Journal of

Background and Aim: Personal Health Record (PHR) systems play a key role in employing patient-centered care. Besides, the inclination to use Internet services has increased in recent years. The goal of this study is to describe the needed requirements for developing the proposed hybrid PHR model in a social network. 
Materials and Methods: Using a descriptive study, a hybrid PHR model was designed in this paper to be implemented in the social health network. Then, by using observation, introspection and questionnaire methods, the requirements of the proposed social network were listed. The elicited requirements were then analyzed by SPSS 16 using descriptive statistics (absolute frequency). Finally, the proposed system was described in the Software Requirement Specification (SRS) standard format. 
Results: The proposed hybrid PHR model has benefits of all existing PHR models and is most consistent with PHR definition (individuals control and manage their PHR). It is also applicable and reliable both for individuals and physicians. The results indicated that the proposed system had PHR capabilities as well as social network functionalities. So, the possibility of creating relations between individuals provided more benefits in comparison to other PHR models.    
Conclusion: By providing reliable information, the social health network can improve patient-physician relationships. As a result, the proposed social health network can make possible the utilization of web 2.0 and social network capabilities in the healthcare field as well as the benefits of PHR records and patient-centered care.

Background and Aim: In each organization, there is a debate about the use of IT. Human development is one of the factors influencing the efficiency and success of any organization. The present study aimed to investigate the effects of information technology on empowerment of staff working in Tehran University of Medical Sciences.
Materials and Methods: This study was descriptive-survey research and applied in terms of purpose. A total of 274 staff members from the Tehran University of Medical Sciences were surveyed by sampling according to the Krejcie-Morgan table from among 950 employees. The tools used in the Ardalan questionnaire were divided into two parts of IT, including 10 questions and a staff empowerment questionnaire containing 23 questions. Data were analyzed by SPSS 13 software, Kolmogorov-Smirnov test and one-sample T-test.
Results: The research findings showed that the use of information technology on five dimensions of job empowerment including competency, improvement of quality of work, increased decision-making power, increasing self-control, and reducing job stress have a significant effect.
Conclusion: The most important task of managers of universities is to improve the ability and job satisfaction of employees, holding in-service training courses in the field of computers and the Internet and encouraging employees to use more computers in their related activities.

Background and Aim: World Health Organization (WHO) has prioritized cultural competence to provide high-quality healthcare and patient-centered services. Therefore, it is necessary to develop them for all organizational levels. The present study aimed to determine the validity and reliability of the Persian version of OHCC (Ontario Healthy Communities Coalition) organizational cultural competence (2005) instrument in Tehran University of Medical Sciences (TUMS).
Material and Methods: In order to confirm reliability, 143 staff members (nurses and physicians) in different administrative positions working in Imam Khomeini educational Hospital, completed the questionnaire. Modified HSR toolkit for translating and adapting instrument, was used for contextualizing the questionnaire: first, two medical education experts who were proficient in English translated it. Then, the content validity of Persian version was confirmed using Lawshe method (CVR and CVI = 0.79); its internal consistency was calculated by Cronbach's alpha coefficient (0.91). It was backward translated to compare with the original copy and was sent to experts for their approval. Construct validity was calculated by LISREL software and the result showed that the questions were fit to the domains. The KMO, calculated for this instrument, was 0.75 and α was less than 0.05.
Results: Content validity was confirmed by deleting two items from the original 22-item questionnaire. Cronbach's alpha was calculated as 0.95 following the removal of two items.
Conclusion: The organizational cultural competence instrument was confirmed to be valid and reliable with 20 items in Iranian context.

Background and Aim: Glaucoma, with an increasing pressure inside the eye, is one of the causes of blindness worldwide. The only glaucoma treatment is regular eye examination and control of intraocular pressure (IOP). The centralized information obtained from these examinations is an essential prerequisite for providing optimal healthcare which is possible by creating electronic records. Minimum Data Set (MDS) is a standard tool for getting access to accurate data, which is among the basic needs for the design of electronic records.
Materials and Methods: This is descriptive-analytical study. The population of this study consisted of glaucoma patients’ medical records at Farabi Eye Hospital, reference books, and glaucoma specialists. The data collection tool was a questionnaire -- containing patients' records, and demographic and clinical data -- which was distributed between 22 available glaucoma specialists. The validity of the questionnaire was assessed by an expert team and its reliability was determined by test-retest method. Data analysis was performed by calculating the frequency percentage and Delphi test.
Results: After reviewing the rate of experts’ agreement with the components of the survey, all of the cases with over 75% approval rate were considered as minimum data set for glaucoma. Minimum data set was divided into three general categories: patient's records, demographic data, and clinical data.
Conclusion: Determination of minimum data set for glaucoma will be an effective step to integrate and improve the management of patients’ records. Moreover, it will be feasible to store and retrieve such records. 

Background and Aim: Nowadays, one of the most important areas of application of information technology in the health sector is monitoring patients' condition. Recently utilization of body area sensor networks in healthcare had significant advances. The purpose of this article is to examine the applications of wireless health sensor networks in the field of health. 
Materials and Methods: This study was a review study which was done by searching in reliable scientific sources such as Pubmed, IEEE, Science Direct, Springer and other Persian information sources like Magiran and Sid. In order to search English sources, keywords such as “Wearable and implantable body sensors” “Body area sensor network”, and in order to search in Persian sources, keywords such as “implantable and wearable network nodes”, were used.
Results: The tasks of the body sensor networks are to monitor the important parameters of the body, which are vital signs of ill health and illness. Additionally, various types of sensor networks can control various illnesses, for example, heart disease, neoplasms, diabetes, kidney disease, Parkinson's disease, infectious diseases, and so on. Also a variety of wireless body sensor networks in the medical field are divided into two main categories: the wearable wireless body area networks and the implantable wireless body area network.
Conclusion: The use of body sensor networks has a tremendous impact on health and leads to improvements in the life quality and comfort of patients. These technologies are improving, and their development aims to help patients, doctors and the treatment team.

Background and Aim: Ergonomics is the science of refining and optimizing the working environment, occupation and equipment, and matching it with human capabilities and limitations. The purpose of this study was to compare the working environment conditions of the library staff with Ergonomic Principles in selected Universities of Medical Sciences in Tehran in 2016.
Materials and Methods: This is a descriptive and cross-sectional study. The population of this study included all faculty librarians of selected Medical Sciences Universities in Tehran. This study was conducted by census method and all population members (n=85) were studied. The data collection tools were ergonomic checklist in the library environment and a researcher-made questionnaire on the educational status of ergonomic principles. The data were analyzed by SPSS software version 22 after they were collected and entered into the computer.
Results: Based on the obtained findings, it became clear that the status of variables such as body conditions, work space, equipment and environmental conditions was average in terms of ergonomic principles and health variables, and safety factors and welfare facilities were at an undesirable level. In each of the variables of body condition, work space, equipment and safety factors among the libraries of selected Universities, ergonomic conditions did not have significant differences. 
Conclusion: According to the results of this study, it can be concluded that the conditions of the librarians’ working environment in the studied community were not favorable in terms of ergonomic conditions. 

Background and Aim: Successful implementation and optimum use of telemedicine technology depends on providing the necessary infrastructure and the success factors of this technology, such as high-speed broadband. The present study is aimed at feasibility study on the implementation of telemedicine in selected hospitals of Iran.
Materials and Methods: This descriptive-analytic study was conducted in selected hospitals in 2016. The data gathering tool was a researcher-made questionnaire that its content validity and structure were measured by four professors of health information management. Reliability of the questionnaire was determined using internal correlation test (Cronbach's alpha=0.83). The results were analyzed using descriptive statistics (average and standard deviation) and inferential statistics.
Results: According to the findings, 82.2% of the hospitals had no access to 
high-speed broadband and only 5.5% had optics fiber. Insurance and repayment obstacles and shortages of technical staff were identified as the main barriers and medical personnel's resistance and licensing issues were identified as the low importance barriers to the implementation of this technology. Organizational and cultural factors (p-value=0.001), technical infrastructure (p-value=0.005) and financial requirements (p-value=0.021) of telemedicine technology had a significant difference of 5% error rate with education level and orientation.
Conclusion: Due to barriers such as lack of video conferencing tools, the lack of high-speed broadband, and inadequate funding for the purchase and implementation of the necessary equipment, the studied hospitals currently were not able to provide telemedicine services.

Background and Aim: The Ovarian epithelial cancer is one of the most deadly types of cancers in women.Thus, the purpose of this study was to investigate the most effective factors in predicting and detecting Ovarian cancer in the form of a decision tree to facilitate the Ovarian cancer diagnosis.
Materials and Methods: The present study was a descriptive-developmental study. The main research tool applied in this study was a checklist which was designed based on the medical records, published studies, scientific references, and expert consultation.To determine the content validity of the checklist, the CVR method was applied. Next, survey research was done with aid of Likert-based checklist based on expert opinions in gynecology. Finally, to develop the decision tree, the results of the expert survey were analyzed and the final model was implemented based on the survey results.
Results: The data elements of final decision tree were derived from the result of expert surveys, guidelines, clinical pathways and strategies in context of diagnosis and screening of Ovarian cancer. The leaf nodes in the tree include different types of tumor markers, following up, therapeutic measures, and referrals. The accuracy of the decision tree was approved by the experts. The most important tumor markers that obtained from the decision model in this study were CA19-9, ROMA (CA125 + HE4) and CEA.
Conclusion: Clinical decision models can provide specific diagnosis and therapeutic suggestions by creating patient information integration framework. The model developed in this study can improve the diagnosis of epithelial Ovarian cancer considerably by facilitating decision making.

Background and Aim: Ranking of hospital libraries based on standard criteria and taking pattern of top libraries would improve the quality of library services. The purpose of this study was to rate hospital libraries based on LibQual criteria and Vikor model. 
Materials and Methods: This study was conducted in a survey method. The statistical population was 3850 actual users of the library of 8 governmental hospitals (with capacities up to 320 beds) in Tehran in 2016. To achieve the goals, The LibQual questionnaire and AHP technique were used. The validity of both questionnaires has been confirmed in various studies. Cronbach's alpha coefficient greater than 70 percent For LibQual questionnaire and inconsistency rates less than one percent for Vikor questionnaire confirm the reliabilities. Data analysis was performed using the expert choice software. Ranking were done using the Vikor technique.
Results: According to three main dimensions for LibQual, "library as a place" weighing 0.379 was the first preference, and "quiet space for individual activities" weighing 0.364 was the first in this dimension too. The dimension of "information control" weighs in 0.318 at the second, and "service impact" weighs 0.303 was in the third grade. In the ranking based on the Vikor criteria, the Library of Firoozgar hospital was in the first place.
Conclusion: The library of Firoozgar hospital in Iran university of medical sciences was the forefront and could be an exemplar for the other libraries.

Background and Aim: The quality of healthcare services is determinant in patients’ improvement process, upgrading their satisfaction, ranking healthcare centers, and preventing patients’ repeated referrals leading to more costs for healthcare centers and insurance companies. The purpose of this study was to evaluate the quality of services -- from the perspective of patients -- given by the laboratories having contract with Iran Health Insurance Organization (IHIO). 
Materials and Methods: In this cross-sectional study, the opinions of 302 patients having referred to the laboratories in contract with IHIO in Tehran were surveyed with a researcher-developed questionnaire. Descriptive and inferential statistical tests were used to analyze and report the results.
Results: The sample included 43.5% males and 56.5% females. Most of the participants were married (71/3%). Based on the results, the patients' perception of the quality of laboratory services was 78%. Their expectation of services was 85%. The gap between perception and expectation of clients in all dimensions was statistically significant (p<0/001).
Conclusion: The gap between clients’ perception and expectation in all dimensions suggests that there is some room for improving the quality of laboratory services. The results of this assessment can surely affect the way IHIO treats with laboratories in terms of extending contracts and strategic purchase of services from these centers. In addition, patients' opinions will be important in improving the quality of services. 

Background and Aim: The emergence of Web interactive technologies has enabled interactive social networking services. The purpose of this research is to choose a model and present an architectural design for the social network of health at Shariati Hospital in Tehran.
Materials and Methods: At first, valid enterprise architecture frameworks were reviewed. Then, dimensions of the architecture frameworks needed for the social network of health were reviewed and six dimensions including of input, output, goals, views, abstraction, and system life cycle were selected. Architecture frameworks were prioritized on the basis of these six dimensions and the Zachman framework was selected. The extracted elements for these dimensions were evaluated by using a researcher-made questionnaire and experts’ opinion in the t-test. The questionnaire was distributed among 40 health-care information technology experts. After analyzing and verifying the dimensions and sub-indicators of each dimension, probable risks for the implementation of the health social network were identified based on interviews with experts and were approved by a panel of five experts.
Results: The Zachman framework was selected based on six dimensions as a suitable framework and potential implementation risks were identified.
Conclusion: The results showed that the proposed architecture model could be the basis for the implementation of this network in the country. Attention to extracted risks can minimize the failure of the implementation of the health social network.

Background and Aim: The quality of Electronic Health Records (EHRs) depends on the quality of its content and proper documentation. Determining the Minimum Data Set (MDS) to enhance the quality of electronic health records’ content and helping to improve the quality of health care provision to uveitis patients are essential matters. The aim of this study is to determine the essential MDS for uveitis patients’ electronic health records.
Materials and Methods: In this descriptive-analytical study, data collection tools for collecting the Minimum Data Set were library resources and internet-based database. The MDS was obtained through Likert scale questionnaire and was surveyed by 22 ophthalmologists and retina subspecialists.
Results: Among the elements of the survey, all cases with over 90% approval were considered as main elements. Regarding the importance of presented data elements, no significant difference was found between the responses of ophthalmologists who participated in this study. 
Conclusion: The Minimum Data Set of uveitis patients’ electronic health records can be represented by five groups of demographic information: patients’ clinical records, laboratory information, type of uveitis, treatment guidelines, and the information of ophthalmic pictures. A suggested model for manual systems and electronic medical records is available. 

Background and Aim: In the field of scientometrics, little attention has been paid to stem cells. Therefore, the purpose of this study is to draw a Scientific Map of stem cells area (co-word analysis) based on the papers indexed in Web of Science database in selected countries during the years 2011-2013.
Materials and Methods: This study is based on descriptive method, and it was conducted by scientometrics and co-word analysis technique. In this study, 34,142 articles were analyzed from Web of Science database. The search system of Web of Science is a tool for collecting data. Data analysis was done using Web of Science analysis system and CiteSpace software.
Results: Most productions in stem cells are in English and belong to America. Stem cell, cell differentiation, in vitro, gene expression, mesenchymal stem cells, embryonic stem cells and transplantation are the most frequently used words and hot topics in this field.
Conclusion: The growing trend in this area has caused different subject fields to enter stem cells areas. Considering the high frequency of embryonic stem cells in the field, it can be said that different diseases such as spinal cord problems and heart diseases can be treated using these cells.

Background and Aim: Since safety, performance and outcome indicators can improve the quality of care, patient safety indicators are required to monitor and provide safety in care. The aim of this study was to compile a set of patient safety indicators for monitoring in patient safety dashboard.
Materials and Methods: A set of patient safety indicators was collected by reviewing such indicators presented in Australia, England and OECD, ESQH, and AHRQ organizations. Then, the indicators were validated during Delphi process in two stages by the staff of patient safety and quality improvement unit of governmental hospitals and patient safety experts at Tehran University of Medical Sciences treatment deputy office. Data analysis was performed by SPSS version 13 and descriptive statistics.
Results: The present study was conducted on 62 patient safety indicators and eight main categories were classified as follows: safe hospital indicators, childbirth indicators, surgery-related indicators, mortality indicators, infection-control indicators, drug and prescription error indicators, falling indicator, and other special indicators.
Conclusion: Considering the identification of patient safety indicators in different dimensions, measuring the importance of these indicators and using them in the form of dashboard software in health centers will have a significant role in improving patient safety and the quality of health care.

Backgrounds and Aim: One of the effective strategies for targeting chemotherapy in the treatment of cancer is the use of lipid nano-carriers. In this study, an optimal formulation of niosomal drug containing doxorubicin has been developed to better fight cancer cells.
Material and Methods: Niosomal vesicles were prepared using phosphatidylcholine (22%), span60 (52/5%), cholesterol (22/5%) and DSPE-PEG2000 (5%) by thin-film method. Doxorubicin were loaded into the niosomes using inactive loading method. Their physico-chemical features were assayed using Zeta-Sizer, FTIR and SEM, and drug release amount was calculated at 37° C and 44° C. At the end, the toxicity of the nano drug carrier system was measured on the KG-1 cell line of the bone marrow cancer by MTT method.
Results: Niosomal vesicles containing Doxorubicin showed the size of 160.37±65.2 nm, 94.18% drug encapsulation efficiency  -58.11± 1.24 mV of zeta potential and polydispersity index (PDI) of 0.234±0.02 The prepared niosomal system presented drug controlled release and FTIR investigation showed almost no interaction between nano-carrier containing drug and the drug itself. As well, morphological examination of nano-carriers using SEM microscopy revealed that they have spherical structures. Also, cellular studies showed that drug toxicity was higher in encapsulated conditions compared to non-encapsulated conditions.
Conclusion:The results of this study, meanwhile confirming the proper physicochemical characteristics of the system and being Slow-release system indicate that this nano-carrier anionic increases the toxicity of the drug for the KG-1 cell line of the bone marrow, thus, this niosomal nano-carrier can be a suitable carrier for drug delivery to cancer cells.