Assessment of surgery residents' knowledge of medical ethics and law. Implications for training and education

Medical ethics and law are essential topics that should be included in medical residency programs. However, surgery training programs in Iran lack a specific course in medical ethics and law, which can lead to patient dissatisfaction with surgical outcomes. This study aimed to assess surgery residents' knowledge of medical ethics and law and suggest improvements for future residency programs. This descriptive cross-sectional study involved 112 surgery residents from six teaching hospitals. A valid and reliable questionnaire comprising 15 items on medical ethics and 12 items on medical law was used to assess participants' knowledge. Most participants were female (31-40 years old), and their mean knowledge score for medical ethics was 3.26±0.53 out of 5, with the lowest score in "futile treatment and DNR orders." The mean knowledge score for medical law was 3.69±0.69, with the lowest score in "surrogate decision-maker." Age did not affect residents' knowledge, but gender did, with female residents demonstrating significantly better knowledge of medical ethics (3.344/5 vs. 3.112/5) and law (3.789/5 vs. 3.519/5). Surgery residents had a relatively favorable knowledge of medical ethics and law, but they require further training in some areas to improve their knowledge. Training should include journal clubs, role-play programs, standardized patient programs, and debates to achieve better results, as purely didactic lectures appear inadequate.

Evaluation of image quality, organ doses, effective dose, and cancer risk from pediatric brain CT scans

PURPOSE

The present study was conducted to assess organ doses, effective dose, and image quality, and to estimate the risk of exposure-induced cancer death (REID) in pediatric brain computed tomography examinations.

METHODS

This investigation was performed on 179 pediatric patients (99 men and 80 women) under 12 years old who underwent non-contrast brain CT scans. Patients were classified into four age groups of ≤ 1, 2-5, 6-9, and 10-12 years old. Organ doses and effective doses were calculated using the ImpactDose program. Cancer risk models presented in the BEIR VII report were used to estimate REID values. Image quality assessment in this study was performed by measuring image quality parameters such as noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR).

RESULTS

The highest organ dose in all age groups belonged to the brain. The mean REID values were 12.34 per 100,000 males and 16.77 per 100,000 females. REID values decreased with the increasing age of patients in both genders and were higher for female children than male children. The mean SNR of gray matter, SNR of white matter, and CNR were 11.04, 10.5, and 2.31, respectively.

CONCLUSIONS

According to the results of this study, brain CT scans in children are associated with an increased potential risk of cancer. Therefore, minimizing unnecessary radiation exposure in pediatric patients and using alternative imaging modalities are of particular importance. Moreover, optimizing the radiation parameters while maintaining the diagnostic image quality in children should be considered.

Ethical challenges of cord blood banks: a scoping review

Cord blood is a rich source of hematopoietic stem cells used to treat many diseases of blood origin. Thus, storage banks were created to store and provide umbilical cord cells. With the development of diagnostic and therapeutic technologies and techniques in medicine, ethical issues have also become more widespread and complex. After the creation of the cord blood banks, efforts were made to address the ethical issues associated with such banks. The present study attempts to identify the ethical challenges in these banks in the published studies. Databases including PubMed, Scopus, Web of Science (WOS), Embase, Proquest, and Google Scholar were searched from January 1996 to January 2021. Then, the ethical challenges of the cord blood bank were extracted from the results section using thematic content analysis. 22 studies were selected based on inclusion and exclusion criteria. The ethical challenges raised in the studies included private or public ownership of the bank, fair access to banking services, informed and voluntary consent, failure to provide sufficient information to individuals about the process, confidentiality of user's information, conflict of interest of bank founders (who are commonly doctors). The findings of this study indicated that there are serious ethical concerns regarding umbilical cord blood banks. Responding clearly to these ethical challenges calls for the attention of policymakers and medical ethics professionals; this will require a clear statement of the various aspects of these banks for society.

Patient’s Rights in Iran and Iraq

Background: The aim of this study was to compare, review, and evaluate the studies on patients right in Iran and Iraq. Methods: This is a review study conducted by searching the Iranian and Iraqi databanks, such as Scientific Information Database (SID), Iranian Research Institute for Information Science and Technology, Iran Medex, Iraqi Academic scientific journals, and Google Scholar for both Iranian and Iraqi articles from 2002 to 2017 using the keywords, such as “Patient Rights”, “Patient Rights Charter”, “Patient Rights Observance”, “Iraq”, “Iran”, and “Patient Awareness and Rights”. Results: Of a total of 32 Iranian and Iraqi articles, only 25 articles met the aim of our study. Conclusion: The growing number of articles published indicates that from 1999 forwards, this topic began to attract the attention of Iranian researchers in a gradual manner, as for the Iraqi researchers, their attention has been attracted from 2013 onwards. Also, despite the poor knowledge of physicians about the patients’ rights in Iran, they have shown acceptable awareness and attitude regarding some patients’ rights. The same is true for Iraqi doctors and health care providers, but they have shown unsatisfactory consequences for some of the rights of Iraqi patients. Patient education through media and careful observation of the patient rights charter, and educating healthcare professionals, and developing professional training on patients’ legal rights by engaging them in educational sessions and lectures on patient rights is necessary. Adequate monitoring of practice according to the patient charter is strongly suggested.

Ethical Considerations in Conducting Clinical Trials

Background: Clinical trials are the golden key in medical science research with human participants. They have always been considered interesting topics by researchers and scientists working in this field. However, the samples are “human participants,” so the research should be carefully conducted. Methods: In the present study, the published articles on the ethical challenges of conducting clinical trials were evaluated between 2010 and 2019 in Google Scholar, PubMed, and Scopus. The English search keywords were “clinical trial,” with at least one of the phrases of “ethical consideration” or “standard”. Results: In this article, we examined the ethical requirements and considerations in these research studies in four stages: research design and question, proposal review and approval, supervision and implementation, and publication of the results. We have examined them using relevant articles published between 2010 and 2019 and identified important and prominent issues or neglected ones. Conclusion: During this study, it was found that the “research design and question” stage was the most discussed and challenging stage, and the authors’ sensitivity about it has been more than the other three stages. On the other hand, the “results publishing” stage has been considered less sensitive with the least number of references in articles.

Knowledge and Attitude of Midwives and Obstetricians Towards Therapeutic Abortion Law and its Ethical Pitfalls

Background: Despite the implementation of a safe motherhood program in many countries, unsafe abortion continues to be a matter of reproductive health. Thus, urgent efforts to make abortion legal and safe have been recommended in developing countries. The present study was done to determine the knowledge of midwives and obstetricians about the therapeutic abortion law as well as their attitude about the ethical pitfalls. Methods: In this descriptive knowledge and attitude study, a researcher-made questionnaire was used to gather data, after estimating the appropriate Cronbach’s Alpha coefficient. A total of 162 midwives and obstetricians working in public and private medical centers affiliated to Shahid Beheshti University of Medical Sciences in 2018 were included in the study by convenience sampling method. Results: According to the results, 9.3% of participants had a low level, 72.8% had a moderate level, and only 17.9% had a good level of knowledge. The total mean score of knowledge was 7.17±1.7. The mean score of knowledge in the group of obstetricians (7.60±1.74) was significantly higher than midwives (6.94±1.54), (t=2.29, p=0.024). There was a significant correlation between participants’ age and their knowledge (r=0.912, p=0.001). Also, 47.53% of the participants believed that the therapeutic abortion law has some pitfalls. The most frequent attitude was about the restriction of the therapeutic law up to 19 weeks for fetal indications. Conclusion: The level of participants’ knowledge was low to moderate. The findings indicated the need for training the professional standards related to prenatal genetic screening and therapeutic abortion.

Consequences of Presence of Forensic Nurses in Health Care System: A Qualitative Study

Background:

Nursing is a vital element in providing safe and effective care. Forensic nursing is one of the specialties in this discipline which, in addition to creating more satisfaction in nurses, is considered essential in holistic, quality, and safe care. This study aimed to describe the consequences of the presence of forensic nurses in the health system.

Materials and Methods:

This qualitative study was conducted between 2017 and 2018 in Iran. Semi-structured interviews were performed with 18 participant experts in the field of health and law. The interviews were analyzed using the inductive content analysis approach proposed by Graneheim and Lundman.

Results:

The consequences of the presence of nurses in the health system were summarized into two categories: positive and negative consequences. The positive consequences consisted of improved performance, better legality of nurses, the calmness of nurses, prevention of patients' rights violations, advancement comparable with developed countries, reduced costs, increased accuracy and speed in dealing with forensic cases, improved performance of Iranian Legal Medicine Organization and increased employment. On the other hand, the negative consequences were role conflict with other involved professionals and nursing shortage. Participants included nurses (with different specialties), nurse lawyers, forensic medicines, forensic midwives, a judge, and a medical lawyer.

Conclusions:

If planners and policymakers have a positive attitude toward the presence of forensic nurses, we can anticipate better forensic services for clients through the development of systematic educational programs, the formation of forensic teams, and the expertise of this profession can provide many benefits.

Ethical challenges in the relationship between the pharmacist and patient in Iran

Purpose

Based on the developmental process of pharmacy in medical relationships, it is essential to pay attention to ethical issues in this field and develop a good pharmacist–patient relationship. The present study aimed to mention the frequency of ethical challenges of pharmacy in Iran as a fundamental step towards designing a practical ethical guideline for professionals.

Design/methodology/approach

In this observational study, data were collected using a two-part questionnaire with 64 items developed after examining relevant texts and conducting unstructured interviews with pharmacy specialists. The first part determined the frequency of ethical challenges that the pharmacist confronts, using 43 short scenarios, whereas the second part comprised 21 questions with short answers. For validation, the questionnaire was sent to 20 medical ethics specialists who were familiar with issues in pharmacy ethics.

Findings

Data were collected from 48 members of the Iranian Association of Pharmacists (Working Group of Hospital Pharmacists). and the frequency of ethical challenges was determined. The most frequent issues were patient's request for over-the-counter drugs, asking about their lab results, asking drug for another person and returning the drug.

Research limitations/implications

One of the limitation of our study is its population, there were hospital pharmacist, other pharmacist such as community pharmacist may face different challenges.

Practical implications

The finding of this study could lead the policymakers to develop ethical guidelines for pharmacy practices.

Social implications

The pharmacist–patient relationship is one of the important aspects of health system, and therefore regulating this relationship based on the professional ethics guidelines could have a positive impact on therapeutic relationships.

Originality/value

Results showed that designing codes of ethics and practical guidelines based on the frequency of the noted challenges enhances the quality of treatment, improves the pharmacist–patient relationship, increases the level of cooperation and decreases patient complaints.

Reviewing the Status of Professional Commitment Principles in the Physician-Patient Communication Models

Much attention is paid to the importance of the relationship between patients and physicians and the ethical issues that have been considered from different perspectives. Moreover, different models have been developed to establish such a relationship. In one of the most advanced methods, Emanuel EJ categorized 4 paternalistic -informative-interpretive models that have been agreed upon by many medical professionals. Each model has its characteristics and in the relationship between a patient and a practitioner, and to some extent, the professional commitment values (professionalism). In other words, the observance of the values of professionalism in each of these models has been based on the definitions of these principles; each is of particular importance, and individual attention has been paid to these values in different models. The present work aimed to evaluate each communication model according to the values of medical resource planning. Analyzing and adapting these models in terms of professional ethics could finally lead to analyzing the comparative approaches to professional commitment values.

Changes in ethical attitudes of clinical laboratory professionals after teaching them ethics using three different methods

Background: Ethical attitudes and personal values play a significant role in clinical decision-making; however, they have been given limited attention by professionals in laboratory medicine. Studies suggest that individual attitudes are not static and that professionals learn ethical attitudes through a variety of formal and informal learning methods. This study was conducted to investigate changes in the attitudes of clinical laboratory professionals after teaching them ethics and to compare the results among the 3 groups. Methods: Four topics were selected in the field of medical laboratory ethics as teaching materials. A questionnaire including 22 items was designed and validated. Teaching sessions for the 3 study groups were held. All 65 clinical laboratory participants completed the questionnaire before and after the classes. Paired t test and ANOVA were used to assess differences among groups. Results: Significant differences were found in the mean scores of ethical attitudes before and after the educational intervention among the lecture-based teaching group (p=0.016), problem-based learning group (p=0.001), and all participants (p=0.004). However, no significant difference was found between the mean scores before and after the intervention in role-playing group (p=0.623). Conclusion: Teaching by lecturing and problem-based learning was more effective to change ethical attitude of the laboratory professionals than the role-playing method. Thus, we suggest the implementation of teaching ethics using these methods to improve the ethical attitude of clinical laboratory professionals.

Analytical method for analysis of electromagnetic scattering from inhomogeneous spherical structures using duality principles

In this article, an analytical approach is presented for the analysis of electromagnetic (EM) scattering from radially inhomogeneous spherical structures (RISSs) based on the duality principle. According to the spherical symmetry, similar angular dependencies in all the regions are considered using spherical harmonics. To extract the radial dependency, the system of differential equations of wave propagation toward the inhomogeneity direction is equated with the dual planar ones. A general duality between electromagnetic fields and parameters and scattering parameters of the two structures is introduced. The validity of the proposed approach is verified through a comprehensive example. The presented approach substitutes a complicated problem in spherical coordinate to an easy, well posed, and previously solved problem in planar geometry. This approach is valid for all continuously varying inhomogeneity profiles. One of the major advantages of the proposed method is the capability of studying two general and applicable types of RISSs. As an interesting application, a class of lens antenna based on the physical concept of the gradient refractive index material is introduced. The approach is used to analyze the EM scattering from the structure and validate strong performance of the lens.

Knowledge and Ethical Issues in Organ Transplantation and Organ Donation: Perspectives from Iranian Health Personnel

Background

Organ transplantation is one of the most critical topics in medical ethics that is commonplace in various countries. This study aimed to evaluate the knowledge and the ethical issues surrounding organ transplantation and organ donation among healthcare personnel in Tehran, Iran.

Material/Methods

In a cross-sectional study performed on 450 healthcare personnel, self-administered questionnaires were used to derive data from individuals. Among the 450 health personnel who received the questionnaires, 377 completed their questionnaires (83.77%).

Results

The willingness and unwillingness to donate organs among individuals were 47.48% (n=179) and 52.51% (n=198), respectively. Among the individuals who signed the organ donation card, 96.5% (n=55) were willing to donate their organs and 3.5% (n=2) were unwilling to donate their organs. Most of the individuals that were willing (48.34%; n=175) and unwilling (51.66%; n=187) to donate their organs claimed religious support for organ donation (P=0.00). Out of these people, 110 willing people (67.48%) and 53 (32.52%) unwilling people were familiar with the idea of brain death. The individuals who selected cadavers (67.64%; n=255) and brain death (24.4%; n=92) were chosen as the best candidates for organ donation. Most individuals believed that young patients (n=123; 32.62%) and people who had not already had organ transplants (n=90; 23.87%) should be the preferred recipients of organs. Most individuals had learned about organ transplantation from television (30.24%; n=114), newspapers (23.61%; n=89), and the radio (19.89%; n=75).

Conclusions

In conclusion, there is a need for more educational programs for the improvement of knowledge and ethical consideration with regard to organ transplantation and organ donation among healthcare personnel.

Organ Transplantation in Iran; Current State and Challenges with a View on Ethical Consideration

Organ transplantation is a new issue in medical science. It is an important achievement and a sign of the progression and ability of medical centers around the world. Governments, populations, the medical community and people involved in culture, art, and media all have a decisive role in the culture of organ donation, which is the only way to guarantee that the healthy organs of a brain-dead person can continue to work and save the lives of people in need of organ transplantation. The brain death phenomenon and its possible application in organ transplantation, while offering new hope for the salvation of a number of patients, has led to many ethical, cultural, and legal issues. Ethical issues in organ transplantation are very complicated due to many social factors such as religion, culture, and traditions of the affected communities. The ethical and legal points of removing organs from the body of a living or cadaveric source, the definition of brain death, the moral and legal conditions of the donor and the recipient, and the financial relationship between them and many others, are all critical issues in organ transplantation. While there may be no available explicit solution to these issues, they should be rigorously considered by the experts. Efforts to systematically eliminate barriers and solve problems in organ transplantation, can not only reduce the costs of maintaining brain-dead patients and encourage patients that need organ transplantation but can also prevent immoral and illegal activities. In this paper, we have reviewed the most important and current challenges in organ transplantation with a view to the ethical considerations, and we have suggested some strategies to extend it in Iran.

Organ transplantation and donation from the point of view of medical students in Iran: Ethical aspects and knowledge

Organ transplantation is an effective process that prolongs the lives of individuals suffering from incapacitating conditions. The aim of this study was to evaluate the view point of medical students in Iran regarding ethical aspects and knowledge on organ transplantation and donation. The participants included 165 medical students from different faculties of Shahid Beheshti University of Medical Sciences, Tehran, Iran. They were assessed using a reliable questionnaire that examined their ethical aspects and knowledge regarding organ transplantation and donation. All data analyses were performed using Chi-square and analysis of variance tests with SPSS software. Results showed that main sources of respondents’ knowledge on organ transplantation and donation were TV, 51.52 % (n = 85) and Internet, 19.39 % (n = 32). 91.51% (n = 151) of the respondents understand and 8.48% (n =14) do not understand the concept of brain death. 49.69% (n = 82) of the respondents were willing to donate their organs. A brain death donor was selected by respondents as the best option for organs transplantation (72.12%; n = 119). The respondents selected young patients as the preferred recipients of an organ (69.69%; n = 115). There was no correlation between gender, age, educational level, marital status and attitude towards organ transplantation. From the results, there is need for an organized educational planning for medical students in ethical issue and knowledge on organ and tissue transplantation.

Personal factors affecting ethical performance in healthcare workers during disasters and mass casualty incidents in Iran: a qualitative study

In emergencies and disasters, ethics are affected by both personal and organizational factors. Given the lack of organizational ethical guidelines in the disaster management system in Iran, the present study was conducted to explain the personal factors affecting ethics and ethical behaviors among disaster healthcare workers. The present qualitative inquiry was conducted using conventional content analysis to analyze the data collected from 21 in-depth unstructured interviews with healthcare workers with an experience of attending one or more fields of disaster. According to the data collected, personal factors can be classified into five major categories, including personal characteristics such as age and gender, personal values, threshold of tolerance, personal knowledge and reflective thinking. Without ethical guidelines, healthcare workers are intensely affected by the emotional climate of the event and guided by their beliefs. A combination of personal characteristics, competences and expertise thus form the basis of ethical conduct in disaster healthcare workers.

Knowledge of medical professionalism in medical students and physicians at Shahid Beheshti University of Medical Sciences and affiliated hospitals-Iran

Although medical professionalism is a fundamental aspect of competence in medicine and a distinct facet of physicians' competence, evidence suggests that the subject of professionalism is not taught or assessed as part of medical students' curricula in Iran and many other countries. Assessing the knowledge of medical students and physicians about medical professionalism seems to be helpful in identifying the weaknesses of training in the field of professionalism and devise plans for future training on the subject.The present cross-sectional, quantitative, observational, and prevalence study recruited 149 medical interns, clinical residents, physicians, and professors working in hospitals selected through stratified random sampling using a questionnaire designed by the researchers and confirmed for its validity and reliability. The results were analyzed by Stata at a significance level of 0.05.Out of 149 cases, 61.64% were male with the mean age of 30.81 years. A total of 66 participants (44.29%) (95% confidence interval [CI]: 36.44%-52.44%) had heard and 83 (55.70%) (95% CI: 47.55%-63.55%) had not heard the term "medical professionalism" before the study. After adjusting for potential confounders, age and degree did not have statistically significant difference in assessed knowledge of medical professionalism, but sex had (mean difference: 5.88, P = 0.045), and the mean of the female was significantly higher than that of the male participants. The mean percentage of correct answers was 47.67.The present study demonstrated that the medical professionals working in the national healthcare system have an unfavorable theoretical knowledge about medical professionalism in Iran; although this does not indicate that their practices are unethical, it should be noted that one of the prerequisites of possessing a high level of medical professionalism and for establishing a proper relationship between the medical community and the patients is to have a proper knowledge of this concept. Improving behaviors and performances in medical professions requires adequate training on the concepts of medical professionalism and consequently the assessment of the levels of professionalism achieved in medical professionals.

Assessment of patients' awareness of their rights in teaching hospitals in Iran

INTRODUCTION

Respecting patients' rights is an essential component in health care. Passing a regulation is not a guarantee for the protection of patients' rights. This article aimed to assess patients' awareness of the contents of the Patient's Bill of Rights in Iran and to determine if they had received a service compatible with their rights charter.

METHODS

This is a descriptive study in 202 hospitalised patients. A questionnaire was used, and associations between variables were examined using Pearson's correlation test. The significance level was p < .05.

RESULTS

The patients' ages ranged from 18 to 87 years of age, 33% were male and 79% were married. Patients' knowledge was lowest regarding the need for consent for the treatment process and was highest regarding the patient's right to know the expertise of the treatment team. The mean of patients' knowledge was 77.56%. As for patients' exercising their rights, the highest score belonged to the patient's right for attending doctors and treatment team's confidentiality; the lowest score belonged to the right to receive necessary information about probable complications, other treatment options and participation in the final selection of treatment method. The mean score of patient satisfaction was 8.06 (out of 11). There was no significant relationship with their education level or the number of admissions.

CONCLUSION

Health-care professionals can provide care based on patients' rights, and their knowledge of patients' rights needs to be evaluated. Educational programmes, leaflets, booklets and posters can be helpful in this regard. In addition, professional organisations and the Ministry of Health need to be more sensitive to this issue.

Conceptualization of Idle (Laghw) and its relation to medical futility

A major debate in medical ethics is the request for futile treatment. The topic of medical futility requires discrete assessment in Iran for at least two reasons. First, the common principles and foundations of medical ethics have taken shape in the context of Western culture and secularism. Accordingly, the implementation of the same guidelines and codes of medical ethics as Western societies in Muslim communities does not seem rational. Second, the challenges arising in health service settings are divergent across different countries. The Quranic concept of idle (laghw) and its derivatives are used in 11 honorable verses of the Holy Quran. Among these verses, the 3rd verse of the blessed Al-Muminūn Surah was selected for its closer connection to the concept under examination. The selected verse was researched in the context of all dictionaries presented in Noor Jami` al-Tafasir 2 (The Noor Collection of Interpretations 2) software. "Idle" is known as any insignificant speech, act, or thing that is not beneficial; an action from which no benefit is gained; any falsehood (that is not stable or realized); an entertaining act; any foul, futile talk and action unworthy of attention; loss of hope; and something that is not derived from method and thought. The word has also been used to refer to anything insignificant. The notes and derived interpretations were placed in the following categories: A) Having no significant benefit (When medical care does not benefit the patient (his body and/or soul and his life in this world and/or the Hereafter), it is wrong to proceed with that medical modality; B) Falsehood (Actions that fail to provide, maintain, and improve health are clearly futile); C) Unworthy of attention (An action that neither improves health nor threatens it is wrong and impermissible).

Comparison between Clinically Used Irregular Fields Shielded by Cerrobend and Standard Lead Blocks

INTRODUCTION

In radiation therapy centers across Iran, protection of normal tissues is usually accomplished by either Cerrobend or lead block shielding. In this study, the influence of these two shielding methods on central axis dose distribution of photon beam a Cobalt unit was investigated in clinical conditions.

MATERIALS AND METHODS

All measurements were performed for 60Co γ-ray beams and the Cerrobend blocks were fabricated by commercial Cerrobend materials. Standard lead block shields belonged to Cobalt unit. Data was collected through a calibrated ionization chamber, relative dosimetry systems and a TLD dosimetery.

RESULTS

Results of the percent depth dose (PDD) measurements at depths of 0.5, 1, 5, 10, 15 and 20 cm for 23 different field sizes of patients with head and neck cancer showed no significant differences between lead and Cerrobend shielding methods. Measurement results of absolute dosimetry in depths of 1.5, 3, 5, 7, 10 and 12 cm also showed no significant differences between these two shielding methods. The same results were obtained by TLD dosimetry on patient skin.

CONCLUSION

Use of melt shielding methods is a very easy and fast shield-making technique with no differences in PDD, absolute and skin dose between lead and Cerrobend block shielding methods.

Relationship of Moral Sensitivity and Distress Among Physicians

BACKGROUND

Providing health services is described as an important moral measure, since its major aim is to ensure the welfare of the people who need treatment and care. Moral sensitivity is the ability to identify the existing moral problem and understand the moral consequences of the decisions made on the patient's part. Physicians are always exposed to moral distress due to various circumstances.

OBJECTIVES

In this survey, we evaluated moral sensitivity and moral distress among physicians and the relationship of these ethical factors on them. Hence, we assessed y relationship between moral sensitivity and moral distress in physicians will facilitate their sound management so as to provide high-quality and safe health services. Moreover it will confirm proposed theories regarding this subject.

MATERIALS AND METHODS

This cross-sectional descriptive-analytic study aimed at investigating the relationship between moral sensitivity and moral distress among 321 specialist physicians working in hospitals affiliated to Tehran Medical Universities in Tehran. The samples were selected through two-stage random cluster sampling method. A three-partite questionnaire comprising of demographic characteristics, moral distress, and moral sensitivity was used for collecting data which then were analyzed using SPSS-20.

RESULTS

There was a negative significant relationship between moral sensitivity and moral distress frequency; there was a positive significant relationship between moral sensitivity and moral distress intensity. Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress.

CONCLUSIONS

Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress.

Oral delivery of nanoparticles containing anticancer SN38 and hSET1 antisense for dual therapy of colon cancer

An oral delivery system intended for treatment of colon cancer in HT29 cancerous cells was investigated by encapsulating hSET1 antisense and SN38 anticancer in nanoparticles based on cysteine trimethyl chitosan (cysTMC) and carboxymethyl dextran (CMD). Studies have shown hSET1 as the main type of histone methyltransferase (HMT) complex, is significantly overexpressed in malignant cells. In this study, hSET1 antisense was employed to inhibit gene expression. Additionally, SN38 was incorporated into nanoparticles to enhance the efficiency of the system by inhibition of topoisomerase 1. CysTMC was synthetized and characterized by (1)H NMR and FTIR. Nanoparticles were prepared through complexation of CMD and cysTMC. Particle size and surface charge was 100-150 nm and 17-21 mV respectively with drug content of around 2.6%. Gel electrophoresis assay proved the stability of antisense in simulated gastric and intestinal fluids. Nanoparticles showed high mucoadhesion and glutathione responsive release. Cellular uptake was observed by confocal microscopy and quantified by flow cytometry. Cytotoxicity of NPs was assessed using MTT assay. Results showed hSET1/SN38 nanoparticles had significantly higher cytotoxicity against HT29 cells compared with nanoparticles containing SN38, free SN38 or naked hSET1. Therefore, present system could be considered an effective combination therapy of highly hydrophobic SN38 and hSET1.

Moral distress in physicians practicing in hospitals affiliated to medical sciences universities

BACKGROUND

Researchers have regarded moral distress as a major concern in the health care system. Symptoms associated with moral distress may manifest as frustration, dissatisfaction, and anxiety and may lead to burnout, job leaving, and finally, failure to provide safe and competent care to patients. Proper management of this phenomenon can be fulfilled through study of its causes at different levels of health services and taking necessary measures to solve them.

OBJECTIVES

This study aimed to determine the status of moral distress in physicians practicing in hospitals affiliated to Medical Sciences Universities in Tehran.

MATERIALS AND METHODS

This cross-sectional study was carried out using the Standard Hamric Scale to collect data after modification and evaluation of its reliability and validity. A total of 399 physicians responded to the scale. Data analysis was performed using descriptive and correlation statistics with respect to the variables.

RESULTS

Results showed that the frequency of moral distress of physicians was 1.24 ± 0.63 and the intensity of moral distress and composite score of moral distress were 2.14 ± 0.80 and 2.94 ± 2.38, respectively. A significant negative correlation existed between age and frequency and composite score (r = -0.15, P < 0.01 and r = -0.16, P < 0.01, respectively) as well as years of experience and composite score (r = -0.11, P = 0.04). Moral distress composite score in adults specialists was higher than pediatricians (P = 0.002), but lower in physicians participated in medical ethics training courses compared to those not participated.

CONCLUSIONS

Physicians may encounter moral distress during their practice; therefore, the common causes of distress should be identified in order to prevent its occurrence.

Specific activation requirements of zona-free sheep oocytes before and after somatic cell nuclear transfer

In this study, the effect of the steps involved in zona-free somatic cell nuclear transfer (SCNT) on oocyte transcripts was investigated in sheep. To establish the reliable combined electrical-chemical activation for zona-free oocytes, oocytes were first exposed to an electrical pulse and then treated with 18 chemical activation regimens designed through modifying duration and concentration of ionomycin and 6-dimethyl aminopurine (6-DMAP), which is routinely used for SCNT. Electrofusion-mediated nuclear transfer significantly reduced transcript abundances of CCNB1, POU5F1, NPM2, GMMN, and CX43 compared to intact oocytes. Maximum parthenogenetic blastocyst development was obtained when oocytes were submitted to electric pulse and then to (1) 5 μM ionomycin for 5 or 2.5 min, both followed by 2 h of incubation with 6-DMAP (41.7±1.1, and 42.4±1.4%, respectively), (2) 5 μM ionomycin for 1 min+6-DMAP for 4 h (43.1±1.4%), and (3) 2.5 μM ionomycin for 1 min+6-DMAP for 2 h (42.4±1.4%), with significant differences compared to all the other groups. Statistical assessment of interactions between duration and concentration of ionomycin and duration of 6-DMAP exposure revealed that (1) concentration of ionomycin may be a more important factor than its duration, (2) both a long exposure period and a low concentration of ionomycin had marked decreasing effects on parthenogenetic development of zona-free oocytes, and (3) high duration of exposure to 6-DMAP can reduce parthenogenetic development. Despite an activation preference of parthenogenetic oocytes, a significantly higher rate of cloned blastocyst development was observed when reconstructed oocytes were activated with 5 μM ionomycin for 5 min rather than 2.5 μM ionomycin for 1 min (8.8±2.5 vs. 1.25±2.2%). These results suggested that SCNT steps have determining effects on oocyte transcripts and activation preferences of the reconstituted oocytes compared to intact counterparts. In this sense, reconstituted oocytes may need a higher concentration of ionomycin for a longer period than intact oocytes.

Cryosurvival of in vitro produced embryos as affected by health status effect of oocyte donor cow

In vitro embryo production and embryo vitrification of genetically superior cows that culled inevitably due to health problems can accelerate genetic progress. This study was carried out to investigate whether maternal age and health status effects of high genetic merit cows affect cryosurvival and developmental competence of IVP embryos. In this sense, the effects of ageing and four common culling causes of dairy cows [repeat breeding (RPB), udder problems (UPM), chronic endometritis (CRE), and lameness (LAM)] on in vitro embryo development, and in vivo developmental competence after embryo vitrification were evaluated. The mean number of oocytes obtained per cow did not vary significantly between donors indifferent groups. Cleavage rates in RPB (86.0+/-4.2%), SEN (81.3+/-2.5%) and CRE (77.6+/-6.3%) cows which were comparable to control (95.9+/-1.5%) but were significantly higher than the related rate of UPM donors (50.6+/-2.6%). Importantly, there was no significant difference between the blastocyst rates of different groups. Mean overall survival rate was not different between the groups and was not affected by the blastocyst production rate. There was no significant difference between pregnancy rates of different groups. The results of the present study indicated that in cattle, neither ageing, nor these four diseases affect ovarian potential in terms of the yield and quality of in vitro embryo development.

Response of salivary peroxidase to exercise intensity

Oral peroxidase, one of the most important salivary antioxidant enzymes, is subjected to alternation due to various body conditions. The aim of this study was to assess the effect of exercise intensity on salivary peroxidase activity. Using a randomized design, ten healthy male university students (mean age, 23.22; s (x) = 2.34 years) completed treadmill runs with initial velocity 6.73 km/h at the rate of 1.58 km/h increase every 3 min until exhaustion. Unstimulated whole saliva collected over a 5-min period in pre-weighed tubes before, immediately after exercise, and 1 h after exercise was analyzed for total protein and saliva peroxidase activity. The saliva flow rate ranged from 0.08 to 1.40 ml min(-1) at rest and was not significantly affected by the exercise. Peroxidase activity in each sample was measured using 4-amino antipyrine as substrate. In the incremental exhaustion run and also at 75% VO(2max), the secretion rates of peroxidase increased. No significant changes in saliva flow rate were observed in any treadmill run. Treadmill runs at 75% VO(2max) and to exhaustion increased the activity of peroxidase immediately after exercise which decreased after 1 h. It was concluded that short-duration, high-intensity exercise increases the activity rate of peroxidase despite no change in the saliva flow rate. These effects appear to be associated with changes in sympathetic activity and not the hypothalamic pituitary adrenal axis.