Journal of

Background and Aim: Development and evaluation of rehabilitation services as a section of health system, which plays an important role in the improvement of the quality of life, needs a mechanism for information management as well as other healthcare levels. The effectiveness of information management has been assured through standardization & ongoing evaluation of rehabilitation centers. There is no standardization on rehabilitation information management processes in Iran, Therefore we surveyed the standards of information management at Commission on Accreditation for Rehabilitation Facilities and compared them to same English & Australian rehabilitation services evaluation & standardization organizations. At the end, we present a framework for necessary standards for this field.

Materials and Methods: In this literature review article CARF standards in axis of information management infrastructural standards, data gathering, content of records, documentation principles, information reveal for confidentiality policies of standard classification has been investigated. We used reliable electronic references in this article.

Discussion and Conclusion: The CARF information management standards are included a standardized outcome-oriented program evaluation & management systems as a fundamental & infrastructural requirement, data gathering standards, internal content of patient records, the framework for complete documentation and maintenance of information confidentiality. Therefore CARF standards in term of information management are the most complete model and have enough details in compare to the others. The results indicate that CARF standards can be a proper model for standardization activities and evaluation rehabilitation centers.

Background and Aim: Peptic Ulcer Disease (PUD), which is a prevalent disease, can have a considerable impact on patients' quality of life (QOL). The aim of this study was to explore the factors related to QOL based on PRECEDE Model in patients with PUD in Sanandaj, Iran.

Materials and Methods: A non-probability sample of 120 outpatients with PUD, referring to Beasat Hospital, in the city of Sanandaj participated in the study. The study took place between March and June of 2009. A descriptive, cross-sectional design was employed and the data were collected using a survey questionnaire based on PRECEDE model, consisting of QOL, Health Status, predisposing, reinforcing and enabling factors and self-management behaviors constructs. The data collected by interview and analyzed by SPSS v. 11.5. The statistical analysis of the data included Pearson correlation, t- test, one-way ANOVA and linear regression.

Results: Health status (p<0.01), reinforcing (p<0.01) and enabling (p<0.05) factors and knowledge (p<0.05) as a predisposing factor were related to quality of life of peptic ulcer patients. Moreover, health status (p<0.05) and social support as a reinforcing factor (p<0.01) had significant relationships with self-management behaviors. Finally, all of PRECEDE variables accounted for 68.9% of the variation of quality of life in PUD patients.

Discussion and Conclusion: With respect to the results of this study, preparing an educational program to promote self-management behaviors and quality of life in peptic ulcer patients is proposed. It was concluded that the PRECEDE Model may be used in developing countries, like Iran, as a framework for planning intervention programs in an attempt to improve the quality of life of patients with PUD.

Background and Aim: Today, psychological diseases like so many diseases, have an old history. Clinical Information System of psychological diseases resulting from war is a part of the information management system of mental illnesses, due to the management of mental patients from the war. This study is aimed to compare information management of psychological diseases in American, Australia and England with Iran.

Methods and Materials: This research is a study. At first, the existing situation was studied in three Psychiatric Centers in Ahvaz and Tehran with the use of a cheek list. Then information system of psychological disease has been studied in elected countries and based on the need of our own country, proposing practical solutions for Iran.

Results: The results of this study showed that there was no a information system of psychological disease in Iran. Also, four factors of this system including (goals, content structure, informational elements, information registration criteria) are reviewed in four selective countries.

Discussion and Conclusion: The design and implementation of this system in psychiatric centers is recommended to set two main goals including quality control and cost control in Iran.

Background and Aim: Teeth-mouth diseases include a cost between 10-5% of the total of cost of health care and have the damaging effects on childhood and in adult. Transtheoretical Model shows change of behavior dynamically. The purpose of this study was to determine Stages of change of inter-dental cleaning behavior based on Transtheoretical Model in male and female students in Yazd, Iran.

Results: In this study 54.8% female and 45.2% males participated with mean age of 17.35 ±.55 years. %49.6(59student) of students were in pre contemplation stage. Other participants were 5.3 % (19) in contemplation, 24.1 % (87) in preparation, 6.8% (31) in action and 12.5% (5) in maintenance stage. There was a positive significant relationship among stages of change with self-efficacy (r=0.33) and perceived benefits (r=0.19). Also a negative significant relation between stages of change and perceived barriers (r= -0.19) was oberved. Constructs of the model were statically significant predictors of stages of change and accounted for 0.15% of the variation that self efficacy was most important predictors (β=0.212).

Materials and Methods: This cross-sectional study was performed on pre-university 361 students in 8 schools cluster sampling. The instrument for collecting the information were questionnaires consisting of demographic characteristics, self-efficacy questions, decisional balance (perceived advantages and perceived obstacles) and stages of change of interdental cheaning behavior. Reliability and validity of questionnaires was confirmed. The data collected by interview and analyzed by SPSS.

Discussion and Conclusion : In this study, most of students were in pre contemplation stage. They will be probably exposed to dental caries. Not only Trans-theoretical Model can be a model to determine strategies to each stage of change of teeth-mouth self - care Behavior but can also be used in educational interventions.

Background and Aim: Information Technologies (ITs) has become a significant resource for dissemination of information and resulted to an increase of health knowledge in communities. With attention to patient - centered approach this study was done to determine knowledge of inpatients about ITs.

Materials and Methods: A descriptive - cross-sectional study was done on 461 inpatient in Kashan University of Medical Sciences hospital's with a reliable (spearman Brown, r =0.83) and valid (face and content) questionnaire in two section, demographic information and study objects. Data gathering was done with interview then analyzed by SPSS and descriptive analysis.

Results: %42.1 and %26.7 of participants had knowledge about computer and the Internet relatively. %41.9 of them had the Internet access. 86.3% and 88.3% relatively would be interested to access and get medical records and their information. They intended to get test (%85.7), refill her/his prescription (79%), get appointment (%76.4), consult with physicians (%80), and get information about diets (80%) through ITs.

Discussion  and Conclusion: It seems ITs attitude in inpatients is relatively good. Providing their information needs especially about prescription order and diets from CD or the Internet by hospital sites and introducing good medical sites to patient were recommended.

Background and Aim: Analysis of efficiency in hospitals, as the most expensive operating unit of the health system, is very important. This costly unit has several departments that one of them is medical records. This study is trying to analyze the efficiency of medical records department for the enhancement of using medical records facilities.

Materials and Methods: In this study, technical, scale and managerial efficiency of medical records department has been studied by data envelopment analysis method, and assuming the scale efficiency variable and the input axis. Information used in this study was the input variables (number of technician personnel and lower and Master of Science personnel and higher), output variables (number of emergency and outpatient and inpatient medical records and the number of filing unit visitors to respond) during 2007-2009.

Results: The average technical efficiency of medical records departments is 84 percent, that indicates there is at least 16 percent capacity for an increase in performance. Average of management and scale Performance in units during the 3 years of study are 95 and 89 percent respectively. Most input surplus is relevant to technician and lower personnel. The average performance of these units in general hospitals is 80 percent and in specialized activities is 92 percent.

Discussion and Conclusion: Relationship between studied indicators in this study with performance medical records departments showed that using such as employee personnel with undergraduate degrees and higher and educated in medical records filed, the use of managers with enough experience in this department and more use of computer systems for unit activities can fill 16 percent capacity of performance improvement in these units.

Background and Aim: The benefits of a unique computerized medical records and communication equipments is utilized to collect, storage, process, extract and relate to patient care information and management information. If this utilization is in accordance with the needs of managers and staff of medical records, many of the nation's health system problems will be dissolved. Information systems in health supply system by compiling, analyzing and publishing data provide utilization of information improve the health of the society. The purpose of this study is to investigate the process of clinical information systems in general hospitals of Tehran University of Medical Sciences based on available clinical information system in these hospitals.

Materials and Methods: This descriptive study is an application study that conducted in order to determine the process of clinical information system in general hospitals of Tehran University of Medical Sciences based on available clinical information in these hospitals. The required data have been collected by a valid and reliable questionnaire. Descriptive statistics were used to analyze data.

Results: With regard to the current condition and the importance of survey of the process of clinical information system in the studied hospitals, the authors provided the desired checklist in general hospitals with studying the related system in America, Australia and England countries, on the basis of country requirements in the form of clinical information system processes. We studied clinical information system processes in departments of admission, filling and retrieving, statistical and coding and also soft wares in this department.

Discussion and Conclusion: It is necessary to create a coordinated and integrated clinical information system with suitable process and empower experts in the field of proper use of data with regard to the position of information system in each organization and its fundamental role in the adoption of accurate policies. We found that relative frequency of clinical information system processes is more than 60% in this department and clinical information system elements was observed 75% in all the departments except admission.

Background and Aim: Females were reported to have significantly lower hematocrit (Hct), which might be the cause of increased need for blood transfusion. The goal of this study is to determine risk factors affecting blood transfusion in patients undergoing coronary artery bypass graft procedure related to gender

Materials and Methods: A cross sectional review of 500 (306 males and 194 females) ASA physical status I or Il patients undergoing bypass procedures with saphenous vein graft performed over a one year period were included in this study. The conducting of anesthesia was standardized. For each patient, we recorded the gender, age, body weight, height, body surface area (BSA), and duration of surgery. Hematocrit levels prior to surgery and the end of surgery were recorded. Packed red blood cell (PRBC) administration and use of fresh frozen plasma (FFP) and platelets were noted. Differences between the data for female and male patients were evaluated using Student's t-test, Chi-square test and using regression analysis.

Results: Approximately 57.2 % (111) female and only 39.9% (121) male patients received PRBCs. On average, females received 1. 6 units of PRBCs intraoperatively and 2. 6 units of PRBCs during the entire hospital stay, while the males received 1.1 units and 1.8 units for similar periods (P=0.0001). When females and males were compared within the same subgroups for age, body surface area (BSA), duration of surgery, and preoperative Hct, etc. ...had a significant correlation with age, postoperative Hct and BSA in females but had a significant correlation with preoperative Hct, preoperative PRBC and duration of surgery in males (P<0.05). Multiple logistic regression analysis showed that the probability of a patient receiving or not receiving PRBC transfusion is significantly influenced by preoperative Hct, postoperative Hct, duration of surgery, preoperative PRBC mass, and gender.

Discussion and Conclusion: Gender is an independent essential determinant of blood transfusion in CABG patients, and may interact with BSA, preoperative Hct, duration of surgery and other factors in determining the probability of transfusion.

Background and Aim: The study of organizational culture as a managerial tools, is necessary in health care organizations. Hospital administrators should compare present with desired hospitals' organizational culture continuously. This research is aimed to compare the present with desired organizational culture as administrators' view in Tehran University of Medical Sciences' Hospitals.

Materials and Methods: A Cross - Sectional' descriptive and analytical study was conducted among 15 Tehran University of Medical Sciences' Hospitals administrators by a questionnaire including demographic information and 30 questions which determined the approach of TUMS hospitals administrators about current and appropriate organizational culture components. Before the main study, validity and reliability of the questionnaire was performed. The data was collected by SPSS version 15 software and analyzed by Chi-square, Pearson and T tests.

Results: The result of this study showed that leadership was the most and control was the least organizational culture components which observed in present condition.

Discussion and Conclussion: As TUMS hospital administrators' view, all of the hospitals organizational culture components, exception control and communication patterns, are not observed in current status. There is a significant difference between current and appropriate hospital organizational culture components as the administrator's view which impressed on the hospital management system. Therefore, the hospitals administrators are required to do strategic planning to optimize the hospitals organizational cultures.

Background and Aim: The balance between ROS generation and antioxidant activity is critical to the pathogenesis of oxidative stress related disorders. In this study the prooxidant - antioxidant balance and its correlation with lipid profile and uric acid was determined to evaluate the PAB as a prognostic factor for CAD.

Materials and Methods: Seventy - two patients and sixty eight healthy volunteers were enrolled in this study. The values of PAB were determined by using standard solutions and ELISA method.
Triglyceride, total cholesterol, LDL- cholesterol, HDL - cholesterol and uric acid were measured by enzymatic method.

Results: The PAB values of CAD patients and control group were 70.01±3.36 (HK unit) and 66.40 ± 2.84 (HK unit) respectively. There was no significant difference between PAB values among the two groups (P= 0.41). There was no significant difference between uric acid levels among the two groups (P= 0.46). There was a significant correlation between the uric acid values among patients and healthy volunteers and PAB values (P <0.01). There was a significant correlation between the TG, values among patients and healthy volunteers and PAB values (P<0.05).

Conclusion: This study showed oxidative stress could be used as a significant risk predictor in the coronary artery disease patient

Background and Aim: The major tasks of libraries is collecting information resources in appropriate shapes for clients needs and organize resources for making them available. This study has been done to review this status in school and hospital libraries of Tehran University of Medical Sciences.

Materials and Methods: This is survey descriptive research. Method statistical population consisted of all college and hospital libraries of Tehran University of Medical Sciences. Intrument data collection was a questionnaire that its resiability and validity was measured Setting tables and getting percentages is performed as the Average measures in Excel spss version 12 programes.

Results: The highest rate of bachelores and masteres in libraries organized sector (more than 62 percent) belong to the libraries professionals. Staffes of 7 libraries (32 percent)are familiar with abstract and indexing services and staff is of more than 45 percent of libraries (more than 10 libraries) are familiar with a variety of subject headings and thesauri .

Conclusion: Low percentage of the average organization also show little attention in organizing some non-book materials. Low percentage of librarians orientation with abstracting and indexing services and also thesauri (45%) are the reason for this little attention.

Background and Aim: Hospital's traditional charter that mostly emphasized productivity has been replaced by a charter that stresses social and environmental issues. On this basis, to achieve success, managers should regard both the inner and the outer environments of hospitals. This study aims at measuring hospitals' social responsibility.

Materials and Methods: The present descriptive-analytic study was carried out through a cross-sectional method in 2010. The study population consisted of hospital managers of the city of Isfahan (n=21). The data collection instrument was a researcher-made questionnaire. The instrument's content validity was determined by the experts' views and its reliability calculated through Cronbach's α was found to be 0.95. The collected data were analyzed using SPSS software (version 16) and the hypotheses were tested by t-test, ANOVA and Eta coefficients. The maximum mean score was 100.

Results: The mean score of hospitals' social responsibility was computed to be 68.6. The mean scores of leadership and inner processes, market place, community policies, environmental policies, and workplace policies were found to be 72.2, 70, 67.8, 67.4 and 66.2, respectively. There was no significant relationship between hospital's social responsibility and type of hospital's possession and activity (pvalue > 0.05).

Conclusion: The social responsibility of hospitals was assessed as moderate. To improve hospital's social responsibility, it is suggested that more attention be paid to workplace and environmental policie

Background and Aim: One of the most important reasons why organizations are distinguished from one another is the degree of application and implementation of information technology in their organizational activities. In this regard, individual factors contribute considerably to the application of information technology (IT). Such factors include employees' perceptions and attitudes towards information technology and their demographic characteristics which affect the level of information technology acceptance and implementation.

Materials and Methods: In this cross-sectional study, 110 middle managers from teaching hospitals of Tehran University of Medical Sciences (TUMS) were chosen. A structured questionnaire was used as the data collection device and its validity and reliability were confirmed by a pilot study.

Results: Of the participants, 62.9% were males and 37.1% were females. The findings show that there is a statistically significant relationship between perception and making decisions based on the implementation of information technology. However, there was no significant relationship between work experience, education and training on the one hand and IT implementation on the other.

Conclusion: The results show that human factors (perception and decision) have a considerable impact on the implementation of information technology. Top managers and experts should consider the important aspects of human factors and also the factors affecting them.

Background and Aim: Excessive Bleeding continues to play a key role and an important cause of morbidity and mortality after cardiopulmonary bypass (CPB). The goal of this study was to determine the differences in bleeding and transfusion between OPCAB and on -pump CABG patients.

Materials and Methods: In a randomized, double blinded prospective study 300 patient's undergoing coronary revascularization surgery were enrolled, 150 CABG patients were compared with 150 OPCAB patients. The patients were assessed during the first 72 hours to determine the postoperative side effects. The 2 groups were compared using the chi-square test or fisher's exact test and the rank sum test.

Results: CABG patients received more intraoperative red blood cells (P<0.0001), more albumin and more fresh- frozen plasma (P<0.0001). Postoperatively, CABG patients were more likely to receive more platelets (29.3% ν 70.7 %, P<0.007). During the operative and the initial 4-hour postoperative period OPCAB patients exhibited greater blood loss (P<0.0001) however, at 12,24and 72 hours postoperatively, CABG patients exhibited greater blood loss. There were4 death in CABG patients (P<0.05)

Conclusion: Despite not reversing the heparin at the end of the OPCAB surgery, OPCAB surgery was associated with an overall reduction in platelets, fresh- frozen plasma, Albumin and transfusion requirements.

Background and Aim: Malnutrition is one of the causative agents of death in children. So, this study was done for assessment of anthropometric indices of students and malnutrition status in Golpayegan, Iran.

Materials and Methods: This research was done as a descriptive - analytical (inferential) study. Sampling was done as clusters and multistage. In order to collect data, the standard questionnaire of anthropometric indicators standards (ANIS) pattern was used. Low and low height was used based on Z score. Collected data was analyzed by Epi-info and SPSS software.

Results: Of 1062 schoolboys, 550 were male and 512 were female. Anthropometric indicators including age (month), weight (kg) and height (Cm) showed significant differences (P < 0.05). The mean of malnutrition index was 5.4 % (WAZ<-2) and 3% (WAZ<-2) in our study.

Conclusion: The significant difference between prevalence of slimness, low weighting and low growth in rural and urban Schoolboys is an indicator of the undesirable situation in rural areas. Therefore, nutritional planning should be considered in rural children.

Background and Aim: Adverse events in hospitals are found to be a major problem of all health systems in the world. In fact, drug interaction side effects are now the fourth leading cause of death in the U.S. The aim of the current study was to identify the opinions of clinicians working in Shariati and Emam hospitals towards the use of computer applications for detecting drug-food interactions.

Materials and Methods: Ninety clinicians including physicians, pharmacists and nurses were selected randomly in the current descriptive- analytical study. The opinions of clinicians toward using computer application systems for detecting drug-food interactions were assessed by a questionnaire. The questionnaire's validity and repeatability was examined in a pilot study. Cronbach's alpha was 0.85 which indicated an acceptable level of repeatability of the questionnaire. The questionnaire was distributed among the academic staffs in order to determine its validity.

Results: 95.4% of clinicians had positive attitudes towards the requirement of computer application to detect drug-food interactions. Around 94% of them showed their willingness towards using the computer application systems. Therefore, use of computer application seems to be necessary in health system.

Conclusions: The collection and analysis of data encourages further investments in computerized system to prevent drug-food interaction. Such built-in warning systems in hospitals alert doctors to drug-food interaction and improvement in patient care. Screening each patient's medication plan for drug-food interactions can reduce medical error and improve the quality of health care

Background and Aim: Myocardial infarction (MI) is a major cause of morbidity and mortality worldwide. Epidemiological studies indicate that MI results from complex interactions between long-term environmental influences, concomitant disorders, and genetic susceptibility factors. Identification of genetic risk factors, particularly in premature MI, is very important. Since thrombosis plays a critical role in the pathophysiology of MI, recent studies focus on coagulation genetic polymorphisms. The critical role of platelets and their surface glycoproteins in the formation of occlusive thrombus leading to acute myocardial infarction is now well accepted. Platelets have two major receptors for collagen, glycoprotein I/IIa (integrin α2β1) and glycoprotein VI. In the present study, platelet GP VI T13254C polymorphism was chosen due to its potential association with altered platelet reactivity. The aim of the present study was to determine whether or not GP VI T13254C polymorphism was associated with premature acute myocardial infarction.

Materials and Methods: One hundred patients with premature acute myocardial infarction and 100 age-matched controls with normal coronary angiograms were studied. Genotyping was done using PCR followed by RFLP. Statistical analyses included chi-square, t-test and logistic regression model.

Results: The findings of the present study showed that the prevalence of T13254C polymorphism did not differ much between patient (38%) and control (33%) groups and that polymorphism was not associated with premature acute MI (P=0.46). Logistic regression analysis also indicated no association between this polymorphism and premature acute MI (P=0.20).

Conclusion: This study showed that there was no significant association between GP VI T13254C polymorphism and premature acute MI.

Background and Aim: Vaccination is one of the most important primary prevention and preventing the spread of infectious diseases. DTP3 is commonly used as a criteria for the availability of health services. The purpose of this study was determining vaccination coverage of DTP3 and factors influencing it.

Materials and Methods: One thounsed and four hundred fiftey eight children (12-24 month old) from 17th district of Tehran were enrolled in this cross sectional study. In this study, vaccination status of the DTP3 vaccination schedule according to the demographic variables was determined. Information was collected by a questionnaire referring to children's vaccination card. Sampling method was cluster sampling and included 146 clusters with 10 children in every cluster. Data collected were analyzed using spssv13 software and chi-square and t tests.

Results: In this study, 744 girls and 714 boys participated. 1241 patients, (85.1%) cases received their vaccines at the right time. 190 patients (13%) cases had not received the vaccine at the proper time, and 27 patients (1.9 %) were not vaccinated. Between vaccine status and mother's education (p=0.003), father's education (p=0.012), family income (p=0.003), number of children in the family (p=0.006), birth order (p=0.007), and status of family's medical record in the health center (active - inactive)(p=0.002), significant difference was observed.

Conclusion: Although vaccination coverage rate of DTP3 was 98%, more than 13% of cases, did not receive the vaccine at the right time and this constitutes to childhood illness. More research is needed to identify factors influencing no vaccination at the right time.

Background and Aim: The hierarchical and bureaucratic form of governmental administration is changing into a new type of flexible and market-based public management called Enterpreneurial Management Revolution. According to Stevenson, entrepreneurial management comprises a number of opportunity-based management activities for the maintenance of organizations in order to have their contribution in social value creation. This research study aims to study the organizational performance of medical sciences universities of Tehran based on Stevenson Model.

Materials and Methods: This research is a field study in which a structured questionnaire containing 22 main questions on the Likert Scale was distributed among the staff members of medical sciences universities in Tehran. The validity of the questionnaire was confirmed by experts and its reliability was estimated using Test- Retest Method. The Cronbach alpha coefficient was found to be 0.95. The data collection device was given to 379 staff members, of whom 325 filled it out. The data were completely recorded and then analyzed by SPSS software version 18.

Results: The results of the study show that regarding entrepreneurial management approach, medical universities are at an average level.
According to the present research and all related studies, this is the case in all other governmental organizations.

Conclusion: The results of the study indicate that organizational restructuring, decentralization, and continuous improvement in processes are the milestones of entrepreneurial revolution strategies in medical universities and all other public organizations.

Background and Aim: Micro RNAs are a group of small non-coding RNAs which play an important role in multiple processes such as proliferation, differentiation, apoptosis, and cancer. Recent studies indicate that mir-210 is overexpressed into erythroid linage during the differentiation of hematopoietic precursor. The main goal of the present study is to investigate the influence of mir-210 on the pattern of expression in hemoglobin gamma chain.

Materials and Methods: First, K562 cell line was cultured in RPMI1640 media. Then, pre-miR-210 was transferred into K562 cell line by lipofectamin. Finally, the alterations in the pattern of gamma chain expression were analyzed in days 7 and 14 by RT-PCR and real time PCR technique.

Results: It was demonstrated that the overexpression of mir-210 in K562 cell line would lead to a 25-fold increase in the expression of gamma chain in comparison with the control group. Data analysis revealed that the change in the pattern of hemoglobin gamma chain expression was meaningful (p<0.002).

Conclusion: Based on these data, overexpression of mir-210 can lead to a significant increase in the production of gamma chain. Therefore, more studies in the field may reveal the fact that an increase in mir-210 can be a suitable goal in the improvement of sickle cell anemia and β-thalassemia.