16 weeks. Exenatide usage decreased serum triglycerides indifferent to dose and study duration while its effect on cholesterol was not prominent. Along with these impacts, exenatide changed LDL and HDL cholesterol at the lower dose. The hemodynamic effect of exenatide was observed as significant decrements in systolic and diastolic blood pressure at the higher dose. The risk of nausea, vomiting and hypoglycemia was significant and indifferent to dose while headache and nasopharyngaitis were seen more at lower dose. It is concluded that exenatide can be considered as a good hypoglycemic agent in type-2 diabetic patients with benefits on lipid profile and blood pressure with partially questionable tolerability.

1

15

Journal of Pharmacy and Pharmaceutical Sciences

2011

The efficacy and tolerability of exenatide in comparison to placebo; a systematic review and meta-analysis of randomized clinical trials

Nikfar S., Abdollahi M., Salari P.

Discrimination in service delivery can interfere with follow-up care, service receipt, and return to normal quality of life. This study was conducted to assess and compare patients' perception of caregivers' behaviour and attitudes in two groups; self-immolation and cases of unintentional burn. This study was conducted at the burn unit of Taleqani Hospital in Ilam in 2008. All patients admitted to the burn unit over a 6-month period from September 2008 to March 2009 were enrolled. In the total of 116 patients, 57 cases of self-immolation and 59 cases of unintentional burns were studied. Data were generated through interviews and questionnaires. Among the hospitalised cases, 49.1% were cases of self-immolation. Medical staff behaviour and attitudes were judged as relatively good or good in 86.5% and 68.4% of unintentional burn and self-immolation patients, respectively (P = 0.011). This inter-group difference was only dependent on the nature of burns (self-immolation vs. unintentional), and other studied variables did not significantly affect results. The stigma of self-immolation should not impair the quality of care or the behaviour and attitudes of caregivers. It is necessary to train and monitor staff in this regard so that cases of self-immolation can receive services without discrimination. © 2010 Elsevier Ltd and ISBI. All rights reserved.

1

37

Burns

2011

Treating patients differently: Comparison of medical-staff behaviour and attitudes towards cases of self-immolation and unintentional burns

Zargoushi R., Asghari F., Zeraati H., Fotouhi A.

Nowadays β-blockers are commonly used for a broad spectrum of diseases including cardiovascular diseases but their effects on the bone are an issue of concern. Animal studies support their protective effects on bone however, human studies are controversial. We followed this issue by conducting a systematic review of all existing materials through all available search engines. Results indicate a major controversy existing among studies. Most of studies are limited to lack of considering pharmacokinetic/pharmacodynamic properties of this class of drugs, Body Mass Index (BME) as well as physical activity of patients, adequacy of sample size or ability to sub-analyze data, smoking behavior and patients' lifestyle that all can be a source of bias and cause controversy. Further studies by paying attention to above-mentioned bias sources are highly recommended to help making sure about the safety of this class of medications on bone. © 2010 Asian Network for Scientific Information.

5

6

International Journal of Pharmacology

2010

A systematic review on the relationship between β-blockers and bone health

Salari Sharif P., Abdollahi M.

Financial shortage in resource-limited and poor countries restricts treatment in HIV-infected patients especially in poor countries. Higher HIV prevalence in poorer countries makes drug rationing a real concern. Different countries solve the problem with different methods regarding WHO guidelines, but fairness and equity should be a major consideration in drug rationing. This paper is aimed at reviewing different strategic approaches to drug rationing in AIDS treatment and then discusses pharmacists' role. In conclusion, there is no fair and equitable strategy, and in each society, cultural, ethical and socioeconomic issues along with considering a critical role for pharmacists must be taken into account. © 2010 Pooneh Salari Sharif and Mahshad Noroozi; Licensee Tehran Univ. Med. Sci.

3

Journal of Medical Ethics and History of Medicine

2010

AIDS and drug rationing

Sharif P.S., Noroozi M.

[No abstract available]

4

1

AJOB Primary Research

2010

An Iranian study or a kashanian one?

Aramesh K.

Background: This study aims at evaluating doctors' attitudes towards handling medical errors made by their peers. Materials: This cross-sectional questionnaire survey was conducted between April and July 2006 and targeted general practitioners attending continuing medical education programmes in Tehran. A total of 474 doctors were approached, 400 of whom completed the questionnaire. The questionnaire contained a clinical vignette with three hypothetical patient outcomes: near-miss, leading to harm, and leading to death. The participants were asked how they would deal with each case. They were also asked how they would prefer their peers to react when they themselves made a medical error. Results: The most common attitude toward peers' medical errors was reporting it to the original doctor and asking them to disclose it to the patient (near-miss: 63.0%; 95% CI 58% to 68%; leading to harm: 70.0%; 95% CI 65.4% to 74.6%; and leading to death: 62.5%; 95% CI 57.5% to 67.5%). In most cases, doctors expected their peers to report their medical errors to them (92.7%; 95% CI 89.7% to 93.0). About 67% of the participating doctors had encountered a peer's medical error in the past 6 months, although 90% of them had received no or very little training in dealing with this issue. Discussion: The most acceptable approach to dealing with a peer's medical error is to report it to the responsible doctor and encourage them to disclose it to the patient.

1012

86

Postgraduate Medical Journal

2010

Doctors' views of attitudes towards peer medical error

Asghari F., Fotouhi A., Jafarian A.

Objectives This study aimed to examine the most common and important ethical issues confronting medical students during clinical rotations so that ethics-related topics can be prioritised according to students' needs and this information used to develop a curriculum for the ethics course. Methods In a cross-sectional approach, we reviewed the medical ethics-related cases recorded in the logbooks of all medical students (n = 241) at Tehran University of Medical Sciences who attended the medical ethics course during October 2006 to July 2007. As part of a graded assignment, each student was required to record three encounters with ethics-related issues in his or her logbook. A total of 713 cases were assessed. Information related to the ethical issues and the conditions in which ethical issues arose was extracted and recorded by two experts, whose analysis showed agreement of kappa 0.77. In cases of discrepancy, both experts reviewed and discussed the record until they achieved agreement. Results A total of 713 cases were analysed. The most common issues reported by students related to ethics in medical education (20.1%, n = 143), professionalism (18.8%, n = 134), confidentiality (7.6%, n = 54), the doctor-patient relationship (7.3%, n = 52), informed consent (7.0%, n = 50) and the doctor-peer relationship (7.0%, n = 50). After adjusting for length of rotation, the highest numbers of ethics-related incidents were reported from urology, general surgery, orthopaedics, internal medicine, neurology, and obstetrics and gynaecology wards. Conclusions The results of this study indicate that professionalism and related elements represent one of the most important areas of concern that need to be addressed when planning courses for medical students. The other significant area of concern is that of ethics in medical education, which, although the subject is not considered essential for medical practitioners, should be taught and respected so that student sensitivity to medical ethics is maintained and even increased. © Blackwell Publishing Ltd 2010.

7

44

Medical Education

2010

Ethical issues confronted by medical students during clinical rotations

Fard N.N., Asghari F., Mirzazadeh A.

In this study we discuss our experience of including an ethics objective structured clinical examination (OSCE) station in endocrinology board exam. One OSCE station on truth telling was developed and a standardized patient was trained for role playing in this station. Based on a pilot study, the evaluation checklist got modified. Then the finalized station added into the OSCE phase of endocrinology board exam. Based on this experience, adding ethics station in board exams is practical and reasonable. Since OSCE method could evaluate students' ethical decision making and communication skill it could be used in combination with other kinds of evaluation in assessing ethics competency of graduates. Using this method could push the ethics learning approach toward more practical and skill based ones.

3

Journal of medical ethics and history of medicine

2010

Evaluation of moral competency using standardized patient: presenting an experience.

Asghari, Fariba; Larijani, Bagher

Inflammatory bowel disease (IBD) is known as a chronic inflammation of gastrointestinal tract that its pathogenesis still is not completely understood. Several drug categories are used for management of IBD but there is no exact cure for the disease, however biological drugs targeting the inflammation of gut are on the center of attention. In investigating the anti-inflammatory drugs, phosphodiesterase inhibitors were found to be effective in different inflammatory disorders. Of them phosphodiesterase 4 (PDE4) inhibitors are considered for treatment of asthma and chronic obstructive pulmonary disease (COPD). Some of the PDE4 inhibitors showed promising efficacy in animal studies, however to date no phase III clinical study showed their effectiveness in IBD. The present study has the most relevant studies in this field. PDE4 inhibitors affect IBD in different ways including anti-inflammatory, anti-depressant, and anti-fibrotic effects. Unfortunately, the most common side effect of PDE4 inhibitors is nausea which limits its use. Tetomilast the second generation of PDE4 inhibitors showed promising effects in phase II studies with better safety profile. Other drugs in this class are ongoing phase II and III trials. © 2010 Bentham Science Publishers Ltd.

33

16

Current Pharmaceutical Design

2010

Phosphodiesterase 4 inhibitors in inflammatory bowel disease: A comprehensive review

Salari-Sharif P., Abdollahi M.

Recently, n-3 fatty acids are in the center of attention for their potent anti-inflammatory effects. Osteoporosis as a chronic senile disease is associated with inflammation, and the role of inflammatory mediators has been demonstrated in recent years. The beneficial effects of n-3 fatty acids on bone were proven in many animal studies, while to date, no conclusive data is available in human. The aim of this study was to evaluate the impact of n-3 fatty acids on bone biomarkers in osteoporotic postmenopausal women. Twenty-five osteoporotic postmenopausal women were recruited in the study and randomized in treatment and control groups. The patients received 900 mg n-3 fatty acid capsules or placebo per day for 6 months. Serum levels of osteocalcin, bone alkaline phosphatase (BALP), calcium, vitamin D, and parathormone and urine concentration of pyridinoline (Pyd) were measured at baseline, second month, and sixth month in both groups. In the treatment group, compared with baseline, at the second month, osteocalcin increased slightly; thereafter, it showed decrement trend until the end of the study. In the control group, it decreased all over the study. None of these changes was significant. BALP showed nonsignificant decrease from baseline over the time in both groups. Urine level of Pyd decreased significantly (P < 0.05) in the treatment group, while no significant change was seen in the control group. Serum calcium and vitamin D increased in both groups; however, changes were not significant. No significant changes were seen in calcium clearance and parathormone. In conclusion, n-3 fatty acids can decrease bone resorption; however, it could not affect bone formation significantly after 6 months treatment. Further investigations are recommended.

2

32

AGE

2010

The effect of n-3 fatty acids on bone biomarkers in Iranian postmenopausal osteoporotic women: a randomized clinical trial

Sharif, Pooneh Salari; Asalforoush, Mahsa; Ameri, Fatemeh; Larijani, Bagher; Abdollahi, Mohammad

Platelets play a critical role in wound healing and hemostasis, as well as in repairing bone fracture. The impact of platelets on inflammation and inflammatory diseases has been appreciated. It has been demonstrated that inflammation and oxidative stress are intimately involved in the pathogenesis of osteoporosis. Degranulation of platelets, anuclear cell fragments, leads to the release of different growth factors and chemoattractants affecting bone metabolism. The net effect is, however, not fully understood. The current review is aimed to examine available studies on the impact of platelets on bone health. We searched data from Scopus, PubMed and Web of Science using keywords such as platelets, osteoblasts, osteoclasts, bone, antiplatelet drugs, bone formation, and bone resorption. As hypothesis of the review is emerging, a small number of in vivo and in vitro studies were found. Based on the available data, platelets and platelet-derived numerous immune and inflammatory agents can be viewed as targets for therapeutic and/or preventive measures in osteoporosis.

5

9

Inflammation & Allergy Drug Targets

2010

The Role of Platelets in Bone Remodeling

Sharif, Pooneh Salari; Abdollahi, Mohammad

Background: To identify the most important expectations that patients have from their physicians. Methods: We collected data from 199 hospitalized and 201 ambulatory patients (response rates 88% and 93% respectively). We used random sampling for selection of hospitalized patients and systematic sampling for the ambulatory ones. The questionnaire consisted of 18 different expectation items categorized in 5 domains. The participants scored each item from 1 to 9 using a VAS scale and ranked domains based on their importance. We analyzed the data using univariate and regression analyses. Results: Among the ambulatory patients, the mean±standard error of the most important expectations was as follows: competency (8.9±0.01), courteousness (8.8±0.04), consultation in case of need (8.8±0.4), clear explanation of the disease (8.8± 0.05) and attentiveness (8.8±0.04). In hospitalized patients, the following items were the most important: competency (8.4± 0.08), courteousness (8.4±0.09), availability of physician (8.4±0.09), consultation in case of need (8.2±0.11), setting following appointments (8.2±0.1), and disease follow-up (8.2±0.09). In both groups, the most important domain of expectations was "competency and quality of care" followed by "availability" in hospitalized and "giving information and patient autonomy" among ambulatory patients. Conclusions: Our findings are similar to what reported in the literature from other countries and cultures. In addition to physician expertise and knowledge, patients value giving information and efficient doctor-patient relationship.

1

39

Iranian Journal of Public Health

2010

What do patients expect from their physicians?

Dormohammadi T., Asghari F., Rashidian A.

[No abstract available]

8

9

American Journal of Bioethics

2009

A closer look at the abortion debate in Iran

Aramesh K.

One of the most important occupational tensions a physician encounters in his/her practice is the complaints lodged against him/her by the patients. The purpose of this study is examining the complaints against physicians and dentists entering the Medical Council Organization of Tehran in the years ending on 20 March 1992, 20 March 1997 and 20 March 2002 from the viewpoint of number, dispersion and inducing factors. The present study was performed as a descriptive and retrospective one with the aid of a questionnaire containing concerned data. Filling in the questionnaire or studying the file was accomplished by a trustee expert of the Medical Council Organization and the data obtained were analyzed after classification. During a 3-year period, 832 complaints were lodged against physicians and dentists. The complaints against physicians in the years ending on 20 March 1997 and 20 March 2002 were 70% more than that in the year ending on 20 March 1992. 83.1% of the physicians and dentists of Tehran that were sued had not been convicted until the date of the performance of the study, on the basis of the contents of the files, and had no malpractice from the vantage point of the Medical Council Organization. The most common causes of complaints from the viewpoint of complainers were therapeutic errors (38%), neglect (30.2%), financial affairs (25.4%) and the physicians' lack of skill (17.7%). On the basis of this study, with the increase of the doctor's practice track record and experience more than 15-20 years, the number of the complaints decreases and most of the complaints are against the middle-aged doctors/dentists with 10-20 years of experience. Most physicians and dentists of Tehran having been sued have not committed any wrong from the vantage point of the Medical Council Organization experts and a large part of the complaints are a consequence of doctor-patient inconvenient interactions. A behavior based on professional commitment of the physician/dentist vis-à-vis the patient can hinder a major part of complaints. © 2009 Ali Jafarian et al. licensee Tehran Univ. Med. Sci.

2

Journal of Medical Ethics and History of Medicine

2009

A survey of the complaints entering the medical council organization of tehran in three time periods: The years ending on 20 march 1992, 20 march 1997 and 20 march 2002

Jafarian A., Parsapour A., Haj-Tarkhani A., Asghari F., Razavi S.H.E., Yalda A.

The growing developments in science and technology have raised ethical challenges which should practically be addressed by scientists, regulatory bodies and policy makers. Likewise, challenging issues of medical ethics have also drawn a great deal of academic attention in Iran. In other words, recent decades have been an occasion of considerable development for contemporary bioethics in Iran. At first, the ongoing initiatives to arrange the national and regional research ethics committees and to compile the national strategic plan for medical ethics is worth mentioning. Currently, research ethics committees are actively established in the universities and research centers across the country. Furthermore, the subject of ethics in different fields of science, which was followed in a traditional approach previously, is an important object of discussion currently. Much research is now being undertaken in various areas of bioethics nationwide. Consequently, during the period under review, considerable articles and books have been published in the emerging subjects of bioethics. Several educational workshops and courses have been frequently taken place in the universities and research centers. Foundation of academic courses and fellowship in bioethics are also among the recent activities in the realm of medical ethics education in Iran. Likewise, considering several areas of bioethics that need legislation or reconsideration of previous regulations; the authorities, policy-makers, and scientists have carried out some endeavors to prepare appropriate law, codes, and guidelines. This report summarizes the bioethical activities and achievements in different fields of policy-making, organizing, teaching, and putting ethics into practice in our country during two recent decades.

SUPPL. 1

38

Iranian Journal of Public Health

2009

A two-decade review of medical ethics in Iran

Zahedi F., Razavi S.H.E., Larijani B.

Organ and tissue transplantation have a long history in Iran. Some researchers believe that Avicenna was the first to suture nerves together. However, organ transplantation using modern methods and technologies goes back to 1930s. Registered data from Iran shows an acceptable progressing trend in the quantity and quality of various types of organ and tissue transplantation in Iran over recent decades. For instance, Iran has one of the most successful kidney transplantation programs in the region, along with various attempts of policy-makers in order to provide preventive approaches for end-stage renal diseases, distribute dialysis equipment, and enhance cadaveric organ donation. Referring to some published and unpublished data, the current article provides an overview of transplant activities in Iran over the past three decades. Furthermore, the background and characteristics of the Iranian Model of kidney donation will be also reviewed.

SUPPL. 1

38

Iranian Journal of Public Health

2009

An Overview of organ transplantation in Iran over three decades: With special focus on renal transplantation

Zahedi F., Fazel I., Larijani B.

Judgment on rightness and wrongness of beliefs and behaviors is a main issue in bioethics. Over centuries, big philosophers and ethicists have been discussing the suitable tools to determine which act is morally sound and which one is not. Emerging the contemporary bioethics in the West has resulted in a misconception that absolute westernized principles would be appropriate tools for ethical decision making in different cultures. We will discuss this issue by introducing a clinical case. Considering various cultural beliefs around the world, though it is not logical to consider all of them ethically acceptable, we can gather on some general fundamental principles instead of going to the extremes of relativism and absolutism. Islamic teachings, according to the presented evidence in this paper, fall in with this idea © 2009 Farzaneh Zahedi and Bagher Larijani; licensee Tehran Univ. Med. Sci.

2

Journal of Medical Ethics and History of Medicine

2009

Common principles and multiculturalism

Zahedi F., Larijani B.

Bone turnover is much important in normal homeostasis of body skeleton. Medications, nutritional status, and systemic illnesses may affect bone metabolism by altering biochemical mediators. Prostaglandins, especially of E and F series are much important in bone physiology by affecting osteoclastic activity and osteoblastic differentiation. In bone fracture, production of prostaglandins affects fracture healing. There is the possibility that non-steroidal anti-inflammatory drugs (NSAIDs) affect bone health by inhibiting cyclooxygenase (COX) enzymes which reduce synthesis of prostaglandins. The aim of this paper is to review the effects of NSAIDs on bone by evaluating both animal and human studies. Using key words such as bone, bone marker, bone mineral density, NSAIDs, COX inhibitor, bone metabolism and search engines like Web of sciences, Scopus, Pubmed, and Google scholar, all relevant studies were collected. Although NSAIDs showed anti-resorptive properties in animal studies and some few human studies, to date no conclusive result has been observed in bone formation. Some limited studies reported higher bone mineral density in daily users of NSAIDs. © 2009 Bentham Science Publishers Ltd.

3

8

Inflammation and Allergy - Drug Targets

2009

Controversial effects of non-steroidal anti-inflammatory drugs on bone: A review

Salari P., Abdollahi M.

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are two chronic intestinal diseases having a mutual pathophysiological pathways with different manifestations. Generally, inflammatory mediators and cytokines orchestrate the scenario that amongst them, tumor necrosis factor-alpha (TNF-α) is a cornerstone. Nowadays different medications and drug classes are administered for treatment of IBD and IBS but there is no full cure and side effects of drugs limit their usage. Concerning the novel suggestion of ATP in the treatment of bowel diseases, we were invited to conduct a systematic review. MeSh keywords of IBD, IBS, TNF-α, IL-12, and ATP were searched in search engines like Pubmed, Scopus, Web of sciences, Embase, and Google scholar. Comparing the common medications with ATP in terms of side effects, efficacy, and other limitations lead us to the conclusion that ATP could be a reasonable alternative that may replace all other medications in this field in the near future. ATP is prepared as lyophilized form that is stable at room temperature for at least 1-3 years and can be used as intravenous infusion in the setting of private homes without direct medical supervision. Other routes of administration include intraperitoneal, subcutaneous, oral, topical, nasal, and sublingual. Also, it can be mixed with parenteral and enteral nutrition cocktails. The review also discussed some recent patents relevant to the field. © 2009 Bentham Science Publishers Ltd.

1

3

Recent Patents on Endocrine, Metabolic and Immune Drug Discovery

2009

Current opinion in the pharmaceutical management of irritable and inflammatory bowel diseases: Role of ATP

Salari P., Abdollahi M.

Background: This study aims at evaluating doctors' attitudes towards handling medical errors made by their peers. Materials: This cross-sectional questionnaire survey was conducted between April and July 2006 and targeted general practitioners attending continuing medical education programmes in Tehran. A total of 474 doctors were approached, 400 of whom completed the questionnaire. The questionnaire contained a clinical vignette with three hypothetical patient outcomes: near-miss, leading to harm, and leading to death. The participants were asked how they would deal with each case. They were also asked how they would prefer their peers to react when they themselves made a medical error. Results: The most common attitude toward peers' medical errors was reporting it to the original doctor and asking them to disclose it to the patient (near-miss: 63.0%; 95% CI 58% to 68%; leading to harm: 70.0%; 95% CI 65.4% to 74.6%; and leading to death: 62.5%; 95% CI 57.5% to 67.5%). In most cases, doctors expected their peers to report their medical errors to them (92.7%; 95% CI 89.7% to 93.0). About 67% of the participating doctors had encountered a peer's medical error in the past 6 months, although 90% of them had received no or very little training in dealing with this issue. Discussion: The most acceptable approach to dealing with a peer's medical error is to report it to the responsible doctor and encourage them to disclose it to the patient.

3

18

Quality and Safety in Health Care

2009

Doctors' views of attitudes towards peer medical error

Asghari F., Fotouhi A., Jafarian A.

Judgment This study was done in order to evaluate the effectiveness of the revisions made in the course of medical ethics for undergraduate medical students. Medical Students of Tehran University of Medical Sciences who took the course of medical ethics in a semester before the implementation of the revision and those who took the course after the implementation of the revision at the beginning and at the end of course responded to two questionnaires (one for evaluating knowledge and the other for assessing their moral judgment). Response rate was between 70 to 93.1 percent. Students' knowledge was significantly higher in the semester after the course revision (mean ± SD: 6.12 ± 1.3) in comparison with the semester before the reform (mean ± SD: 3.63 ± 1.7) (P=0.001). Students' knowledge after taking this course showed an increase of about 60% when compared with their knowledge level before starting the course (P=0.001). There was no significant difference in the level of moral judgment before and after taking the revised course of medical ethics while moral judgment level of students in two semester[before (21.21 ± 4.0) and after 15.25 ± 2.87) reform] were significantly different (P=0.02). The revisions made in the course of medical ethics for medical students were effective in improving students' knowledge but could not improve their moral judgment. This could be due to the short length of this course and also the small sample size in this study. We suggest that this study should be repeated with larger sample size and also with other methods of a course evaluation. © 2009 Fariba Asghari, Aniseh Samadi and Taraneh Dormohammadi; licensee Tehran Univ. Med. Sci.

2

Journal of Medical Ethics and History of Medicine

2009

Effectiveness of the course of medical ethics for undergraduate medical students

Asghari F., Samadi A., Dormohammadi T.

Gestational surrogacy as a treatment for infertility is being practised in some well-known medical institutions in Tehran and some other cities in Iran. While the majority of Muslims in the world are Sunni, the majority of Iranians are Shiite. Most Sunni scholars do not permit surrogate motherhood, since it involves introducing the sperm of a man into the uterus of a woman to whom he is not married. Most Shiite scholars, however, have issued jurisprudential decrees (fatwas) that allow surrogate motherhood as a treatment for infertility, albeit only for legal couples. They regard this practice as transferring an embryo or fetus from one womb to another, which is not forbidden in Shiite jurisprudence. Nevertheless, there are some controversies concerning some issues such as kinship and inheritance. The main ethical concern of Iran's experience with gestational surrogacy is the monetary relation between the intended couple and the surrogate mother. While monetary remuneration is practised in Iran and allowed by religious authorities, it seems to suffer from ethical problems. This article proposes that this kind of monetary relation should be modified and limited to reimbursement of normal costs. Such modification requires new legislation and religious decrees.

5

35

JOURNAL OF MEDICAL ETHICS

2009

Iran's experience with surrogate motherhood: an Islamic view and ethical concerns

Aramesh, K.

Background and aim: To assess the Farsi (Persian) translated and modified version of the questionnaire of the American Board of Internal Medicine (ABIM) for measuring professionalism, and also, measuring the professional attitudes and behaviors associated with the medical residency training environment in Iran. Methods: After a pilot study, a 17-item questionnaire was distributed to 282 medical residents of two major universities of Iran, from December 2006 through February 2007. Results: Of the 282 distributed questionnaires, 259 (95.2%) were used in the analysis. Based on the analyses, two items were omitted and 15 items were retained for further analysis. The mean score was 106 (Standard Deviation (SD), 22.4) out of maximum 150, whereas the item mean was 6.12 (SD, 0.37) out of maximum 10. Corrected item-to-total correlations ranged from low to moderate. The internal reliability of the scale, based on Cronbach's alpha, meets Nunnally's minimal requirement. A factor analysis was performed, based on principal components and varimax rotation. The solution identified three factors (subscales) including excellence, honor/integrity and altruism/respect. Together these factors represented 58.8% of the common variance. Conclusion: This study showed the content validity and internal reliability of the Farsi version of the ABIM questionnaire. Therefore, it can be considered as an encouraging step toward developing a short, reliable and valid instrument for measuring professionalism in medical environments. © 2009 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

8

31

Medical Teacher

2009

Measuring professionalism in residency training programs in Iran

Aramesh K., Mohebbi M., Jessri M., Sanagou M.

Purpose: Despite increasing transplantation in Iran, organ shortage and long waiting lists remain major problems in the country. Many publications have demonstrated that the willingness of healthcare professionals to participate in the donation process can improve the donation rate. Since nurses are usually the first people among the healthcare staff to recognize a patient as a potential donor, they have an important role in the procurement of organ and tissue from cadaveric donors. Our objectives were to survey nurses' knowledge and attitudes toward organ and tissue donation and to examine the effect of having them attend a workshop on organ donation. Methods: A 39-item questionnaire was completed by 66 nurses, before and after participation in a 1-day organ donation workshop that was held at the Iranian Tissue Bank (in Tehran, Iran). The questionnaire contained demographic data, 29 questions regarding knowledge, and 8 questions on attitudes toward organ and tissue donation. Results: 69.7% women and 30.3% men participated in this study. The mean score for knowledge was 16.89 (SD= 3.33) before and 23.76 (SD=1.66) after the workshop (p=0.000). The mean attitudes score was 4.76 (SD=1.71) before and 5.08 (SD=1.34) after the workshop (p=0.235). Although 63.63% claimed they were willing to have a donation card only 15.15% actually carried one. Conclusions: This study demonstrated that educational programs can enhance nurses' knowledge and commitment to the organ donation process and, ultimately, increase the donation rate. Consequently, it is of great importance for organ procurement units to focus on regular training programs for all their healthcare staff. © Witching Editore, 2009.

10

32

International Journal of Artificial Organs

2009

Organ donation workshop - A survey on nurses' knowledge and attitudes toward organ and tissue donation in Iran

Aghayan H.R., Arjmand B., Emami-Razavi S.H., Jafarian A., Shabanzadeh A.R., Jalali F., Goodarzi P., Jebelifar S.

Iranian Tissue Bank prepares a wide range of human tissue homografts such as; heart valve, bone, skin, amniotic membrane and other tissues for different clinical applications. The purpose of this study was to determine the seroprevalence of HTLV in tissue donors. About 1,548 tissue donors were studied during a 5-years period by ELISA assays. HTLV1,2 - antibodies were tested for all of donors with other tests upon American Association of Tissue Banks (AATB) standards. About 25 (1.61%) out of 1,548 tissue donors were HTLV positive that 17 donors were male and 8 were female (female/male ratio was approximately 47%). Regarding to the prevalence of HTLV among tissue donors and importance of cell and tissue safety and quality assurance, we recommend that all blood, cell and tissue banks should be involved both routine serological methods and other complementary tests such as polymerase chain reaction (PCR) for diagnosis of HTLV. © Springer Science+Business Media B.V. 2008.

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Cell and Tissue Banking

2009

Seroprevalence of human T lymphtropic virus (HTLV) among tissue donors in Iranian tissue bank

Arjmand B., Aghayan S.H., Goodarzi P., Farzanehkhah M., Mortazavi S.M., Niknam M.H., Jafarian A., Arjmand F., Jebelly Far S.

Euthanasia is one of the controversial topics in current medical ethics. Among the six well-known types of euthanasia, passive voluntary euthanasia (PVE) seems to be more plausible in comparison with other types, from the moral point of view. According to the Kantian framework, ethical features come from 'reason'. Maxims are formulated as categorical imperative which has three different versions. Moreover, the second version of categorical imperative which is dubbed 'principle of ends' is associated with human dignity. It follows from this that human dignity has an indisputable role in the Kantian story. On the other hand, there are two main theological schools in Islamic tradition which are called: Ash'arite and Mu'tazilite. Moreover, there are two main Islamic branches: Shiite and Sunni. From the theological point of view, Shiite's theoretical framework is similar to the Mu'tazilite one. According to Shiite and Mu'tazilite perspectives, moral goodness and badness can be discovered by reason, on its own. Accordingly, bioethical judgments can be made based on the very concept of human dignity rather than merely resorting to the Holy Scripture or religious jurisprudential deliberations. As far as PVE is concerned, the majority of Shiite scholars do not recognize a person's right to die voluntarily. Similarly, on the basis of Kantian ethical themes, PVE is immoral, categorically speaking. According to Shiite framework, however, PVE could be moral in some ethical contexts. In other words, in such contexts, the way in which Shiite scholars deal with PVE is more similar to Rossian ethics rather than the Kantian one. © 2009 Soroush Dabbagh and Kiarash Aramesh.; licensee Tehran Univ. Med. Sci.

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Journal of Medical Ethics and History of Medicine

2009

The compatibility between Shiite and Kantian approach to passive voluntary euthanasia

Aramesh K., Dabbagh S.

A high number of HIV positive babies are born each year, whereas by highly effective preventive measures, the risk of mother-to-child transmission can be decreased significantly. There are different methods (for example mandatory versus voluntary) for HIV screening in pregnant women, but there are debates on conducting HIV testing by these methods. One of the most important issues in this field is its ethical considerations. Also its limitations cannot be ignored. According to these facts several keywords were searched by search engines such as Web of Sciences, Medline, Google scholar, WHO website. The most relevant and recent articles were chosen. Concerning the importance of vertical transmission of HIV, the role of preventive measures, ethical considerations, and the limitations of HIV screening, we recommend HIV testing offer to every pregnant women at the first clinic visit by providing enough information for patient and considering her autonomy. Also policy makers should provide a guideline for this test according to the pregnant women's autonomy, confidentiality, and dignity.

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Journal of medical ethics and history of medicine

2009

The necessity of HIV testing in Iranian pregnant women and its ethical considerations.

Salari, Pooneh; Azizi, Maryam

Using human dead body for medical purposes is a common practice in medical schools and hospitals throughout the world. Iran, as an Islamic country is not an exception. According to the Islamic view, the body, like the soul, is a "gift" from God; therefore, human being does not possess absolute ownership on his or her body. But, the ownership of human beings on their bodies can be described as a kind of "stewardship". Accordingly, any kind of dissection or mutilation of the corpse is forbidden, even with the informed consent of the dead or his/her relatives. The exception of this principle is when such procedures are necessary for saving lives of other persons. In this article using the human dead body for medical education, research and treatment is discussed and the perspective of Iranian Shiite religious scholars in this regard is explained.

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Journal of medical ethics and history of medicine

2009

The ownership of human body: an islamic perspective.

Aramesh, Kiarash

[No abstract available]

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American Journal of Bioethics

2008

Justice as a principle of Islamic bioethics

Aramesh K.

Marie-Francois Xavier Bichat (1771-1802) was a prominent French anatomist during a time of revolution and one of the founders of French scientific medicine. He conducted several experimental studies, which laid the foundation for modern physiology. Based on autopsy findings, Bichat introduced 21 tissues as the basic elements of organs. His name is carried on by several eponyms in anatomy and histology; Bichat's fossa (pterygopalatine fossa), Bichat's protuberance (buccal fat pad), Bichat's foramen (cistern of the vena magna of Galen), Bichat's ligament (tower fasciculus of the posterior sacroiliac ligament), Bichat's fissure (transverse fissure of the brain) and Bichat's tunic (tunica intima vasorum). This paper cleats with the life and works of this early pioneer in anatomy and physiology. (C) 2008 Elsevier GmbH. All rights reserved.

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ANNALS OF ANATOMY-ANATOMISCHER ANZEIGER

2008

Marie-Francois Xavier Bichat (1771-1802) and his contributions to the foundations of pathological anatomy and modern medicine

Shoja, Mohammadali M.; Tubbs, R. Shane; Loukas, Marios; Shokouhi, Ghaffar; Ardalan, Mohammad R.

Rapid advances in biomedical science and technology, which have revolutionized medicine and health-care services in different societies, have been associated with inevitable ethical challenges. Undoubtedly, these innovations could lead to irreversible disasters if they are not limited by appropriate regulations. Substantial attempts have been made in the Islamic Republic of Iran to establish a structured approach for identifying, analysing and resolving ethical issues in clinical practice. Given the consensus of religious and scientific scholars, some laws recently approved by the parliament include the Deceased and Brain-Dead Patients Organ Transplantation Act (2000), Embryo Donation to Infertile Spouses Act (2003) and the Therapeutic Abortion Act (2005). National guidelines for ethical assessment and supervision of research proposals have also been compiled by the authorities. This paper reviews the main endeavours made in bioethics legislation in the Islamic Republic of Iran.

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86

Bulletin of the World Health Organization

2008

National bioethical legislation and guidelines for biomedical research in the Islamic Republic of Iran

Zahedi F., Larijani B.

Introduction: This study, the first of its kind in Iran, was to assess Iranian patients' preferences for receiving information and participating in decision-making and to evaluate their satisfaction with how medical information is given to them and with their participation in decision-making at present.Method and materials: 299 of 312 eligible patients admitted to general internal medicine or surgery wards from May to December 2006 were interviewed according to a structured questionnaire. The questionnaire contained questions about patients' preferences regarding four domains of information and their participation in decision-making. Patients' responses were measured on a visual analogue scale graded from 1 to 10.Results: The mean (SD) score for desire to receive information was 8.88 out of 10 (1.5) and for participation in medical decision-making was 7.75 out of 10 (3). The desire to receive information was greater in women than men (9.0 (1.5) vs 7.8 (1.4), p = 0.025). It was also correlated with their education (r = 0.2, p = 0.001) and their estimation of the severity of their own disease (r = 0.13, p = 0.027). The score for preference to participate in decision-making was higher in women than in men (7.95 (2.8) and 7.0 (3.2), respectively; b = 0.8, p = 0.022) and was negatively correlated with education (r = 20.14, p = 0.015).Discussion: This study shows that Iranian patients are highly interested in receiving information about their condition and participating in clinical decision-making. No predictive variable for such attitudes was found; therefore, the only way for the physician to recognise patients' desire is to ask them explicitly.

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JOURNAL OF MEDICAL ETHICS

2008

Patients' preferences for receiving clinical information and participating in decision-making in Iran

Asghari, F.; Mirzazadeh, A.; Fotouhi, A.

Background: One of the domains of scientific activities is working on animals. Performing experiments on animals is permissible only with the purpose of obtaining necessary information for saving and improving life of human beings or animals. Principally, all religions believe that human life is more valuable than animal life and humans have a God-given authority over animals, but they should not be cruel to animals and cause their pain or suffering. Based on Islamic view points, although Allah has put the Man as the lord of all creatures, he has not the right to use other creatures for any conditions and does not respect their real statues. Because of the widespread use of experimental animals in our country, special ethical codes should be redefined for living conditions of experimental animals based on the present regulations in Iran and also other countries. Therefore, all our researchers should have enough information about ethical codes of treating experimental animals as well as Islamic principles in this regard.Methods: All Islamic and international sources related to treating animals and also valid international ethical guidelines were collected and classified in order to extract the aimed points. Then all extracted points were reviewed by experts familiar with Islamic and ethical rules of treating animals.Results: Finally the strategies for appropriate and complete implementation of the national ethical guidelines of animal research in Iran were suggested.Conclusion: It is obvious that the suggested principles are applicable only with appropriate planning of training courses based on the facilities and needs of our country. © 2008, Iranian Journal of Public Health. All rights reserved.

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Iranian Journal of Public Health

2008

Proposing a national ethical framework for animal research in Iran

Mobasher M., Aramesh K., Aldavoud S.J., Ashrafganjooei N., Divsalar K., Phillips C.J.C., Larijani B.

[No abstract available]

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7

American Journal of Bioethics

2007

An Islamic perspective on euthanasia

Aramesh K., Shadi H.

[No abstract available]

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7

American Journal of Bioethics

2007

An Islamic view to stem cell research and cloning: Iran's experience

Aramesh K., Dabbagh S.

[No abstract available]

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22

Human Reproduction

2007

Considerations of third-party reproduction in Iran

Zahedi F., Larijani B.

[No abstract available]

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7

American Journal of Bioethics

2007

The influences of bioethics and Islamic jurisprudence on policy-making in Iran

Aramesh,Klarash

In the field of health care and medical practice, gain sharing plans should be carefully examined to be sure they reflect the codes of ethics. Ethical principles involved in gain sharing include informed consent and conflict of interest. Physicians must discharge their responsibilities to patients with loyalty, honesty and good faith, all the while avoiding conflict of interest. Conflict of interest rules usually focus on financial gain. This may raise some important issues, including kickbacks, fee-splitting and self-referral. These practices can potentially distort professional judgment. Some countries have rules of professional conduct governing these issues. In this article, we intend to describe importance of the issues of kickbacks, fee-splitting and self-referral in the field of clinical medicine and discuss some ethical issues that should be considered by physicians.

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Iranian Journal of Diabetes and Lipid Disorders

2006

Gain sharing and medical ethics

Zahedi F., Larijani B.