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Introduction: Discharge summaries (DSs) are among the most important tools for transferring information from hospital physicians to other physicians and play an important role in the continuity of care. Low quality and lack of information are the main problems of DSs, and evaluation of their quality from the physicians' perspective in Iran has rarely been done. This study aimed to evaluate the DSs' quality of content and completeness. Method: This descriptive cross-sectional study was performed on the DSs of Shafa Hospital in Kerman. A valid and reliable researcher-made questionnaire (α=0.97) was used. This questionnaire had three sections, including questions related to demographic information, evaluation of the quality of DSs (8 questions), and the degree of completeness of the DSs (8 questions). Results: Out of 110 physicians, 98 (89%) filled out questionnaires. Completeness, awareness, continuity of care, legibility, relevancy, length, consistency, organization, and physicians’ satisfaction were below the average (50%) throughout the hospital. The highest level of physicians' satisfaction with the quality of the content (79.27%) and completeness (77.73%) was attributed to electronic discharge summaries of the neurology department. Organization, legibility, and consistency, respectively, were identified as the best predictors of physicians' satisfaction with the quality of the DSs’ content. Conclusion: Policymakers should increase the quality of DSs by creating instructions, holding documentation training courses, increasing the supervision of senior physicians on interns and residents, and finally developing electronic automated DSs.

Introduction: The American Medical Association has introduced the newest medical subspecialty field known as "Clinical Informatics" since 2011. In order to present similar courses in Iran, it is necessary to design and evaluate a training program. The comparison of educational systems improves the content and quality of design of an educational program. Therefore, the objective of this study was to identify and compare the clinical informatics curriculum in several top universities in the world. Method: The present study was an applied one conducted in 2019. The tool used in this study was a researcher-made checklist that was designed based on reviewing the texts and opinions of experts in group discussion sessions. Its validity was confirmed by seven experts in medical informatics, clinical specialties, and medical education and its reliability was confirmed using the equivalence method. The data were collected by referring to the university websites to complete the study checklist. Results: In most of the studied universities, the clinical informatics fellowship course was implemented according to ACGME standards and the main content of this course included four main topics: principles and concepts, clinical decision-making and improving the care process, health information systems, and guiding and managing change. Conclusion: The similarities were mostly related to the duration of the course and the opportunity to conduct relevant researches in the field of clinical informatics. Most of the differences were also related to the opportunity to teach clinical informatics and learners' participation in holding a journal club during the course.

Background:Cardiac rehabilitation program (CRP) is a useful method of modifying cardiovascular risk factors, improving life expectancy and quality of life in patients with ischemic heart disease (IHD). The present study was conducted to evaluate the effects of cardiac rehabilitation on the pulmonary artery systolic pressure (PASP) and left ventricular end-diastolic pressure (LVEDP). Methods: This Quasi-experimental study with pretest-posttest design was conducted on 80 patients with IHD who had participated in CRP after undergoing coronary artery bypass graft (CABG) surgery. Echocardiography was performed before the beginning of CRP (the 1st session) and at the end of the rehabilitation sessions, and ventricular function indices (ejection fraction), PASP (using the tricuspid regurgitation velocity), and LVEDP (using Nagueh formula: 1.24×E/e´+1.9) were measured. Results: Ejection fraction (EF) was changed from 49.3 ± 7.8 before rehabilitation to 50.7 ± 7.4 after rehabilitation, which was a statistically significant difference (P=0.003). The pulmonary artery systolic pressure altered from 30.3 ± 8.4 before rehabilitation to 27.3 ± 6.6 after rehabilitation. The left ventricular end-diastolic pressure (LVEDP) changed from 10.5 ± 3.7 before rehabilitation to 9.1 ± 2.9 after rehabilitation, which was a statistically significant difference (P= 0.000). Conclusion: According to the results, LVEDP and PASP in patients with IHD who underwent CABGs decreased after cardiac rehabilitation.

Medical Informatics, an emerging multidisciplinary field at the intersection of medicine, technology, and information sciences, is believed to significantly impact health and medical practice.

Introduction: New diagnostic methods like immunohistochemistry staining in skin cancer can help the physicians to have more accurate diagnosis. The purpose of this study was to compare a method based on decision tree for differential diagnosis of two kind of skin cancer (Basal cell cancer and Squamous cell cancer) based on the results of staining methods. Method: Sixty skin cancer patients’ data from Malaysia were assessed by two methods of decision tree, CART and CHAID, in data mining and using Clementine 12 and SPSS 19. The results of three staining methods including B-cell lymphoma-2 antibody (BCL2), Galectin-3 (Cytoplasm), and Galectin-3 (Nucleus) were analyzed. The best predictive model for decision tree induction was compared with another researcher-made model based on critical values resulted from Receiver Operating Characteristic (ROC) curve analysis. Results: In final synthetic model, the sensitivity and specificity for Basal Cell Carcinoma (BCC) were 82.1% and 100%, and for Squamous Cell Carcinoma (SCC) were 100% and 82.8%, respectively. The overall accuracy of the model was 90.38% and the positive predictive values (PPV) for SCC and BCC were 82.1% and 100%, and the positive likelihood ratios (PLR) were 5.8 and 5.5 respectively. Conclusion: The decision tree model based on two methods of immunohistochemistry staining in skin cancer, can help in the diagnosis of these malignant disease and provide further studies.

مقدمه: سیستم‌های رایانه‌ای پشتیبان تصمیم در پزشکی می‌توانند در کاهش انواع خطاهای پزشکی در برخی فرایندهای درمان مؤثر باشند. هدف از این پژوهش، شناسایی دیدگاه‌های پزشکان و پرستاران در زمینه‌ی کاربرد عملی این سیستم‌ها برای پیش‌گیری یا کاهش بروز خطاها بود. روش بررسي: مطالعه‌ی مقطعی حاضر به مدت دو ماه در بیمارستان‌های آموزشی دانشگاهی کرمان در سال 1389 انجام شد. نمونه‌گیری به روش آسان و با استفاده از دو پرسش‌نامه‌ی پژوهشگر ساخته‌ی معتبر و پایا به صورت تحویل حضوری میان 100 پزشک و پرستار توزیع گردید. نظرسنجی در مورد برخی جنبه‌های مهم درمان و مراقبت‌های پرستاری قابل پیش‌گیری توسط سیستم‌های هشدار دهنده یا یادآورنده صورت گرفت. سپس داده‌ها به وسیله‌ی نرم‌افزار SPSS نسخه‌ی 17 تجزیه و تحلیل شدند. يافته‌ها: 65 زن و 35 مرد پرسش‌نامه‌ها را پاسخ دادند. 86 درصد پزشکان و 90 درصد پرستاران به امکان بروز خطاهای پزشکی در محل کارشان معتقد و 88 درصد کل افراد موافق بودند که نصب سیستم رایانه‌ای کارامد سبب کاهش خطا خواهد شد. از نظر بیشتر پاسخگویان، تأثیر سیستم‌های رایانه‌ای بر کاهش بروز زخم بستر و آمبولی، حذف مشکل دست‌خط ناخوانای پزشکان، کیفیت بهتر خدمات با دسترسی به اطلاعات روزامد، کاهش احتمال بروز آلرژی یا تداخل دارویی و بهبود کیفیت تجویز با دسترسی به سوابق دارویی بیمار مثبت ارزیابی گردید. مهم‌ترین اولویت‌های پزشکان به ترتیب امکان دسترسی به اطلاعات روزامد، هشدار در مورد آلرژی‌های شدید دارویی و تداخلات دارویی و از دید پرستاران امکان یادآوری برای پیش‌گیری از زخم بستر، بروز آمبولی و امور مهم در زمان شلوغی بخش بود. نتيجه‌گيري: کادر درمانی بیمارستان‌های آموزشی کرمان نیز به اثربخشی سیستم‌های رایانه‌ای پشتیبان تصمیم اعم از هشدار دهنده و یاد آورنده و یا ثبت دستورات به ‌صورت کامپیوتری اعتقاد دارند و توجه به نظرات آنان و پژوهش‌های مشابه، می‌تواند در جهت توسعه‌ی استفاده از این سیستم‌ها مؤثر باشد. واژه‌‌هاي کليدي: سیستم‌های پشتیبان تصمیم‌گیری بالینی؛ خطاهای پزشکی؛ انفورماتیک پزشکی؛ انفورماتیک پرستاری

A new world of distance education demands new thinking Key components to complete the distance educational system require that institutions determine how the process is designed delivered integrated and supported To have a better chance to develop online education in Iran the academic staff should mention a lot of punctual notes in order to prepare the material which is going to be published as the online course As a rule teachers must pay careful attention to the common principles and standards in virtual education Moreover they must improve their skills in designing and editing course contents In the process of virtual education taking five exact steps can lead us to achieve the main educational goal that is effective learning These five steps include analysis instructional design interface design development online testing and evaluation The key to success in virtual education concerns serious attention to the quality of educational content and the capability to reuse learning objects It is definitely necessary for the countrys higher educational system to consider this fact having a specialized and scientific view

Background:Cardiac rehabilitation program (CRP) is a useful method of modifying cardiovascular risk factors, improving life expectancy and quality of life in patients with ischemic heart disease (IHD). The present study was conducted to evaluate the effects of cardiac rehabilitation on the pulmonary artery systolic pressure (PASP) and left ventricular end-diastolic pressure (LVEDP). Methods: This Quasi-experimental study with pretest-posttest design was conducted on 80 patients with IHD who had participated in CRP after undergoing coronary artery bypass graft (CABG) surgery. Echocardiography was performed before the beginning of CRP (the 1st session) and at the end of the rehabilitation sessions, and ventricular function indices (ejection fraction), PASP (using the tricuspid regurgitation velocity), and LVEDP (using Nagueh formula: 1.24×E/e´+1.9) were measured. Results: Ejection fraction (EF) was changed from 49.3 ± 7.8 before rehabilitation to 50.7 ± 7.4 after rehabilitation, which was a statistically significant difference (P=0.003). The pulmonary artery systolic pressure altered from 30.3 ± 8.4 before rehabilitation to 27.3 ± 6.6 after rehabilitation. The left ventricular end-diastolic pressure (LVEDP) changed from 10.5 ± 3.7 before rehabilitation to 9.1 ± 2.9 after rehabilitation, which was a statistically significant difference (P= 0.000). Conclusion: According to the results, LVEDP and PASP in patients with IHD who underwent CABGs decreased after cardiac rehabilitation. [ABSTRACT FROM AUTHOR]