Journal of

Background & Aim: Unified Medical Language System (UMLS) is an extensive ontology of biomedical knowledge developed and maintained by U.S. National Library of Medicine (NLM). Traditional Iranian Medicine (TIM) does not have any position in the structure of metathesaurus of UMLS. The main aim of this study was designing a scheme of TIM cluster's crotch mapping in the structure of metathesaurus of UMLS. Moreover, the TIM position and its proportion in the domain of vocabulary and concepts of universal medical knowledge was another aim of this study.

Materials and Methods: System analysis was the method of this study. To investigate structure of UMLS metathesaurus, and to survey lacking of TIM cluster's crotch, we applied UMLS Knowledge Source (KS) by using inductive, deductive, inductive-deductive approaches. 

Results: One Concept Unique Identifier (CUI) two synonym terms with Lexical Unique Identifier (LUI), L0025131 and L6330122 two ancestor and parent concept nine concepts which with TIM crotch were the child concepts of two ancestor and parent eighteen sibling concepts six narrower and five other related found concepts were identified for the proposal TIM crotch mapping in metathesaurus of UMLS. In addition, we found the "Biomedical Occupation or Discipline" semantic type assigned to it.

Conclusions: Current domain of metathesaurus of UMLS does not represent complete and formal domain and position of TIM. Therefore, this metathesaurus needs to depict a domain and position for TIM.

Background and Aim: Today provision of an adequate and appropriate health services depend on many factors. Human resources are one of the most important factors. Nursing managers with more exact understanding of nursing activity could prevent of human resource wastage. In other way goal achievement in an efficient remedial system depends upon favorite delivery services and one of the appropriate ways for quality of care evaluation is patient satisfaction measurement about care delivery. This study was conducted and implemented to measure the nursing care time and its relationship with patient satisfaction.

Materials and Methods: This descriptive and analytical study was done in internal ward in Gorgan 5th Azar educative and therapeutic center for one month. nursing activity checklist was used for measuring the time that spend for Nursing staff activity and patient satisfaction scale. Data were analyzed with SPSS for Windows package.

Results: In this research findings showed, 46.46% of nursing activity time was spent for direct care, 15.8% of total time was used for documentation activities and 22.5% of time spent for nurses' individual activity, whereas only 7.43 percent of total time was spend for patient assessments. 60.3% of patients were satisfied about care delivery and 24.8% of them had moderate satisfaction. A significant correlation was seen between patient satisfaction and nursing direct care (r =0.272, P= 0.001).By increasing The spent time for direct care, patients' satisfaction was also increased.

Discussion and Conclusion: Nursing managers' awareness from scientific methods of management, rules modification, use of new equipment and technology and also delegating of some nursing activity to nursing assistants could promote quality of care with increasing of nursing direct care.

Background and Aim: Enteroinvasive Escherichia coli (EIEC) strains include a group of diarrheagenic Escherichia coli (DEC) and are known to cause shigellosis-like symptoms in both adults and children. They belong to a limited number of serotypes and their somatic (O) antigens are identical with, or related to, certain Shigella antigens. EIEC strains are confirmed by demonstration of invasiveness by polymerase chain reaction (PCR) for detection of the ipaH (invasive plasmid antigen H)  gene that is specific for these strains among DEC.Since in our country,Iran study for detection of  these strains. hasnot been carried out therefore the aim of this study was detection of EIEC in diarrheal under 5 year old children in Tehran.

Materials and Methods: During the descriptive study,300stool samples were collected from children with diarrhea in Ali Asghar Hospital and children medicinal center of Tehran during 4 months (April-Jul 2008). E.coli species were isolated by standard bacteriological and biochemical tests. Presence of invasive plasmid antigen H (ipaH) gene in confirmed colonies was investigated by PCR technique.

Results: Among 300 stool specimens studied using culture method and biochemical tests,39(13%) E.coli species were isolated. Among these 39 strains,7(2.3%) strains containing ipaH gene (EIEC) were detected by PCR technique.

Conclusions: Enteroinvasive Escherichia coli (EIEC) in our country, Iran, may be as bacterial pathogen causing childhood diarrhea. Therefore we should apply new techniques for investigation of these strains.

Background and Aim: Prevalence of anabolic steroids (ASs) consumption among bodybuilders has increased progressively. Therefore, the purpose of this study was to evaluate the effect of ASs consumption on C-reactive protein (CRP) in bodybuilders.

Materials and Methods: Sixty healthy men (age: 24/1± 9/1yr weight: 77±10 kg and height: 172±12 cm) participated in the study voluntarily. These subjects were selected from three groups. First group (FG) was bodybuilders who consumed ASs (n=20), second group (SG) was bodybuilders who did not consume ASs (n=20) and third group (TG) were untrained subjects as control (n=20). Blood samples were collected in fasting state (12 hours) at 09:00 for CRP assessment. Strength and volume of the forearm, pectoral major and femur muscles were measured via 1RM test and muscle circumstances, respectively. Speed was assessed by 30m speed test. Analysis of variance test and LSD post-hoc test was used.

Results: FG had significantly greater blood CRP (P<0/05) compared to other groups. However, differences between SG and TG were not significant. Muscle strength, and forearm and femur circumstances were greater in FG than other groups. Furthermore, this was greater in SG than TG. But chest circumstance was greater in FG and SG than TG only. There were no significant differences in speed between groups.

Conclusion: ASs consumption for muscle strength and volume improvement in bodybuilders is accompanied by higher level of CRP (as a cardiovascular risk factor).

Background and Aim: Despite the information regarding CAD risk factors, there isn't agreement between the relation of this risk factors and coronary artery diseases. This study was done for determination of related factors with vessels involved in coronary artery angiography.

Materials and Methods: In this descriptive and analytical study, 2390 patients' .were selected via census sampling from Kosar Angiography center in the Golestan province. Data gathering form included data such as age, gender, body mass index (BMI), blood pressure, diabetes, smoking and opiates addiction history. Vessels involved were determined by angiography. Data analysis was done with one way ANOVAs and logistic regression using SPSS 16 soft ware.

Results: Mean and standard deviation of patient's age was 57.9±10. 58.2 percent of them were male. There were significant correlations between age, gender and BMI with numbers of vessels involved. Male gender(OR=1.329), hypertension (OR=1.25) and diabetes(OR=1.20) increased the probability of more than one vessels involvement. Regression analysis showed there were no significant correlations between age, BMI, smoking and opiates addiction history with more than one vessels involvement.

Conclusion: Our finding confirmed that male gender, hypertension and diabetes are the main risk factors in involvement of more than one vessel.

Background and Aim: Self-reliance is a psychological belief that is formed in an individual during growth and is not changed easily and quickly.
The present study aims to evaluate the relationship between nursing managers' self-reliance and patients' satisfaction in hospitals affiliated to Tehran University of Medical Sciences(TUMS).

Materials and Methods: In this cross-sectional study, 400 individuals(200 nursing managers and 200 patients) were interviewed in various clinical wards of TUMS hospitals. Nursing managers' self-reliance and patients' satisfaction were evaluated using a structured questionnaire.
The data were entered into Stata 11 software and analyzed with non-parametric ANOVA and Spearman's correlation coefficient tests. The significance level was determined to be p<0.05.

Results: Of the nursing managers, 58(29%) were male and 142(71%) were female. The mean and SD of their self-reliance were 134.9 and 19.8, respectively. The patients, however, comprised 81(40.5%) males and 118(59.5%) females. The mean and the standard deviation of patients' satisfaction were 57 and 18.2, respectively the only individual factors affecting their level of satisfaction were educational level(p<0.005) and insurance status(p<0.0001). Besides, a multivariate analysis showed that there was a significant negative association between managers' self-esteem and patients' satisfaction(P=0.04).

Conclusion: The findings revealed that female managers had less self-esteem than male managers. Moreover, it showed that managers' higher self-esteem would cause patients' lower satisfaction. Furthermore, patients with higher education and/or with health insurance were more satisfied than others.

Background and Aim: Female pattern hair loss(female androgenic alopecia) is a common but puzzling condition in women which increases by aging. Female hair loss is strongly linked to hormones and hormonal imbalances. The aim of this study was to determine the serum level of hormones such as T4, TSH, free testosterone, Prolactin(PRL) and Alb, SHBG in women(15-50 years old) with hair loss versus those without hair loss.

Materials and Methods: In this cross-sectional case-control study, 71 women with hair loss and 70 normal women were selected from skin and hair care day clinics. The level of hormones and SHBG were measured by ELISA, and Alb was measured by spectrophotometery. Data were analyzed by independent t-test.

Results: After analyzing the data and determining the levels of TSH, T4, Prolactin, Alb, SHBG, no significant difference was found between the case and control groups. However, free Testosterone level was significantly different between patients and controls(P= 0.000), with a higher mean level in the case group(patients).

Conclusion : Since androgens have a major role in regulating the biological cycle of hair in women and since there was a significant difference between free testosterone in patient and control groups, we suggest that the serum level of free testosterone should be measured in women with androgenic alopecia .

Background and Aim: Having a preparedness program for earthquake in hospital, with regard to its function for victims of accidents, is very important. The main objective of this study was evaluation of effective factors on the rate of preparedness of Tehran University of Medical Sciences’ teaching hospitals, to deal with earthquake danger of earthquake .

Materials and Methods: This cross-sectional analytical survey was performed in the follow ing hospitals: Sina, Farabi, Roozbeh, and Razi. Data was collected by checklists and questionnaire. Data analysis was performed using statistical software (SPSS19) and Pearson correlation , ANOVA, t-test statistical tests.

Results: The most and the least preparedness against earthquake was in disaster management and construction mitigation plan fields respectively. Relationship between the field of hospital curriculums with construction mitigation plan (p= 0/045 and r=0/644) and hospital environmental health action plan (p=0/048 and r=0/636), was significant.

Conclusion : Average of Hospitals preparation against earthquake was evaluated in an intermediate level (51.81percent). Due to the significant relationship between education and other fields that are listed above it is suggested that in addition to short-term training programs, non-structural retrofitting of hospitals should be considered as a priority.

 Background and Aim: Isoflurane is one of the selective and mostly-used respiratory anesthetic materials in the field of neurosurgery. Studies have shown that temporary rise in the level of liver enzymes may occur after anesthesia by halogenic ethers and hence cause liver lesions. The aim of this study was to investigate the effects of isoflurane on the activity of ALT-AST-ALP-GGT enzymes as an indicator of liver function.

 Materials and Methods: This study was performed on a sample of 40 patients who were under neurosurgery without any liver disease in Milad Hospital of Tehran. The patients' blood samples were collected before, 24, and 72 hours after anesthesia. The enzymes activities was assessed by spectrophotometric method.

 Results: Insignificant changes before and after anesthesia were seen in the activity of ALP, and AST enzymes. The level of ALT enzyme has a significant rise, 72 (P=0/022) and 24 (P=0/014) hours after anesthesia in comparison with before anesthesia. The level of GGT enzyme in comparison to its past has significant rise 72 hours after anesthesia (P=0/002). The level of this enzyme showed a significant difference 24, and 72 hours after anesthesia (P=0/041).

 Conclusion: The significant changes seen in the levels of ALT, GGT enzymes in three different periods of time might be as a result of possible liver parenchymal and cholestatic damage caused by using Isoflurane or other drugs such as Midazolam which effects liver function. It seems the assessment of the levels of these enzymes can provide useful information for probable subsequent actions.

 Background and Aim: Nanomedicine is growing very fast. Transfer and commercialization of research results in Nanomedicine is a missing link between technology and market. This is affected by some factors which are barriers to commercialization. The aim of this study was to identify barriers to transfer and commercialize nanomedicine research results in Iran.

 Materials and Methods: The research method was qualitative method based on eight semi-structured in-depth interviews with nanomedicine and commercialization experts in year 2011 in Iran.

 Results: The proposed model of commercialization consisted of five distinct parts: transferor, transferee, transfer object, transfer mechanisms and environmental factors. In this study twenty six environmental factors in seven categories as Environmental Barriers to Transfer and Commercialization of Nanomedicine Research Results was identified.

 Conclusion: The most important barrier to nanomedicine commercialization in Iran are licensing system, lack of capital, and consumption culture.

Background and Aim: Breast cancer is the most common type of cancer among women. A subset of isoflavones such as phytoestrogens (plant estrogens) have mammalian estrogen-like properties. Alfalfa has high isoflavone content. The aim of this study was to examine the effect of alfalfa’s isoflavones on breast cancer and lipid profile in these patients.

Materials and Methods: Thirty BALB-C mice (17±2 gr weight range) were selected. The rats were divided into four groups. The first and second group triggered to breast cancer by implanting cell lines. The third and fourth groups were healthy. Alfalfa extract was prepared by vacuum distillation.

Groups I and II received extraمct of alfalfa. Groups II and IV (control) received no treatment. After 6 weeks the blood serum of all mice were prepared. Concentration of estradiol, LDL-cholesterol, HDL-cholesterol and total cholesterol were measured.

Statistical analysis was performed by t-student and Graphpad statistical software. The significance level was set at P=0.05.

Results: The level of estradiol, total cholesterol, and LDL-cholesterol decreased significantly in the first group versus the second group (P<0.00 for all). The level of HDL-cholesterol increased insignificantly in the first group when compared to the second group (P=0.09).

Conclusion: Alfalfa extract with effect on esteradiol levels and lipid profile in mice with breast cancer could be useful in improving the patient’s condition.

 Background and Aim: Every educational system, whether micro or macro, needs its training programs to be studied and educationally evaluated. This study aims to assess training and internship programs in hospitals based on surveying the students of Tehran University of Medical Sciences (TUMS).

 Materials and Methods: This is a cross-sectional study with survey descriptive design. The data collection tool was a questionnaire with 14 five-point Likert style items. The TUMS Educational Development Center (EDC) surveyed all 185 students of training and internship programs, using a questionnaire with the Cronbach’s alpha coefficient of 0.81 in 2011, in order to adjust the education with the society’s needs and to improve its quality.

 Results: The mean assessment scores of training and internship programs were 3.32%, 2.98%, 3.38%, and 3.29% for applied training, mental skills, communication skills, and practical skills courses, respectively.

 Conclusion: The students’ satisfaction rate regarding the quality of educational courses of training and internship programs was 50.2%. Educational authorities have made necessary attempts to implement these programs and use potential resources for realizing the objectives and achieving the educational quality however, they should make further attempts in this regard.

Background and Aim: Considering the potential damages caused by inaccurate, inadequate and incomplete information published in web pages, the aim of this study was to evaluate Persian-language web pages containing nutritional information, using Silberg criteria.

Materials and Methods: Internet pages related to nutrition were found in “peyvandha.ir” and by searching 20 nutrition-related keywords in five search engines. The first fifty results of every keyword in every search engine were evaluated according to the inclusion criteria. From every website/weblog, three issues were randomly chosen. The Silberg checklist and the qualitative questionnaire were completed and the data were analyzed using SPSS software.

Results: In total, 56 websites /weblogs (47 websites and 9 weblogs) were found to have nutrition-related information. Among these websites/weblogs, 40 were active in the field of nutrition, 14 in health-related fields, and the rest in news, general information and cooking. Mean Silberg score (out of 9) was 2.3±1.9 for websites and 1.75±1.3 for weblogs. The highest score in this study was 8 (one website) and the lowest score was zero (13 websites/weblogs). In 82.5% of websites/weblogs, the sources used in compiling the articles were not mentioned and 64.9% of them lacked their authors’ names. Of all websites/weblogs, 94% didn’t have any disclaimer rejecting the responsibility for accuracy of the information.

Conclusion: Due to the poor quality of internet pages on the one hand and the importance of nutritional knowledge on the other, the development of reliable Persian-language web pages to improve public awareness of nutritional issues is necessary.

Background and Aim: Learning is essential in healthcare environments, where knowledge and skills are quickly outdated due to continuous advances in medical science. Organizational learning is a dynamic process that enables learning organizations to be campatible with change in good time. The aim of this study was to determine the status of organizational learning in an Iranian healthcare organization in Tehran, and to assess the extent to which this organization could be considered as a learning organization.

Materials and Methods: In this cross-sectional and descriptive study, 200 nurses were selected in an Iranian healthcare organization. Dimension Learning Organizational Questionnaire (DLOQ) was used to collect data to be analyzed using descriptive statistics methods by frequency, percentage, mean, and standard deviation.

Results: The mean overall score for organizational learning was 3.36±0.69. Among the various dimension of organizational learning, continuous learning had the highest average (3.44±0.39), and the empowerment had lowest amount (2.72±0.06).

Conclusion: The findings from this study provide useful information for these organization's managers regarding the areas where there is a need for improvement in OL and to make it a more LO.

Background and Aim: Evaluating and improving the employees’ quality of work life is one of the most important responsibilities of managers in each organization. The aim of this study was to design and prepare a questionnaire for evaluating the residents’ quality of work life and checking the validity and reliability of this tool.
Materials and Methods: We collected the questionnaires which were used for the employees’ quality of work life, and designed by Delphi method a comprehensive questionnaire for measuring residents’ quality of work life. This questionnaire was distributed two times with one-week interval between 14 residents of Tehran University of Medical Sciences and then the validity and reliability was assessed by α cronbach model. We used the 5 experts in the field of health care management, medical education and health economics to determine the validity of quality of working life questionnaire. The classification of cronbach's α for intra-rater reliability was: very good (0.9-1), good (0.8- 0.89), average (0.7- 0.79), bad (0.6-0.69) and very bad (under 0.59).
Results: The results of  αcronbach test for questions reliability and the result α cronbach test for internal consistency of each class of question indicated the rather high reliability and validity of these questions.
Conclusion: Regarding to the results of α cronbach test, we can deduce that our designed questionnaire encompass have satisfied validity and reliability and it can be used for future studies.

Background and Aim: Safety is an important component in the quality of health care that lack of attention to it leads to harmful results. This study was conducted to estimate the safety management status in selected hospitals affiliated with Tehran University of Medical Sciences. 
Materials and Methods: This analytical-descriptive cross-sectional study was conducted in four selected hospitals affiliated to Tehran University of Medical Science in 2012. Data collection was performed through a valid and reliable questionnaire (Safety management) involved 112 questions in 3 parts: organization, safety and event committee’s management, investigation of organization and hospital’s structure and evaluation standards for surgery rooms by safety management views, in 5 options of Likert criteria. SPSS software frequency, mean and standard deviation and Kruskal–Wallis were used for statistical analysis of data’s.
Results: In the evaluation of the hospital organization factor and its structure from safety management approach, each hospital’s organizational structure form safety management view was in a suitable condition (72.50). The result also showed that in respect to evaluation of surgery rooms for safety management, the highest average of calculated score was for hospitals number 1 (90.00) and the lowest was related to hospital number 4 (69.09). 
Conclusion: According to the results, safety in hospital was in an acceptable level. But it seems that continuous monitoring and safety management training courses is essential.