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Background and purpose: Evaluation is one of the most important bases of promoting the quality of education. It is very important to know the attendings’ and students’ viewpoints as evaluated and evaluator groups. So in this study the viewpoint of the attendings and students of School of Medicine of Mazandaran University of Medical Sciences (MUMS) about the students evaluation of the attendings, were studied.
Materials and Methods: In this descriptive-cross sectional study, all faculty members (FM) and students of the school of Medicine were included in the study by census sampling. Data collection was done using a questionnaire including demographic questions and educational variables, the FM and students viewpoint about manner of evaluation (time, the way of distributing the forms and the explanation), the student's features in evaluation (awareness, truthfulness and puposes) and the instrument of evaluation (questionnaires and items).
Results: 345 individuals (95 FM and 250 students) took part in this study. The manner of evaluation (time, distribution and explanations) to most of FMs' and students’ opinion was appropriate. About student's awareness and truthfulness in filling in the questionnaires a considerable percentage of FMs (20-40%) had a negative opinion and over half of them had a negative attitude about the whole process of evaluation. About the items of theoretical, practical and clinical questionnaires, while the students laid stress on aspect such as: being a teacher and concepts transferring, on attendings opinion these aspects were less important.
Conclusion: To most FMs and students opinion, the manner of evaluation is appropriate but a considerable negative attitude exists among attendings about students’ awareness and truthfulness in filling in the questionnaire. The priorities of evaluation are different in these two groups’ point if view.

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Background and purpose: Presently, computers and the development of information technology have resolved many limitations in the health and medical arena, and have also opened many doors to improve communication, information and ability for better patient care, in health and medical care provider centers. Moreover, they have many applications such as virtual reality, medical data-bank, tele-health, expert systems and information-networks. The purpose of this study was to evaluate reporting software of ADS9 counteri¢s program.
Materials and methods: This research is a descriptive study which was performed in 2008. Population of this study include employees in office of statistics of Medical Universities in Iran, that work in conjunction with Hospimp software and is answerable regarding Hospimp software in the Ministry of Health and Medical Education. For data collection, researcher used a two-part questionnaire for evaluating general and specified criteria pertaining to the software. The analysis of data was used in descriptive manner with SPSS. The grade of variables studied in this research involved: evaluation of general properties, specified properties, statistical reporting, data-bases, goal of groups and aim of the program with Hospimp software, that is, in average 37.5, 22.58, 41.66, 57.14, 36.36 and 27.27, with a standard deviations of 0.09, 0.08, 0.15, 0.2, 0.15 and 0.14.
Results: Technical tissue fall in the slide was not observed. 93.93 % of SCC was stained by p63. None of the small cell carcinoma was stained by p63. In the first 2 months, 53.34% of distained section’s had similar staining intensity, compared with re-cut sections, 46.66% of cases were decreased in staining intensity and none were negative.
Conclusion: Generally, in the evaluated dimensions, Hospimp software has more blind spots rather than strength spots. General properties of the software have a better intensity level, than its specified properties. In order to improve and develop useable software’s in the health and medical arenas, we will recommend the development of international standards in designing, production, testing, measuring and software conservation.

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Background and purpose: Toxoplasmosis is a parasitic protozoan disease producing severe complications in congenital and immunocompromised cases. The enzyme-linked immunosorbent assay (ËLÏSÂ) is the most common laboratory method for serodiagnosis of toxoplasmosis. Çommercial kits have no unique procedure for standardization and this may influence the consistency of the results. The present study was designed to determine the reproducibility of results obtained by ËLÏSÂ in different laboratories using similar commercial kits. Âlso, the results obtained from different commercial kits were compared.
Materials and methods: Three Toxoplasma gondii ÏgG-ËLÏSÂ kits from different commercial companies were used and the results reported by three different university laboratories evaluated. Ëighty one serum samples from patients referred to a private laboratory for serologic determination of toxoplasmosis were examined. The results of the tests were reported as qualitative values (positive, negative, borderline), and the agreement rates determined using the Kappa coefficient.
Results: Çomparing three different kits, the results of 76 serum samples were similar and the Kappa coefficients calculated at 0.85, 0.90, and 0.97. When comparing different laboratories, the results of 80 serum samples among three laboratories were similar and the Kappa coefficients calculated at 0.97-1.
Çonclusion: Based on the results of the present study, it could be concluded that the ËLÏSÂ test for detection of antibodies to T. gondii has the potential to produce consistent results in different laboratories while using different kits.

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Background and purpose: Fear of negative evaluation consists of anxiousness about other people’s evaluation of oneself, worries resulting from these negative evaluations, and the expectations from others, that they would develop only negative evaluations of one. The purpose of the present study was to determine the effect of metacognitive therapy (MÇT) on symptoms of fear of negative evaluation in social phobia disorder patients.
Materials and methods: This study was carried out as a controlled clinical trial. Participants were referred from clinics in the city of Shiraz, Ïran, and 19 patients were selected. They were randomly assigned to either the experimental or the control group. Âfter running the pretest, which was done using the fears of negative evaluation scale (FNË) and social phobia symptoms assessment questionnaire (SPSÂQ), the experimental group received 8 weekly metacognitive intervention sessions, while the control group received no intervention. Post-test and follow-up (after 3 months) were performed using the same tools.
Results: The results of analysis of multivariate covariance showed that MÇT had a significant effect on alleviating the symptoms of fear of negative evaluation (p<0.05).
Çonclusion: This intervention emphasizes on the promotion of efficient adaptive and flexible skills through metacognitive processes and their effect on a decrease in fear of negative evaluation in patients suffering social phobia disorder.

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Abstract Background and purpose: Teaching evaluation questionnaire of instructors is an important instrument used in educational processes which can be performed using different methods including students' feedbacks. This is now considered as a challenging educational issue and different positions exist in this regard. The purpose of this study was to assess the reliability of students' feedback in different terms and majors in the evaluation of instructors teaching the same course. Materials and methods: In a cross-sectional analytic study, evaluation of 40 instructors was carried out by 89 groups of students. Each instructor was teaching a specific course to several groups of students. The questionnaire was classified into four areas. The total score was assessed for each instructor and analyzed using descriptive statistics and correlation test. Reliability was assessed by Cronbach's alpha coefficient. Results: The reliability of the questionnaire was high (α=0.96) based on Cronbach's alpha coefficient. The reliability index was the highest in the area of teaching skills (α=0.96) and the lowest in terms of educational discipline (α=0.81). There was a significant correlation among different studied variables scored by different groups of students for each instructor. A significant correlation was also found between the total and the average score (P<0.001). Conclusion: The questionnaire used for the evaluation of the instructors was highly reliable and reliability was higher than optimal level in all areas. Therefore, it seems that students' feedback is one of the reliable methods in the evaluation of instructors using an appropriate questionnaire.

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Background and purpose: Cognitive theories propose that fear of negative evaluation (FNE) is the core feature of social anxiety disorder. Recently, fear of positive evaluation (FPE) has also been discussed as a cognitive component of social anxiety. The aim of the present study was to investigate the relationships between fear of positive evaluation and social anxiety by controlling FNE. Materials and methods: The participants included 176 students in Shahid Chamran University (88 males, 88 females) who were selected through multistage random sampling. The Social Anxiety Scale and the Fear of Positive Evaluation Scale were used to collate the data. Results: The findings showed a positive correlation between FPE and social anxiety, its component and social self-concept, but no correlation was found between anxiety symptoms (AS) and FNE. Three hierarchical regressions indicated that FPE accounted for significant variance in social anxiety and social self-concept but it could not predict anxiety symptoms. An explorative factor analysis provided additional support for the distinction between FPE and FNE. All of the two scale items were loaded on separate factors. Conclusion: FPE and FNE have distinct roles in social anxiety and are probably associated with different type of anxiety symptoms.

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Background and purpose: Nowadays, development of aquaculture is one of the reasons for river pollution. The purpose of this study was to evaluate the effect of aquaculture effluent on physicochemical parameters of Kabkian River in 2011-12. Material and Methods: Sampling was conducted during three seasons in 2011-12 from 12 selected stations. Dissolved Oxygen, pH, TDS, EC and T parameters were measured on site and NO3-, NO2-, PO43-, NH4+, BOD5, and COD parameters were measured in laboratory. Results: Statistical analysis showed significant differences in mean concentration of NO2- and COD (P<0.05). The minimum and maximum mean concentrations of NO2- were found with 0.004 ± 0.001 and 0.049 ± 0.01 mg L-1, respectively for stations A, C, and H. Also the minimum and maximum mean concentrations of COD were found with 8.00 ± 1.20 and 27.67 ± 5.33 mg L-1, respectively for stations B and J. The analysis of qualitative parameters in different sampling periods showed significant differences in mean concentrations of studied parameters (P<0.05). Conclusion: According to this study and the WHO recommendation on concentrations of pollutants for drinking and agricultural water, self purification of Kabkian River is possible. However, increasing number of aquaculture farms and lack of monitoring of pollution sources could result in serious problems, especially eutrophication.

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Background and purpose: Cerebral palsy is a common disorder in children leading to their dysfunction in many aspects. Therefore, to provide appropriate treatment plan that could improve the function of these children, a valid assessment tool is needed. Pediatric Evaluation Disability Inventory (PEDI) is designed to evaluate the performance of children with disabilities in three dimensions: self-care, mobility, and social function. The purpose of this study was to evaluate the reliability of the Persian version of PEDI in children with cerebral palsy aged 3 to 9 years old.

Materials and methods: In this study, 75 participants were selected by convenience sampling. Information was collected using demographic questionnaire and Gross Motor Function Classification System (GMFCS). The parents were interviewed and PEDI was completed. After two weeks, in order to evaluate the reliability of the test-retest, 22 parents were re-interviewed. Internal consistency was examined by Cronbach's alpha, and the reliability of the test-retest was assessed by intra-class correlation coefficient (ICC).

Results: In examining the internal consistency, Cronbach's alpha was found to be high (0.94-0.98).The results of test-retest reliability of the functional skills and caregiver assistance scale were excellent (0.96-0.97). Also, the results of test-retest reliability in modification scale were excellent in self-care and social performance (0.99 and 1, respectively) and good in mobility dimension (0.66).

Conclusion: This study proved the internal consistency and test-retest reliability of the Persian version of PEDI in evaluating the performance of Persian-speaking children with cerebral palsy. Therefore, PEDI could be applied in research and clinical settings for evaluation of children with cerebral palsy in Iran.

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Background and purpose: Body dysmorphic disorder is one of the common disorders in which adolescents pay excessive attention to their appearances. It causes disruptions to both individual and social life. This study investigated the efficacy of acceptance and commitment therapy (ACT) on body dissatisfaction and fear of negative evaluation in high school girls with body dysmorphic disorder.

Materials and methods: An experimental study (pre-test, post-test design) was performed in which 30 female high school students with body dysmorphic disorder were recruited. The participants were selected using multistage random sampling and divided into experimental (n=15) and control (n=15) groups. The experimental group attended an eight-week ACT programme (1.5 hr) while the control group received no intervention. Structured Clinical Interview for DSM IV (SCID-I), body dissatisfaction questionnaire, and fear of negative evaluation questionnaire were used in pre-test and posttest stages.

Results: ACT produced significant reductions in body dissatisfaction (P<0.01) and fear of negative evaluation (P<0.01) in post-test.

Conclusion: Based on this study, ACT therapy could be used as an efficient intervention for reduction of body dissatisfaction and fear of negative evaluation in high school girls with body dysmorphic disorder.

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Background and purpose: Image quality together with low patient dose is two important goals in radiography procedures. Acquire radiographic images with inadequate quality give rise to uselessly patient dose, improper diagnosis, waste the cost and impose the biological effect to the patients. In this study image quality was evaluated for most common radiographic procedures based on indentified image quality criteria in Sari referral governmental hospitals.
Materials and methods: In this cross-sectional study more than 1200 radiographic images were evaluated for adult patients in two referral hospitals in Sari. Image quality were assessed based on identified image criteria in the Commission of European Communities guidelines and Merrill's atlas. Image evaluation were done in two image criteria as anatomical visibility and radiographic indicators.
Results: Mean radiographic images which met all quality criteria on anatomical visibility evaluation in Imam Khomeini and Bu-ali sina hospital were %71.9 ± 9.8. The Highest quality adherence was in image edge sharpness as a important radiographic criteria. Lumbar spine radiography had the best image quality in two hospital than the other radiographs.
Conclusion: This study shown that radiographic images in referral governmental hospital in sari had good quality. Having the deep inspiration of patient in chest radiography and proper field size in skull radiography improves radiographic image quality criteria adherence in two hospitals, considerably.

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Background and purpose: Health organizations play a major role in improving the quality, efficiency and effectiveness of health services, if they have appropriate structures for systematic evaluation. The purpose of this study was to evaluate the software systems of the hospital information system (HIS) in Sari Bou-Ali Sina Hospital.
Materials and methods: A descriptive-case study was done on the HIS provided by Pooya Samaneh Diva Co. Data was collected using observations and interviewing the head of IT department. Data analysis was done using the evaluation indicators of HIS proposed by Iran Ministry of Health.
Results: The HIS in Sari Bou-Ali Sina Hospital consists of 6 software programs and 42 subsystems. The software for administrative and financial subsystems had more subgroups while the central subsystem had the least number of subgroups. Reporting was not available in management and central subsystems. The subsystems for management of information did not have any quantitative or qualitative upgrades according to the needs.
Conclusion: The reasons for not paying attention to upgrading the software capabilities are as follows: not involving the users in designing the software, inadequate training and user awareness of expected performances and capabilities, delays in financing, failure to notify the company about the latest instructions and notifications of the Health Ministry and delays in implementation of the instructions in the software, and multiplicity of software programs alongside the current HIS.
 

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Background and purpose: Proton pump inhibitors (PPIs) are one of the main therapeutic agents for acid-dependent diseases. Inappropriate use of this group of drugs especially Intravenous form of pantoprazole can lead to unnecessary cost. The aim of this study was to assess the IV Pantoprazole utilization in a teaching hospital in North of Iran.
Materials and methods: This cross sectional study was performed within four months in 100 patients hospitalized in Ramsar Imam Sajjad Hospital, 2016. Demographic data, type and doses of Pantoprazole, risk factors for stress ulcer, and other relevant clinical data were recorded. Appropriate use of Pantoprazole was assessed according to recommendations provided by Fact Drug Information 2016, Medscape 2016, and UpToDate 2016.
Results: Among the patients 54% had indication for receiving a PPI and only 16% had indication for parenteral form of PPI. Oral PPIs could have been used in 73% of the patients but they received parenteral form of Pantoprazole. In 92% of IV injections, a vial of 40 mg Pantoprazole was dissolved in 10 ml distilled water and injection was done in less than 10 seconds which was incompatible with guidelines.
Conclusion: In current study, utilization of Pantoprazole was not compatible with guidelines in most cases, including right indication, right preparation methods and right rate of drug administration.
 

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Background and purpose: Internal evaluation is the systematic process of collecting and analyzing information to determine the benefits and disadvantages of a program and the extent to which its objectives are achieved. The aim of this study was to investigate the status of internal evaluation in clinical departments of Mazandaran University of Medical Sciences in two consecutive academic years.
Materials and methods: This descriptive cross-sectional study was performed in all clinical departments of Mazandaran University of Medical Sciences during 2015-2016 and 2016-2017. Data from eight domains of internal evaluation were collected using a checklist and some researcher-made questionnaires. Then, we studied the status of departments in eight domains of internal evaluation in relation to the standards and the status of all departments in two consecutive academic years. The evaluations for the years were compared and the dynamic trend was assessed. Data analysis was done applying descriptive statistics in SPSS. 
Results: A good status of clinical departments was seen in most of the domains. Best performances within the two academic years studied were associated with courses, educational curriculum, and graduate affairs (74.53%, 78.66%, and 88.61%, respectively). Total scores for all clinical departments were 64.22% and 70.69% in 2015-2016 and 2016-2017, respectively.
Conclusion: Continuous internal evaluation reveals the strengths and weak points of the clinical departments. Therefore, more appropriate planning would be done and the departments could apply for further residency programs.  
 
 

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Background and purpose: Thalassemia is a preventable genetic disorder that is a major health problem. It is now two decades since implementation of the national program for preventing β-thalassemia major in Iran. This study was conducted to compare the costs and results of this program from 2010 to 2014 in Mazandaran University of Medical Sciences.
Materials and methods: Economic evaluation was done in this descriptive analytic study. We extracted the data from surveillance reports of health deputy and costs of laboratory services from the private and public sectors and Legal Medicine Organization tariffs. Other cost items were determined using published reports and articles, and interviewing the administrators and researchers. All costs were calculated in Excel 2007 based on the economic value of 2014.
Results: The total direct costs of medical services, direct non-medical and non-medical direct costs of implementation of national program for preventing β-thalassemia major in one year were over 18,418,872,744 Rials. The average cost of prevention of a β-thalassemia major birth case was estimated to be be 341,090,236 Rials. The cost ratio of prevention to treatment was 1:12. Five-year implementation of the national program prevented 270 babies born with thalassemia. The success rate of this program was 95% in Mazandaran.
Conclusion: Cost benefit analysis showed that the national program for preventing β-thalassemia major was efficient and economically valuable in Mazandaran province.

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Background and purpose: Recognizing the educational needs of students determine their learning goals and leads to better design of course books and educational materials. In this regard, high quality textbooks are a real need. This study aimed to analyze the content of "English for Dentistry Students'' course book based on the viewpoint of dental students.
Materials and methods: A descriptive cross-sectional study was performed in all dentistry students at Sari School of Dentistry, Iran 2018.  The participants all had passed the English for Specific Purposes (ESP) modules (I and II). The research was carried out using a questionnaire based on Sheldon model of evaluation modified by Karimi consisting of six dimensions. Data analysis was done in SPSS V24.
Results: A total of 123 dentistry students was studied. There were no significant differences between males and females average score for each dimension (P=0.01). The average score for the dimensions of practical subjects, content related to the objectives of the course, linguistic subjects, and order of the contents was 8.83±1.93 and the average score for subjects and subject layout was 12.93±1.86. Overall, dentistry student showed a moderate level of satisfaction towards ''English for Dentistry Students'' course book.
Conclusion: In order to enhance learning, course books should include a variety of pictures and other educational tools such as movies and animations could be beneficial too.
 

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Background and purpose: A timeliness warning of communicable diseases surveillance system (CDSS) in every country is vital for maintaining national, regional, and global health security. This study aimed at providing recommendations to improve the CDSS in Iran.
Materials and methods: This qualitative study was conducted in 64 people working in CDSS and other associated organizations using semi-structured interviews and focus group discussions between October 2016 and April 2017. The interviews were analyzed via conventional content analysis approach using MAXQDA 10.
Results: The solutions that could improve the CDSS were categorized into four main categories and 8 sub- categories as follows: stewardship of the CDSS, improving reporting comprehensiveness, development and improvement of infrastructures, and training and retraining.
Conclusion: The timeliness and comprehensiveness of the CDSS information depend on intersectoral collaboration. Therefore, main recommendations for reinforcement of CDSS include strengthening intersectoral cooperation, using incentives to obtain the supports of private sector professionals, developing reporting systems, and community participation.
 

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Background and purpose: Studies on the function of referral system in Iran had not covered all aspects and structures of the referral system. This could be due to lack of an appropriate tool that could investigate referral system in Iran. The current study was done to translate and investigate the validation of Referral Systems Assessment and Monitoring (RSAM) Toolkit based on family physician in Iran.
Materials and methods: The English version of RSAM was translated into Farsi. Content validity was assessed by calculating content validity ratio (CVR) and content validity index (CVI). For this purpose we used 20 informed individuals familiar with family physician program and referral system. Then, the tool was used in 52 family physician units in Mazandaran province and its reliability was investigated. Data were analyzed in SPSS V24 and LISREL 8.8.
Results: The coefficients of CVR and CVI were 70% and 90%, respectively, which were higher than the acceptable values. The Chrocbach’s alpha coefficient for reliability of multiple choice items was 0.89 (good) and the Kudar-Ricahrson coefficient for two-choice items was 0.83. (acceptable).
Conclusion: The RSAM tool for Family Physician Program in Iran has the necessary scientific features and could be efficient in investigating this form of referral system.
 

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Background and purpose: Drug utilization evaluation (DUE) is one of the most effective methods to assess the correct administration of drugs. Enoxaparin is one of the most commonly used anticoagulant which is widely used as prophylactic or curative treatment. The aim of this study was to evaluate the rational use of enoxaparin in Mazandaran Heart Center.
Materials and methods: In a retrospective study, demographic and clinical data of 200 patients who had received enoxaparin in 2017 were collected on the basis of American Hospital Formulary Service (AHFS) drug information, UpToDate, and Medscape guidelines.
Results: The mean age of patients was 61.52 ± 13.62 years. The dosing of enoxaparin was according to guidelines in 163 (81.5%) patients and outside the target ranges in 37 (18.5%).
Conclusion: In this study, the administration of enoxaparin for therapeutic or prophylactic purposes was not according to guidelines in about one-fifth of the patients and it is necessary to determine the precise dosage.
 

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Background and purpose: This study aimed at evaluating utilization of imipenem and assessing the role of pharmacist in rational use of antibiotics.
Materials and methods: A retrospective/prospective observational study was conducted in Ramsar Imam Sajjad Hospital in 59 patients receiving imipenem, 2018-2019. In retrospective phase, patients’ records were reviewed, while in prospective phase, a pharmacist provided recommendations on use of imipenem. Duration of taking imipenem, dosage, and dosage adjustment in renal insufficiency were compared with standard protocols.
Results: Mean age of the patients was 69.89±16.12 years and there were 29 males. The most common reason for prescribing imipenem was lower respiratory tract infection (54%) which was more used in internal medicine ward (67.28%) ordered by infectious diseases specialist (65%). In retrospective and prospective phases, mean dosage of imipenem, duration of receiving the antibiotic, and dosage adjustment in renal insufficiency were according to standard protocols in 65% and 85%,  45% and 65%, and 60% and 90% of the cases, respectively (P<0.001).
Conclusion: The role of pharmacist in drug utilization evaluations is of great importance for optimal use of drugs and reducing mortality rates caused by infectious diseases.

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 Background and purpose: Clinical education is a good opportunity for students to test themselves in different areas, including knowledge, clinical skills, ethics, communication with patients, problem solving, and decision making. This will help them in getting prepared for future position. The present investigation aimed at studying the quality of different residency programs in Mazandaran University of Medical Sciences, 2019.
Materials and methods: We conducted a combined study. In first phase a qualitative study using content analysis was performed and in second phase, a quantitative survey was carried out using a questionnaire. In quantitative phase, 140 assistants were selected from 15 educational groups via nonprobability sampling. The participants were asked to complete survey items with a five-point Likert scale. Graneheim and Lundman qualitative approach was used for content analysis and Goba and Lincoln criteria were used to assess the accuracy and robustness of the study.
Results: According to findings, residents' satisfaction with welfare facilities, rest time on duty, educational justice, log book, skill lab, and responsibility assignment were 19.6%, 24.7%, 36%, 39.3%, 55.8%, and 54.5%, respectively. The respondents were satisfied with morning reports, morning and evening clinical rounds, evening grand rounds, and OSCE test (more than 75%).
Conclusion: This study showed that many educational programs are in a relatively unfavorable situation that should be among our intervention priorities.