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Accreditation is an important field in health services evaluation that helps health care organizations to gain acceptable situation in performance indicators. The purpose of this system is making a framework for continuous quality improvement to meet health system goals. This study aimed to design an evidence-based national accreditation model for specialized clinics of hospitals.

This descriptive study was conducted from 2009 to 2011. Following a systematic literature review in the SID، Ovid Medline، and PubMed databases using relevant key words، several accreditation models and related standards were extracted. All relevant standards were used to develop a Delphi questionnaire to gain experts opinions. Experts assessed and scored all standards based on two aspects of ‘Importance’ and ‘performance’.

In the systematic review phase، the JCAHO (USA) and CCHSA (Canada) accreditation models were chosen as the best models to benchmark. The Lebanon and Egypt accreditation models were also chosen as the best local (EMRO region) models. Related standards in the selected models were determined and used in our Delphi questionnaire with further standards obtained from the health services management text books. Two rounds Delphi study was done with high response rate. About 68 standards were accepted and 5 standards were rejected. Finally، the designed model was completed by merging similar standards، developing and debriefing essential elements of each standard.

The final designed model had 38 standards with ‘content statement’ and ‘objective measurable components’. This model could be a comprehensive accreditation model in number، range and diversion of the standards. There is no doubt that application of this model might led to significant improvement in health centers performance and clients’ satisfaction.

Introduction & Teaching patterns are regarded as the teachers'' skills and techniques، and the implementation of these patterns reveals the quality and art of the teacher. The aim of this study was to determine the effects of combination of lecture and participatory methods of teaching and learning on nursing students'' sustainable learning in the Principals & Clinical Skills of Nursing course. In the present quasi-experimental study، in which 22 students in their first semester of nursing، passing the three credit course of principles and techniques of nursing، were chosen as the sample. Two credits from the three credit course which was taught by one lecturer and dealt with clinical skills were divided into two individual credits. In the first 8 weeks، the course was taught by the usual method (lecture). In the second 8 weeks the course was taught by modern methods of teaching (question and answer، panel discussion، advanced modeling) which were implemented according to the nature of their course. An exam was taken independently for each method at the end of the course and a post test was taken after 3 months after the first exam. Data collection tools were demographic data and a teacher made multiple-choice exam with short answers based on the course. The analysis was done by the SPSS software using descriptive and inferential statistics as absolute and relative frequency distribution، mean، mean difference scores for each test and t test. Research results in relation to the mean and SD scores of the first exam regarding the traditional method was 1. 9 ± 14. 7، and 2. 6 ± 8. 5 regarding the second exam. The t-test revealed significant reverse difference between the two tests (p= 0. 001). The mean and SD of the final exam of the traditional approach was 14. 67±1. 69، the modern approach 13. 75±1. 7. The t-test showed a significant difference between the two approaches (p=. 025). The mean and SD of the traditional and modern approach for the second exam were 8. 52±2. 6 and 13. 25±3. 51 respectively. Moreover، the t-test revealed a significant difference between the scores of both approaches in the second exam (p <0. 001). The results showed that new methods (active) learning، such as question and answer، group discussion and stable pattern of pre-organizing learning method of teaching students were more effective than the traditional lecture method.

Various studies have been performed to evaluate the effect of physical exercise on factors related to cardiovascular diseases that mostly show the beneficial effects of regular physical exercise on these factors. However, little research has been performed on resistance exercises. The purpose of present study was to investigate the effect of mild and high intensity resistance training on some cardiovascular risk factors.

This clinical trial study was carried out in year 2009. The study population was non-athlete university students of Kurdistan. 30 young healthy me n were selected by random sampling method and divided randomly into three groups of experimental1, experimental2 and control group. The two experimental groups underwent resistance training for six consecutive weeks. ApoB, ApoA, LDL, HDL, ApoB/ApoA, LPL, TG, cholesterol, HDL /cholesterol, BMI, blood pressure and waist to hip ratio were assessed before and after the training period. ANOVA test with repeated measurement, paired t-test, one-way variance analysis and Bonferroni correction test were used for data analysis in SPSS 14 software.

After the training period, LDL, cholesterol, HDL /cholesterol and BMI significantly decreased in experimental groups. HDL only increased in the second experimental group. Other studied factors did not change significantly in any of groups.

Resistance training for six weeks in young healthy males can have beneficial effects on some cardiovascular risk factors. HDL response to resistance training is affected by the training intensity.

Regular blood transfusions in beta thalassemic patients can lead to accumulation of extra iron in the body which may result in cardiac complications and death. Deferrioxamin (DFO) is the standard treatment for this condition but 12-8 hours subcutaneous (SQ) injection of this drug per day can cause local pain which together with lack of patients´ compliance, it is necessary to use another drug to improve the condition of the patients. Deferiprone (DFP), is an approved drug for this purpose and removes iron from cells including cardiac muscle cells. The aim of this study is to compare efficacy of deferrioxamin with that of combined deferiprone and deferrioxamin on echocardiographic indices in beta thalassemic patients. In this randomized clinical trial 40 thalassemic patients who met the inclusion criteria of this study were divided into two equal groups. Controls group received SQ deferrioxamin for six days/week and intervention group received deferrioxamin for three days/week and deferiprone orally for four days/week. Cardiac indices were measured and compared before and after the study. Mean values of the age of the patients were 15.6±5.1 and 14.1±6 years in the intervention and control group respectively. Right ventricle diameter (RVD) indices in control group was 18.7±7.6 and 20.8±6.6 mm before and after treatment respectively (P<0.05). In the intervention group RVD indices were 19.5±5.8 and 18.0 ±4.7 mm before and after treatment respectively (P>0.05). Other indices such as LVEDD, LVESD, aortic root diameter, EF and Fs of left ventricle and also indices of the heart valves revealed no significant differences between the two groups. We didn’t observe any side effect of the drugs in the patients. We concluded combined therapy with 4 days DFP and 3 days DFO per week did not lead to cardiac complications and deterioration of echocardiographic indices.

Liver biopsy is one of the most important diagnostic procedures for liver diseases. Pain is the most common complication of liver biopsy and it can lead to clear morbidity. Finding a way to reduce pain of liver biopsy its complication is very important for investigators. There are limited studies on evaluation of pre-emptive effect of acetaminophen on liver biopsy. The aim of this study was to investigate pre-emptive effect of Acetaminophen codeine on the pain of liver biopsy during the first 24 hours after biopsy. This was a double blind randomized clinical trail study from Oct 2007 to Oct 2008 in gastroenterology and liver disease unit of Tohid hospital in Sanandaj. Sample size included all the patients who were candidate for liver biopsy. Forty four patients (23 in experimental group and 21 in placebo group) were enrolled into the study on the basis of randomized blocking method. Exclusion criteria included any contraindication for liver biopsy or need of penetration of needle for two or more times for biopsy. Visual analogue scale (VAS) was used to assess pain after liver biopsy, 0,1,3,6, and 24 hours after biopsy. This study was conducted after approval of Ethical review Committee of Kurdistan University of Medical Sciences and obtaining the informed written consent from the patients. The patients received acetaminophen codeine or placebo one hour before biopsy. Data were analyzed by means of Chi square, t-test, analysis of variances, and nonparametric tests. The mean value of the pains intensity in zero, one, three, six, and twenty four hours after biopsy in experimental group was higher than that of placebo group but there was no significant differences between two groups (P>0.05). Intensity of the pain after liver biopsy in females was higher than in males in the two groups but there was no significant differences between two groups (P>0.05). Comparison of the results of the present study with those of other studies shows that acetaminophen codeine is not effective in reducing the pain of biopsy. Further clinical trail studies for determination of the effect of other analgesics drugs are recommended in the future.

The thalassemia is belived to be the most prevalent of all human genetic diseases and caused by mutations of the synthesis of hemoglobin.Regular blood transfusions are necessary in major thalassemia patients. The combination of transfusion and chelation therpy has dramatically extended the life expectancy of thalassemic patients but an important complication is iron overload in different organs of the body. Despite improved hematologic care in recent years, in these patients primary hypothyroidism and other endocrine disorders due to iron overload are still common complication and affect the patient's quality of life. The aim of this study was to identify the prevalence of thyroid dysfunction and to determine its correlation with ferritin plasma level, amount of blood transfused and liver function in thalassemic patients. In this cross sectional study, fourty patients with beta thalassemia (20 males and 20 females; mean age, 12.7 ± 5.8 yrs) were evaluated. Serum ferritin levels, SGOT, SGPT were evaluated by ELISA method and TSH were evaluated byIRMA. Hypothyroid index was defined according to the criteria of Kronberg et al. Normal thyroid hormone values were found in 34 patients (85%) and 6 (15%) had subclinical hypothyroidism. Mean ferritin levels in hypothyroid and normal patients were2220 ± 1056 mg/l and 2028 ± 1548 mg/l respectively, (p= 0.2). Thyroid dysfunction could not be correlated with amount of blood transfused, liver function or ferritin plasma level. The high rate of thyroid dysfunction may be the result of poor disease control and manegment in early life when irreversible tissue damage ocuures due to iron overload and chronic hypoxia, and indicates the importance of regular follow-up of beta thalassemia patients for early detection and manegment of associated complications.

The aim of this study was to investigate the effect of cigarette smoking on Cu-Zn superoxide dismutase, glutathione peroxidase and catalase activity in smoker and non-smoker staffs of Kurdistan university of medical sciences. Subjects were randomly divided into 2 groups. Smoker group had smoked at least 10 cigarettes per day for at least one year. While non smokers had no previous smoking experience. All individuals in smoker and non smoker groups had no previous history of endocrine, gastrointestinal, cardiovascular diseases and no one had nutritional supplements or drug consumption. The subjects were between 25-50 years of age. The collected data about the health status of the subjects, average number of cigarettes smoked per day, and the onset of smoking were recorded in a questionnaire for each patient. Erythrocyte activity of Cu-Zn superoxide dismutase,glutathione peroxidase and catalase were assessed. Glutathione peroxidase (p=0.001), catalase (p=0.001), and Superoxide dismutase showed a significant difference in their activities in the 2 groups. Activity of anti-oxidant enzymes (SOD, GPX, CAT) had been lower markedly in the smokers than non smokers (p<0.001). The results of our study showed a high reactive oxygen species (ROS) production and decreased SOD and CAT activities, which support the oxidative stress hypothesis in carcinogenesis. The relatively low GPX, GR, SOD and CAT activities may not be adequate to detoxify high levels of H2O2 into H2O, leading to the formation of the most dangerous 0OH radical. Therefore, administration of antioxidants may be helpful in the management of BC patients. However, further definitive clinical studies are required to evaluate the role of these antioxidant enzymes in BC management.

Improper pakaging, personnels and instruments are the major sources of nutrient contamination. Contamination can be decreased by screening food handlers through physical exam and laboratory tests. The aim of this study was determining the quality of exams performed by sanandaj central laboratory to certify the health of food handlers. This study was descriptive and studeid population included 447 food handlers refered to sanandaj central laboratory to obtain health certificate. Stool exam results compared between central and reference laboratories. Collected data was analyzed using diescriptive statistics. 54 of the examined persons was illiterate. There was significant difference between those who diagnosed with intestinal parasite infection in central (6.9%) and reference (28.5%) laboratories. The age of 50% of persons with parasite infection was between 20-29. The job of 38.7% was bakery. The most commone intestinal parasites detected were giardia and ascaris Since the aim of the screening laboratory tests is screening infected persons and with respect to the low sensitivity of the exam results (14%) in sanandaj central laboratory, regular monitoring of central laboratory are recommended.

To reach a goal the most economic way must be selected. Different ways including cost-effectiveness and cost – efficiency analysis allow us to reach this purpose. This study was done in 2002 to analyze the cost of Sanandaj health centers services. This study was descriptive and carried out in 16 health centers and 7 health sites. Through interview, observation and by referring to registered documents data was collected and registered in a designed questionnaire. Statistical description including sum of cost, median and Standard deviation of data was done using excel software. Based of analyzing collected data, the average per unit costs of Health family, Midwifery, Vaccination, Environment health, Professional health, physician, Dentist, Injection & Dressing and Pharmacy units during a six months period were 11932, 11205, 10974, 14550, 22514, 18953, 54304, 34825, 19316 rials respectively. By transferring part of health and therapeutic services to private sectors and through appropriate management of human resourses including multi occupation and motivation of personnel the cost of service –unit can be decreased.