Journal of Education and Health Promotion

Abstract Introduction: Family psychoeducation is one of the most routine interventions in a
schizophrenic patients’ management. We evaluated the effects of a needs‑assessment‑based
educational program in comparison with the current program on global function and quality of
life (QOL) of the patients and their families. Materials and Methods: In this controlled study,
60 schizophrenia patients and their families were allocated for a needs‑assessment‑based
psychoeducation (treatment) and current education (control) programs. The family members
of both the groups participated in 10 sessions of education, within about six months. The
patients’ global function and QOL were assessed with the global assessment of function (GAF)
and the Schizophrenia Quality of Life Scales (SQLS), respectively. The families’ QOL was
assessed with the World Health Organization’s (WHO) Quality of Life‑BREF (WHOQOL‑BREF).
Assessments were done at the beginning and then every six months, for a total of 18 months.
Results: Forty‑two cases completed the study. Global function was improved with the
treatment (P = 0.002), but not in the control group (P = 0.601). The patients’ quality of life
in the treatment group showed significant improvement on the psychosocial (P < 0.01)
and symptoms/side effects subscale scores (P < 0.01), but not on the energy subscale
score (P > 0.1). There was no significant change in the family’s quality of life in both groups.
Conclusions: The family psychoeducational needs assessment may lead to more improvement
in schizophrenic patients’ global function and quality of life, but has no significant effect on
their families’ quality of life. It is recommended that the psychiatric care centers develop their
psychoeducation profiles based on the needs‑assessment program.

Abstract Background: In order to incorporate new knowledge, skills and emerging concepts from
dynamic fields of public health into ongoing courses reform of curriculums sounds necessary.
Accordingly, this study was performed to modify health education curriculum of public health
undergraduate level. Materials and Methods: Using Delphi technique, 18 health education
lecturers from Tehran, Tabriz, Yazd, Shiraz, Gonabad, Ghazvin, Avhvaz and Kurdistan Universities
Medical of Sciences based on their expertize in health education with PhD degree as scientific
members, also 5 heads of departments according to working at health deputy for at least more
than 5 years were asked during three rounds through panel experts to suggest and rate topics
they deemed most important to graduate public health experts and curricula related to the
areas of knowledge and skills in health education course. Results: The experts suggested
that health enhancing behaviors and reduce health risks, advocate health, behavior change
theories and developing a framework are key objects in the curriculum. Much more new topical
outlines were related to previous course. Skills rated as important included need assessment
and health communication. The most evaluators suggested that adding a practicum unit to two
theory units will be helpful. Conclusion: The results from our survey suggested that changes
in the course definition including new course objectives, topical outlines, and required skills
were deemed important by the lecturers and were appropriately integrated into the health
education course curriculum. The new curriculum should be evaluated constantly to seek and
provide experiences that will best prepare students to meet challenges as a health educator.

Abstract Background: Diabetes as the most common diseases caused by metabolic disorders is an
important global challenge. This is a disease that requires lifelong self‑care because self‑care and
improved quality of life is cost effective. This study is aimed to determine the impact of self‑care
education program on reducing HbA1c, type 2 diabetic patients and was conducted in Zahedan.
Materials and Methods: This is an experimental study done on 138 diabetic female patients in
Zahedan city, in 2011 (1390). This sampling method of patients was based on inclusion and exclusion
criteria of the Diabetes Center, at Hazrat Ali Asghar Hospital(AS) in Zahedan. Samples were divided
randomly in to two groups: 69 cases and 69 controls. Data collected included validity and reliability
confirmed questionnaire. Checklist was based on patients ‘performance of reporting and (HbA1c)
testing. Before the educational intervention, the checklist of questions for recording the (HbA1c)
test for both the groups were completed, and study samples received 5 sessions of education (with
the group discussion and film show) for a month. However, the control group received only routine
training. Three months after the educational intervention, both groups completed the questionnaire
and the check list and data using SPSS software and the appropriate tests were analyzed.
Results: Findings showed that the mean domain scores of area of knowledge, attitude and practice
educational groups, were recorded as (46.6 ± 8.57, 46.5 ± 0.86 and 29.06 ± 10.02), respectively.
And after education scores of knowledge, attitude and practice were recorded as (52.80 ± 2.20,
12.98 ± 1.02 and 39.69 ± 4.74), respectively, and in study group significant difference (P < 0/001)
was seen. Conclusion: Self‑care training in striation leads to improve knowledge, attitude and
self‑care performance of the study samples and also improves the average (HbA1c). Because it
seems to increase the active participation of learners in their care that they have experienced with
this training method and their motivation enhanced them to learn better self‑care. So this type of
care education should be given to the attention of nurses and healthcare’s staff.

Abstract Introduction: Performance measurement is inevitable for university libraries. Hence, planning
and establishing a constant and up‑to‑date measurement system is required for the libraries,
especially the university libraries. The primary studies and analyses reveal that the EFQM
Excellence Model has been efficient, and the administrative reform program has focused on
the implementation of this model. Therefore, on the basis of these facts as well as the need for
a measurement system, the researchers measured the performance of libraries in schools and
hospitals supported by Isfahan University of Medical Sciences, using the EFQM Organizational
Excellence Model. Materials and Methods: This descriptive research study was carried out by
a cross‑sectional survey method in 2011. This research study included librarians and library
directors of Isfahan University of Medical Sciences (70 people). The validity of the instrument
was measured by the specialists in the field of Management and Library Science. To measure
the reliability of the questionnaire, the Cronbach’s alpha coefficient value was measured (0.93).
The t‑test, ANOVA, and Spearman’s rank correlation coefficient were used for measurements.
The data were analyzed by SPSS. Results: Data analysis revealed that the mean score of
the performance measurement for the libraries under study and between nine dimensions
the highest score was 65.3% for leadership dimension and the lowest scores were 55.1% for
people and 55.1% for society results. Conclusion: In general, using the ninth EFQM model the
average level of all dimensions, which is in good agreement with normal values, was assessed.
However, compared to other results, the criterion people and society results were poor. It is
Recommended by forming the expert committee on criterion people and society results by
individuals concerned with the various conferences and training courses to improve the aspects.

Abstract Introduction: Today, the websites of college and university libraries play an important role
in providing the necessary services for clients. These websites not only allow the users to
access different collections of library resources, but also provide them with the necessary
guidance in order to use the information. The goal of this study is the quality evaluation of the
college library websites in Iranian Medical Universities based on the Stover model. Material
and Methods: This study uses an analytical survey method and is an applied study. The
data gathering tool is the standard checklist provided by Stover, which was modified by the
researchers for this study. The statistical population is the college library websites of the
Iranian Medical Universities (146 websites) and census method was used for investigation.
The data gathering method was a direct access to each website and filling of the checklist
was based on the researchers’ observations. Descriptive and analytical statistics (Analysis of
Variance (ANOVA)) were used for data analysis with the help of the SPSS software. Findings:
The findings showed that in the dimension of the quality of contents, the highest average
belonged to type one universities (46.2%) and the lowest average belonged to type three
universities (24.8%). In the search and research capabilities, the highest average belonged to
type one universities (48.2%) and the lowest average belonged to type three universities. In
the dimension of facilities provided for the users, type one universities again had the highest
average (37.2%), while type three universities had the lowest average (15%). In general the library
websites of type one universities had the highest quality (44.2%), while type three universities
had the lowest quality (21.1%). Also the library websites of the College of Rehabilitation and
the College of Paramedics, of the Shiraz University of Medical Science, had the highest quality
scores. Discussion: The results showed that there was a meaningful difference between the
quality of the college library websites and the university types, resulting in college libraries of
type one universities having the highest average score and the college libraries of type three
universities having the lowest score.

Abstract Introduction and Objective: Colorectal cancer is one of the most important and most common
cancer and second leading cause of cancer deaths worldwide. Through secondary prevention of
this cancer, effective proactive measures would be taken to treat and to prevent the incidence of the
disease. The fecal occult blood test(FOBT) has priority over other methods and is recommended for
adults above 50 years. This study was carried out to assess perceived barriers related to participating
in colorectal cancer screening programs among average risk population, based on health belief
model. Materials and Methods: A cross‑sectional survey of 196 individuals of more than 50 years
was conducted in Isfahan. The target group consisted of people going to laboratories for doing
FOBT test(n = 98), and those who refrained from going to laboratories (n = 98). The questionnaire
was used based on barrier assessment question associated with performing fecal occult blood
test. The data collected were analyzed using descriptive and inferential statistics methods. Results:
The mean score of perceived barriers in the first group was 40.9 and in other group was 56.54,
with significant difference statistically (P < 0.001). Lack of information, fear of cancer diagnosis,
lack of recommendation by doctors, and not setting the priority of time for doing the test were
some of barriers reported by the nongoing group. Discussion and Conclusion: According to
this study, it seems that there is an urgent need to more information to be provided for the public
about colorectal cancer and its prevention through screening, as important step to increase the
rate of early detection and curb the mortality rate, costs, and improve community health outcomes.

Abstract Background: Health literacy is a measure of individual’s ability to read, comprehend, and act
on medical instructions. Older adults are one of the most important at risk groups affected
by the impact of inadequate health literacy. Health promoting behaviors in older adults have
potential impact on their health and quality of life and reduce the costs incurred to health care.
Given the paucity of information health literacy and health promoting behavior, the purpose
of this study was to examine health literacy level in older adults and the relationship between
health literacy and health promoting behaviors. Materials and Method: A cross‑sectional survey
of 354 older adults was conducted in Isfahan. The method of sampling was clustering. Health
literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA). Data
were collected via home interviewing. Health promoting behaviors were measured based on
self‑reported smoking status, exercise, and consumption of fruit and vegetables. The collected
data were analyzed using descriptive statistics and one‑way ANOVA and χ2 tests under SPSS
18 software. Results: The sample group averaged 67 ± 6.97 years in age. Approximately 79.6%
of adults were found to have inadequate health literacy. They tended to be older, have fewer
years of schooling, lower household income, and being female Individuals with inadequate
health literacy were more likely to report limitations in activity and lower consumption of fruit
and vegetables (P < 0.001). No significant association was found between health literacy
and smoking status. Conclusion: Considering high prevalence of inadequate health literacy
among older adults, and its inverse relationship with some health promoting behaviors. Simple
educational materials and effective interventions for low health literacy people can improve
health promotion in society and mitigate the adverse health effects of low health literacy.

Abstract Background: Postpartum period is the riskiest time for mood disorders and psychosis.
Postpartum depression is the most important mood disorder after delivery, which can
be accompanied by mother-child and family relationship disorders. Meta-analysis with
the integration of research results demonstrates to investigate the association between the mode
of delivery and postpartum depression. Materials and Methods: This meta-analysis uses the
Rosenthal and Robin approach. For this purpose, 18 studies which were acceptable in terms of
methodology were selected and meta-analysis was conducted on them. Research instrument
was a checklist of meta-analysis. After summarizing the results of the studies, effect sizes were
calculated manually and combined based on meta-analysis method. Results: The findings
showed that the amount of effect size (in term of Cohen d) of delivery mode on postpartum
depression was 0/30 (P < 0.001). Conclusion: Delivery mode on maternal mental health is
assessed medium. Meta analysis also indicates moderator variables role, and researcher must
focus in these variables.

Abstract Context: Implementing information technology in the best possible way can bring many advantages
such as applying electronic services and facilitating tasks. Therefore, assessment of service providing
systems is a way to improve the quality and elevate these systems including e‑commerce, e‑government,
e‑banking, and e‑learning. Aims: This study was aimed to evaluate the electronic services in the website
of Isfahan University of Medical Sciences in order to propose solutions to improve them. Furthermore,
we aim to rank the solutions based on the factors that enhance the quality of electronic services by using
analytic hierarchy process (AHP) method. Materials and Methods: Non‑parametric test was used to
assess the quality of electronic services. The assessment of propositions was based on Aqual model
and they were prioritized using AHP approach. The AHP approach was used because it directly applies
experts’ deductions in the model, and lead to more objective results in the analysis and prioritizing the
risks. After evaluating the quality of the electronic services, a multi‑criteria decision making frame‑work
was used to prioritize the proposed solutions. Statistical Analysis Used: Non‑parametric tests and AHP
approach using Expert Choice software. Results: The results showed that students were satisfied in
most of the indicators. Only a few indicators received low satisfaction from students including, design
attractiveness, the amount of explanation and details of information, honesty and responsiveness of
authorities, and the role of e‑services in the user’s relationship with university. After interviewing
with Information and Communications Technology (ICT) experts at the university, measurement
criteria, and solutions to improve the quality were collected. The best solutions were selected
by EC software. According to the results, the solution“controlling and improving the process in
handling users complaints” is of the utmost importance and authorities have to have it on the
website and place great importance on updating this process. Conclusions: Although, 4 out
of the 22 indicators used in the test hypothesis were not confirmed, the results show that these
assumptions are accepted at 95% confidence level. To improve the quality of electronic services,
special attention should be paid to “services interaction.” As the results showed having“controlling
and improving the process in handling users
complaints” on the website is the first and most
important one and the process of “changing
brand/factory name/address in the text of
the factory license/renewal or modification of
manufacturing license/changing the formula”
is the least important one.

Abstract Introduction and Objectives: Health system reforms are the most strategic issue that has
been seriously considered in healthcare systems in order to reduce costs and increase
efficiency and effectiveness. The costs of health system finance in our country, lack of universal
coverage in health insurance, and related issues necessitate reforms in our health system
financing. The aim of this research was to prepare a structure of framework for social health
insurance in Iran and conducting a comparative study in selected countries with social health
insurance. Materials and Methods: This comparative descriptive study was conducted in three
phases. The first phase of the study examined the structure of health social insurance in four
countries – Germany, South Korea, Egypt, and Australia. The second phase was to develop
an initial model, which was designed to determine the shared and distinguishing points of the
investigated structures, for health insurance in Iran. The third phase was to validate the final
research model. The developed model by the Delphi method was given to 20 professionals in
financing of the health system, health economics and management of healthcare services. Their
comments were collected in two stages and its validity was confirmed. Findings: The study of
the structure of health insurance in the selected countries shows that health social insurance in
different countries have different structures. Based on the findings of the present study, the current
situation of the health system, and the conducted surveys, the following framework is suitable for
the health social insurance system in Iran. The Health Social Insurance Organization has a unique
service by having five funds of governmental employees, companies and NGOs, self‑insured,
villagers, and others, which serves as a nongovernmental organization under the supervision
of public law and by decision‑ and policy‑making of the Health Insurance Supreme Council.
Membership in this organization is based on the nationality or residence, which the insured by
paying the insurance premiums within 6-10%
of their income and employment status, are
entitled to use the services. Providing services
to the insured are performed by indirect
forms. Payments to the service providers for
the fee of inpatient and outpatient services
are conservative and the related diagnostic
groups system. Conclusions: Paying
attention to the importance of modification of
the fragmented health insurance system and
financing the country’s healthcare can reduce
much of the failure of the health system,
including the access of the public to health
services. The countries according to the degree of development, governmental, and private insurance companies and existing rules must
use the appropriate structure, comprehensive approach to the structure, and financing of the
health social insurance on the investigated basis and careful attention to the intersections and
differentiation. Studied structures, using them in the proposed approach and taking advantages
of the perspectives of different beneficiaries about discussed topics can be important and efficient
in order to achieve the goals of the health social insurance.

Abstract Background and Objectives: Breast cancer is a major threat to women’s health. Evaluation
of the changes in trend of the incidence rate provides valuable information for the assessment
and planning of development indicators of each country. The aim of the present study was to
apply the JoinPoint regression model for determining changes in the trend of the breast cancer
incidence rate in Isfahan. Materials and Methods: In this cross‑sectional study, 3640 women
with breast cancer referring to oncology and radiotherapy departments of Seyed‑al‑Shohada
and Milad cancer treatment centers of Isfahan during 2001–2010 were studied and sampling
was not done. Joinpoint regression model was used to investigate the pattern of breast
cancer incidence rate. Response and independent variables were the natural logarithm of the
age‑standardized incidence rates and year of diagnosis of breast cancer, respectively, in which
various levels of cancer tumor characteristics (P < 0.05) were analyzed. Results: The incidence
rates increased annually in the age groups of 40–44 years (6.2%), 45–49 years (5.3%), and
55–59 years (5.3%). The trend of incidence rates in women with tumor size ≤2 cm (18.2%),
well (moderately) differentiated tumor grade [8% (10.2%)], positive estrogen (progesterone)
hormone receptor status [10.5% (6.9%)], and the proportion of positive lymph node to surgery
node ≤25% (nonsignificant) was upward. Conclusion: The trend of incidence rates with tumor
size ≤2 cm, well‑differentiated tumor grade, moderately differentiated tumor grade, and positive
estrogen and progesterone hormone receptors was upward. The pattern of breast cancer can
help in cancer prevention and prognosis, and in selecting the best type of surgery.

Abstract Background: The role of spousal response in woman’s experience of pain during the vaginal
penetration attempts believed to be an important factor; however, studies are rather limited in
this area. The aim of this study was to develop and investigate the psychometric indexes of the
partner version of a multidimensional vaginal penetration disorder questionnaire (PV‑MVPDQ);
hence, the clinical assessment of spousal psychosexual reactions to vaginismus by specialists
will be easier. Materials and Methods: A mixed‑methods sequential exploratory design was
used, through that, the findings from a thematic qualitative research with 20 unconsummated
couples, which followed by an extensive literature review used for development of PV‑MVPDQ.
A consecutive sample of 214 men who their wives’ suffered from lifelong vaginismus (LLV) based
on Diagnostic and Statistical Manual of Mental Disorders 4th version (DSM)‑IVTR criteria during
a cross‑sectional design, completed the questionnaire and additional questions regarding
their demographic and sexual history. Validation measures and reliability were conducted by
exploratory factor analysis (EFA) and Cronbach’s alpha coefficient through SPSS version 16
manufactured by SPSS Inc. (IBM corporation, Armonk, USA). Results: After conducting EFA
PV‑MVPDQ emerged as having 40 items and 7 dimensions: Helplessness, sexual information,
vicious cycle of penetration, hypervigilance and solicitous, catastrophic cognitions, sexual
and marital adjustment and optimism. Subscales of PV‑MVPDQ showed a significant
reliability (0.71‑0.85) and results of test‑retest were satisfactory. Conclusion: The present
study shows PV‑MVPDQ is a multi‑dimensional valid and reliable self‑report questionnaire for
assessment of cognitions, sexual and marital relations related to vaginal penetrations in spouses
of women with LLV. It may assist specialists to base on which clinical judgment and appropriate
planning for clinical management.

Abstract Background: Heart failure is incurable disease and patients often have an ongoing decline once
diagnosed. The symptoms of heart failure may impair the ability of patient to perform activities of
daily living. As heart failure progresses, patients normally increase their reliance on family caregivers.
Aims: This paper explored the informational needs and related problems of family caregivers of heart
failure patients as a part of the findings of a study exploring experiences of family caregivers in the
caregiving situation. Setting and Design: Using a qualitative design, 19 family caregivers from three
educational hospitals in Isfahan, Iran, were recruited. Materials and Methods: Participants were
selected by purposive sampling. Data were collected through semi‑structured interviews. Interviews
were transcribed verbatim and analyzed concurrently. Results: Four major themes were emerged
from the analysis of the transcripts: “Lack of care‑related knowledge”, “Inaccessibility to responsible
source of information”, “Lack of guidance from healthcare team” and “caring with ambiguity due to
unpredictable nature of the disease”. Caregivers believed that they did not have the basic knowledge
related to disease and medication administration. They received little guidance and support from
the health care team on the caregiving roles. They experienced high level of ambiguity and stress
in caregiving tasks due to lack of care‑related knowledge and unpredictable nature of disease.
Conclusion: The care, which was performed by the caregivers of HF patients, is beyond of their
knowledge, capabilities, and resources. Nurses and other healthcare providers can use the findings
of this study to develop effective educational and supportive programs to facilitate these needs.

Abstract Background: The prevalence of self‑medication is high all over the world, especially in Iran.
But there is a paucity of studies to explore self‑medication activities among the university
students. Therefore, the present study was undertaken to determine the self‑medication
among student in Isfahan University of Medical Sciences, based on Health Belief
Model (HBM). Materials and Methods: This cross‑sectional study was conducted in 197
medical students of Isfahan University of Medical Sciences who were randomly chosen by
a stratified random sampling method in 2009. The data were collected using a validated
and reliable questionnaire based on HBM. Statistical analysis was performed using SPSS
software (ver. 16). Descriptive and analytical statistics (independent t‑test and test) were used.
A two-tailed P value lower than 0.05 was considered statistically significant. Results: The
mean and standard deviation of participants’ age was 22.00 ± 2.77 years. 67.3% of the sample
consisted of females. The mean scores of knowledge, perceived susceptibility, perceived
severity, perceived benefits, and perceived barrier were 80.36 ± 18.29, 40.92 ± 13.89,
61.48 ± 19.03, 59.11 ± 18.46, and 30.36 ± 12.40, respectively. According to the results,
84.98% of students had experienced self‑medication at least for one disease during the
past 6 months. Conclusions: The prevalence of self‑medication in medical students is high
and we can consider it as a health problem. So, we need educational interventions for the
students, using HBM constructs.

Abstract In a world of continuously changing business environments, organizations have no option;
however, to deal with such a big level of transformation in order to adjust the consequential
demands. Therefore, many companies need to continually improve and review their processes
to maintain their competitive advantages in an uncertain environment. Meeting these challenges
requires implementing the most efficient possible business processes, geared to the needs of the
industry and market segments that the organization serves globally. In the last 10 years, total quality
management, business process reengineering, and business process management (BPM) have
been some of the management tools applied by organizations to increase business competiveness.
This paper is an original article that presents implementation of “BPM” approach in the healthcare
domain that allows an organization to improve and review its critical business processes. This
project was performed in “Qaem Teaching Hospital” in Mashhad city, Iran and consists of four
distinct steps;(1) identify business processes,(2) document the process,(3) analyze and measure
the process, and (4) improve the process. Implementing BPM in Qaem Teaching Hospital changed
the nature of management by allowing the organization to avoid the complexity of disparate, soloed
systems. BPM instead enabled the organization to focus on business processes at a higher level.

Abstract Background: Hemodialysis patients have lower quality of life and one of the ways to improve
their quality of life is providing self‑care education to them using some models including self‑care
model. This study aimed to determine and evaluate the effects of using self‑care model on
health and quality of life outcomes in hemodialysis patients. Materials and Methods: This was
a quasi‑experimental study conducted in 2012 on the patients who were referred to a military
hospital in Tehran, Iran to be treated with hemodialysis. All 32 patients referred to this hospital in
2012 were selected and studied. Required data were collected using the Short Form‑36 (SF‑36)
standard questionnaire and a researcher‑made questionnaire. The educational intervention was
implemented using self‑care model. Collected data were analyzed using SPSS for Windows
version 18.0 and some statistical tests including paired samples t‑test, Wilcoxon and McNemar
tests. Results: The results showed that the mean and standard deviation (SD) of patients’
parameters including weight and blood pressure improved significantly after the educational
intervention compared to before the intervention (P < 0.001). Also, all dimensions of the quality
of life of hemodialysis patients, including physical function, role physical, bodily pain, general
health, vitality, social function, mental health, and role emotional improved compared to those
before the intervention (P < 0.001). Conclusion: Implementing the self‑care model increased
the quality of life of hemodialysis patients. Therefore, the use of this model in hemodialysis
patients is recommended.

Abstract Introduction: The important role of information and communication technologies and their
influence on methods of storing, retrieving information in digital libraries, has not only changed
the meanings behind classic library activates but has also created great changes in their services.
However, it seems that not all digital libraries provide their users with similar services and only
some of them are successful in fulfilling their role in digital environment. The Iranian National
Medical library is among those that appear to come short compared to other digital libraries
around the world. By knowing the different services provided by digital libraries worldwide, one
can evaluate the services provided by Iranian National Medical library. The goal of this study is a
comparison between Iranian National Medical library and digital libraries of selected countries.
Materials and Methods: This is an applied study and uses descriptive – survey method. The
statistical population is the digital libraries around the world which were actively providing library
services between October and December 2011 and were selected by using the key word “Digital
Library” in Google search engine. The data‑gathering tool was direct access to the websites of
these digital libraries. The statistical study is descriptive and Excel software was used for data
analysis and plotting of the charts. Results: The findings showed that among the 33 digital
libraries investigated worldwide, most of them provided Browse (87.87%), Search (84.84%), and
Electronic information retrieval (57.57%) services. The “Help” in public services (48/48%) and
“Interlibrary Loan” in traditional services (27/27%) had the highest frequency. The Iranian National
Medical library provides more digital services compared to other libraries but has less classic
and public services and has less than half of possible public services. Other than Iranian National
Medical library, among the 33 libraries investigated, the leaders in providing different services
are Library of University of California in classic services, Count Way Library of Medicine in digital
services, and Library of Finland in public services. Results and Discussion: The results of this
study show that among the digital libraries investigated, most provided similar public, digital,
and classic services and The Iranian National Medical library has been somewhat successful
in providing these services compared to other
digital libraries. One can also conclude that
the difference in services is at least in part
due to difference in environments, information
needs, and users. Conclusion: Iranian
National Medical Library has been somewhat
successful in providing library services in
digital environment and needs to identify
the services which are valuable to its users
by identifying the users’ needs and special
characteristics of its environment

Abstract Organizations try to outsource their activities as much as possible in order to prevent the problems
and use organizational capabilities in Information Technology (IT) field.The purpose of this paper
was first, to express the effective criteria for selecting suppliers of IT services, second, to explain
the advantages and disadvantages of outsourcing IT in hospitals. This study was narrative
review, which search was conducted with the help of libraries, books, conference proceedings,
and databases of Science Direct, PubMed, Proquest, Springer, and SID (Scientific Information
Database). In our searches, we employed the following keywords and their combinations:
Outsourcing, information technology, hospital, decision making, and criteria. The preliminary
search resulted in 120 articles, which were published between 2000 and 2013 during July 2013.
After a careful analysis of the content of each paper, a total of 46 papers were selected based
on their relevancy. The criteria and sub‑criteria influencing outsourcing decisions in Iranian
hospitals were identified in six major categories including administrative issues, issues related
to the service/product, technology factors, environmental factors, risks, and economic factors
associated with 15 sub‑criteria containing business integration, dependence on suppliers, human
resources, focus on core competencies, facilities and physical capital, innovation, quality, speed
of service delivery, flexibility, market capabilities, geographical location, security, management
control, cost, and financial capability. Identify the advantages and disadvantages of outsourcing
and effective criteria in IT services supplier selection causes the managers be able to take the
most appropriate decision to select supplier of IT services. This is a general review on influencing
criteria for electing of supplier of information technology services in hospitals.

Abstract Context: Establishing and developing minimum data set (MDS), controlled vocabularies,
taxonomies and classification systems are requirements of health information system in every
society. Aims: The aim of this study was to propose an integrated multiple sclerosis (MS) data
set by comparing European database for multiple sclerosis (EDMUS Coordinating Center Lyon,
France) and iMed© software’s (iMed, Merck Serono SA - Geneva). EDMUS is being developed at
the EDMUS coordinating centers in Lyon, France and iMed© is owned and distributed by Merck
Serono in Geneva, Switzerland. Settings and Designs: Retrieval of data of MDS performed
through scholars responsible in related agencies and clinics. Materials and Methods: This
research was an applied. The study was comparative-exploratory. In this study, data elements
in iMed© and EDMUS software’s were compared. Data collecting tool was data raw form.
Statistical Analysis Used: Results analyzing was carried out in a descriptive-comparative
method. MS data elements were proposed in three general categories: administrative; clinical;
and socio-economic. In this study, a MS data set was suggested by studying data elements of
EDMUS and iMed© softwares. Results: The MS data set includes administrative, clinical and
socio-economic data elements that collect information of MS patients during the treatment
course. iMed©, EDMUS and other available databases are suitable patterns for determining
and recognizing MS key data elements. Conclusion: Developing MS data set in this study
and studying other available MS information systems result in establishing standardized MS
data set. By establishing this data set, it will be possible to present MS MDS internationally.
MS MDS is the main base of establishing MS information systems at different levels.

Abstract Context: Iran experiences a high rate of burns accompanied by painful consequences,
death and a lot of disabilities. In order to reduce the burden of this injury, some strategies
such as designing and implementation of registration systems are essential. Aims: The aim
of this study was to compare National Burn Registry in America, England, Australia and Iran.
Materials and Methods: This study was comparative‑descriptive in which data collected from
the National Burn Registry of America, England, Australia and Iran studied in 2013. The study
population included National Burn Registry of these countries and data was collected using
raw data forms. Statistical Analysis Used: Data on each country was categorized according to
objectives and comparisons took place using comparative tables. Finally, descriptive‑theoretical
analysis of the findings was performed. Results: National Security Agency and National
Burn Repository in America, National Institute of Health and the Ministry of Health in England
and the Department of Health and Senior in Australia are responsible for national burning
registry. A seven‑axial model was proposed for Iran’s National Registry. America’s registry
system is broader than other countries due to its cooperation with Canada, Sweden and Asia.
Conclusion: The aim of the Burn Registry System is to gather, store, edit, categorize, analyze
and distribute all burns, injured data from all health care centers in a specific population and
provide valuable information about the occurrence, time and regional distribution of burn injury.