Background: Evidence based medicine (EBM) is very important in the process of decision making, diagnosis and treatment of patients. For years, medical schools have developed instructions for EBM to determine the attitude and knowledge of physicians towards EBM and their related educational needs. Materials and Methods: This study was a questionnaire study among physicians. One hundred twenty physicians were selected using stratified random sampling in Ilam. A main outcome measure was attitudes and knowledge of physicians toward EBM, ability to access and interpret evidence, and best method of moving from opinion based to EBM. Results: Of the 120 questionnaires we have sent, 94 (78.3%) were answered. 56.6% were using the internet to answer their patients questions and 23.8% used the internet to obtain clinical evidence. Mean and standard deviation (SD) of knowledge and attitude scores were 24% ± 23% and 72% ± 10%, respectively. Pearson correlation shows a significant relation between knowledge of physicians and years of graduation (r = -0.37, P = 0.00). There was a significant difference between mean of knowledge score of general practitioners, specialist and subspecialist (P = 0.026). Conclusions: Knowledge and attitude of young physicians were more based on EBM compare to old physicians. A significant difference in knowledge mean score of physician shows that the EBM is still new in Iran, the future physician's critical need to learn EBM and necessity of entering EMB at all medical levels.

We present a rare case of an acute epidural hematoma (EDH) in a neonate. The EDH was caused by a fall during natural vaginal delivery. The clinical findings were normal after fall and the first ultrasonographic study did not show any hematomas. A computed tomography scan on the second day after delivery showed an EDH with 20 mm thickness extending through a skull fracture into subgaleal space. We performed a craniotomy and removed the EDH and subgaleal hematoma. After the surgery we performed follow-up twice ultrasonographic study for seeking probable hematoma recurrence. The patient was discharged after postoperative 3 days without any neurological deficits.

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Correspondence to Dr Milad Rashidbeygi, miladrashidbeygi@yahoo.com DESCRIPTIONA 62-year-old woman with ischaemic heart disease reported having dyspnoea, chest pain in the left hemithorax, epigastric pain and nausea for 4 weeks. The patient's blood pressure was 150/90 mm Hg and ejection-fraction on echocardiography was 30-35%. An electrocardiogram showed a regular rhythm, with a widened QRS complex in all leads. There were notched R waves in V5, V6, aVL, II, III and aVF (figure 1). The small initial R waves in V1 and V2 were followed by deep S waves and wide S waves in left precordial leads (V5 and V6). The electrocardiogram showed characteristics of LBBB and RBBB simultaneously and a wide QRS complex; thus, we suspected an intraventricular conduction defect (IVCD). The ECG appearance of the IVCD was difficult to characterise, because IVCD is often the end result of a number of different pathophysiological processes rather than a discrete defect in the conduction system (as usually occurs with RBBB or LBBB).