Health consequences of the Urmia Lake crisis: the baseline study protocol.

INTRODUCTION: Climate change may affect human health due to various mechanisms including overexposure to environmental pollution or dispersed particles. Lake Urmia (LU) drying in recent years has turned into a crisis with particle distribution as its main manifest. It is told that this crisis may affect the health of neighbouring residents. In this paper, we elaborate on a research protocol developed to assess the potential health consequences of LU drying (LUD) by investigating the distribution of physical and mental health conditions/disorders among residents of LU's surrounding provinces with different exposure levels to LUD outcomes. METHODS AND ANALYSIS: The target population of this study is the residents of the LU basin from East Azerbaijan and West Azerbaijan provinces of Iran. A total of 803 households and 2783 people are studied in 86 clusters. Cluster sampling is applied. The weighting of the samples is based on a satellite map of the density of suspended particles such that people living in areas with higher risk have a higher chance of selection. Various types of measurements are done in three major groups including self-reported health, clinical interview/examination and paraclinical assays. ETHICS AND DISSEMINATION: In this project, all procedures are in accordance with the ethical standards of the Ethics Committee of Tabriz University of Medical Sciences. Moreover, an informed consent letter is obtained from all participants included in the study. The results from this study will be disseminated in international journals and implemented in the primary care guidelines and national policy documents on managing the potential health consequences of LUD.

PERSIAN traffic safety and health cohort: a population-based precrash cohort study.

PURPOSE: Despite to high burden of road traffic injuries (RTIs), the RTI epidemiology has received less attention with rare investments on robust population cohorts. The PERSIAN Traffic Safety and Health Cohort (PTSHC) was designed to assess the potential causal relationships between human factors and RTI mortality, injuries, severity of the injury, hospitalised injury, violation of traffic law as well as offer the strongest scientific evidence. PARTICIPANTS: The precrash cohort study is carried out in four cities of Tabriz, Jolfa, Shabestar and Osku in East Azerbaijan province located in northwest Iran. The participants were people who sampled among the general population. The cluster sampling method was used to enrol the households in this study. The PTSHC encompasses a wide and comprehensive range and types of data. These include not only the common cohort data collections such as medical examination measures, previous medical history, bio assays and behavioural assessments but also includes data obtained using advanced novel technologies, for example, electronic travel monitoring, driving simulation and neuro-psycho-physiologic laboratory assessments specifically developed for traffic health field. FINDINGS TO DATE: A total of 7200 participants aged 14 years and above were enrolled at baseline, nearly half of them being men. The mean age of participants was 39.2 (SD=19.9) years. The majority of participants (55.4%) belonged to the age group of 30-56 years. Currently, approximately 1 200 000 person-measurements have been collected. FUTURE PLANS: PSTHC will be used to determine the human-related risk factors by adjusting for the vehicle and land-use-related factors. Therefore, a lot of crashes can be prevented using effective interventions. Although this cohort provides valuable data, it is planned to increase its size to achieve the highest level of evidence with higher generalisability. Also, according to the national agreement this cohort is going to be extended to several geographical regions in second decade.

Adaptation of a European categorization system for driving-impairing medicines in Iran.

OBJECTIVE: Road traffic crashes due to impaired driving are a leading cause of preventable injuries and deaths. The purpose of this study was adaptation of a European categorization system for driving-impairing medicines in Iran. METHODS: DRUID categorization system was used as a leading model to classify medicines. Medicines that were compatible with DRUID categorization system were identified and classified accordingly. Medicines that were not compatible with DRUID categorization system were assessed in an expert panel in terms of possiblity of classification. Instructions for health care providers and advice for patients were prepared based on the medicine's influence on fitness to drive. RESULTS: Of the 1255 medicines in Iranian pharmacopeia, 488 medicines were classified in four categories. Among classified medicines 43.85% and 25.41% belonged to Category 0 and Category 1. About 13.94%, 10.04%, and 6.76% pertained to Category 2, Category 3, and Multiple categories respectively. Majority of the medicines with moderate and severe adverse influences on driving fitness belonged to the nervous system medicines (72.65%). Most of the medicines with non-existing or minor adverse influences on driving fitness pertained to cardiovascular medicines (16.56%). Majority of uncategorized medicines belonged to Iranian herbal medicines. CONCLUSION: The current study disclosed that DRUID categorization system was implementable for most of the commonly prescribed medicines. Experimental studies are needed to determine the influence of uncategorized medicines of Iranian pharmacopeia. Other countries with similar settings can adapt DRUID categorization system until they develop their own model using original studies.

Categorization and labeling systems concerning driving-impairing medicines: A scoping review.

OBJECTIVE: Classification systems concerning driving-impairing medicines can help healthcare providers identify medicinal drugs with no or the least impairing effects and inform patients of the potential risks of certain medicines to safe driving. This study aimed to comprehensively assess the characteristics of classifications and labeling systems regarding driving-impairing medicines. METHODS: Google Scholar and several databases, including PubMed, Scopus, Web of Science, EMBASE, safetylit.org, and TRID were searched to identify the relevant published material. The retrieved material was assessed for eligibility. Data extraction was done to compare the categorization/labeling systems concerning driving-impairing medicines in terms of characteristics such as the number of categories, description of each category, and description of pictograms. RESULTS: After screening 5,852 records, 20 studies were selected for inclusion in the review. This review identified 22 categorization/labeling systems regarding medicines and driving. Classification systems had different characteristics, but most of them were designed based on the graded categorization system described by Wolschrijn. Initially, categorization systems had seven levels, but later the medicine impacts were summarized into 3 or 4 levels. CONCLUSIONS: Although different categorization/labeling systems regarding driving-impairing medicines are available, the most effective systems in changing driver's behavior are the simple and understandable ones. Besides, health care providers should consider patient's socio-demographic features when informing them about driving under the influence.

Psychometric Properties of EQ-5D-3L Applied through Phone Follow-Ups: An Experience in PERSIAN Traffic Cohort.

Objective: To assess psychometric properties of the European Quality of Life 5-Dimension 3-Level Version (EQ-5D-3L) commonly used tool for measuring road traffic injury (RTI) patients' quality of life. Methods: The psychometric study assessed the reliability and applicability of EQ-5D-3L through phone surveys, based on a national cohort platform. Data of 150 RTI patients recruited from the cohort study were included as 50 patients per each follow-up phase (one, six, and twelve months after discharge). A 12- day-time span was between test and retest. We measured psychometric properties (internal consistency reliability and stability reliability) and agreement using Kappa coefficients and percentages of agreement and Bland-Altman method. Data were analysed using software STATA statistical package. Results: The majority of patients were men (80%) with mean age (SD) of 41(14.7%), employed (78%) and educated (86%). The Persian version represented high internal consistency reliability at total level (Cronbach's α=0.81) and moderate to good reliability at phase levels (0.62-0.87). The stability reliability was excellent at total (ICC=0.98, 95% CI: 0.97, 0.98) and phase levels (0.97-0.98. The kappa agreement coefficients were valued moderate to perfect (0.6-0.8, p>0.0001). The Bland-altman plot illustrated high agreement between test and retest scores. No floor and ceiling effects were found. Conclusion: The study revealed that EQ-5D-3L was highly reliable and responsive to be applied through phone interviews at three different times post injury and discharge, as no previous study considered its psychometric properties at various phone follow-ups after RTIs.

PERSIAN Traffic Safety and Health Cohort: a study protocol on postcrash mental and physical health consequences.

BACKGROUND: Cohort studies play essential roles in assessing causality, appropriate interventions. The study, Post-crash Prospective Epidemiological Research Studies in IrAN Traffic Safety and Health Cohort, aims to investigate the common health consequences of road traffic injuries (RTIs) postcrash through multiple follow-ups. METHODS: This protocol study was designed to analyse human, vehicle and environmental factors as exposures relating to postcrash outcomes (injury, disability, death, property damage, quality of life, etc). Population sources include registered injured people and followed up healthy people in precrash cohort experienced RTIs. It includes four first-year follow-ups, 1 month (phone-based), 3 months (in-person, video/phone call), 6 and 12 months (phone-based) after crash. Then, 24-month and 36-month follow-ups will be conducted triennially. Various questionnaires such as Post-traumatic Stress Disorder Questionnaire, Patient Health Questionnaire, WHO Disability Assessment Schedules, Cost-related Information, etc are completed. Counselling with a psychiatrist and a medical visit by a practitioner are provided accompanied by extra tools (simulator-based driving assessment, and psychophysiological tests). Through preliminary recruitment plan, 5807, 2905, 2247 and 1051 subjects have been enrolled, respectively at the baseline, first, second and third follow-ups by now. At baseline, cars and motorcycles accounted for over 30% and 25% of RTIs. At first follow-up, 27% of participants were pedestrians engaged mostly in car crashes. Around a fourth of injuries were single injuries. Car occupants were injured in 40% of collisions. DISCUSSION: The study provides an opportunity to investigate physical-psychosocial outcomes of RTIs, predictors and patterns at follow-up phases postinjury through longitudinal assessments, to provide advocates for evidence-based safety national policy-making.

Developing a prioritisation framework for patients in need of coronary artery angiography.

BACKGROUND: Effective waiting list management and comprehensive prioritisation can provide timely delivery of appropriate services to ensure that the patient needs are met and increase equity in the provision of health services. We developed a prioritisation framework for patients in need of coronary artery angiography (CAA). METHODS: We used a multi-methods approach to elicit effective factors that affect CAA patient prioritisation. Qualitative data wase collected using semi-structured interviews with 15 experts. The final set of factors was selected using experts' consensus through modifed Delphi technique. The framework was finalised during expert panel meetings. RESULTS: 212 effective factors were identified based on the literature review, interviews, and expert panel discussion of them, 37 factors were selected for modifed Delphi study. Following two rounds of Delphi discussions, seven final factors were selected and weighed by ten experts using pair-wise comparisons. The following weights were given: the severity of pain and symptoms (0.22), stress testing (0.18), background diseases (0.15), number of myocardial infarctions (0.15), waiting time (0.10), reduction of economic and social performance (0.12), and special conditions (0.08). CONCLUSION: Clinical effective factors were important for CAA prioritisation framework. Using this framework can potentially lead to improved accountability and justice in the health system.

The protocol for validating phone interview tools on post-discharge consequences of road traffic injuries.

BACKGROUND: Road Traffic Injuries (RTIs) impose a worldwide burden on public health and economy. RTIs result in a wide range of immediate and long-term consequences. However, little is known about post-discharge consequences of RTIs at national levels. In addition, reliable and producing valid data mostly through prospective studies is fundamentally required to address the issue. The aim of this paper was to describe the research protocol for development and psychometric evaluation of post-discharge consequences of road traffic injuries as part of the Persian Traffic Cohort (PTC) and complementary to the Iranian Integrated Road Traffic Injury Registry (IRTIR). METHODS: Literature review and expert's opinion were used to develop data collection tools. Registry timeframe was designed based on experts' opinion. Reliability of tools will be assessed using intra- and inter-rater reliability. The pilot phase of the Phone interviews on Post-discharge Consequences of Road Traffic Injuries (PCRTI) will be conducted in Tabriz in 2019. RESULTS: The PCRTI is designed to be applied at three different time points: one, six and twelve months after the crash. The PCRTI tools' main domains are: demographic, psychological, medical, social and financial which will be assessed through PC-PTSD, PHQ2, WHODAS, SES-Iran, EQ-5D-3L and Economic assessment standardized tools. The descriptive outcomes will be reported to the Ministry of Health and Medical Education of Iran. CONCLUSIONS: The protocol satisfies the requirements of developing valid data collection tools for PCRTI.

Governance of Iranian Primary Health Care System: Perceptions of Experts.

BACKGROUND: Despite huge advances in improving most health indicators, Iranian primary health care (PHC) has faced several problems in improving the quality of care inside the health care system. Developed countries with similar problems have used various models of PHC governance for improving quality in their PHC system. This study aimed to obtain health professionals' perspectives about the suitable pillars and components of Iran's PHC governance model. METHODS: A purposeful sampling method was used to select seven participants who had a minimum of five years of experience in PHC and background education in the field of medical sciences. Between Jan and Jun 2015, three focus group discussions (FGD) were conducted with seven PHC experts in Tabriz. Data were analyzed using the conventional content analysis method. RESULTS: The eight main categories including quality improvement, management and leadership, community involvement and customer participation, effectiveness of PHC, human resource development, safety, health care evaluation and audit, and health information management plus 51 sub-categories were identified according to participants' expects about the essential pillars and components for Iranian PHC governance model. CONCLUSION: Pillars that suggested for designing Iran's PHC governance model are presented according to internal informed expert's opinions and taking into account PHC system real status. By adding the degree of importance for each component and proper performance indicators to this collection, assessing the progress of the PHC system towards excellence will be possible and it will prevent any mental judgments about system performance.

Status of Iran's Primary Health Care System in Terms of Health Systems Control Knobs: A Review Article.

BACKGROUND: After the establishment of Primary Health Care (PHC) program in Iran, health indicators have improved every year. This progress was so rapid that a number of shortcomings and weaknesses of the PHC program remained silent behind its successes. This study aimed to assess the status of Iran's PHC system (strengths, weaknesses, opportunities and threats) in terms of health system's control knobs. METHODS: The search was conducted through two English 'databases of Web of Knowledge and PubMed, two English publications of Science Direct and Springer and two Persian databases of Magiran and SID. Keywords were selected from MeSH and included primary health care, PHC and Iran in both Persian and English. No time limit was considered. RESULTS: Iran's PHC system has numerous successes in dealing with health system's control knobs; which largely part of that related to the health network implementation, the role of Behvarz, improvement of health indicators in rural areas and the elimination of urban-rural inequality, but there are some weaknesses, opportunities and threats in the Iranian PHC system as well. CONCLUSION: By considering socio-economic changes the current structure of PHC system needs to be reformed to coordinate with phenomenon of chronic diseases, accidents and aging. The current information system in PHC does not provide the required information for decision makers and policy makers so it needs to be transformed to the electronic system with unique electronic health file for individuals.

Effect of Telehealth Interventions on Hospitalization Indicators: A Systematic Review.

BACKGROUND: Telehealth has been defined as the remote delivery of healthcare services using information and communication technology. Where resource-limited health systems face challenges caused by the increasing burden of chronic diseases and an aging global population, telehealth has been advocated as a solution for changing and improving the paradigm of healthcare delivery to cope with these issues. The aim of this systematic review is to investigate the effect of telehealth interventions on two indicators: hospitalization rate and length of stay. MATERIALS AND METHODS: The reviewers searched the PubMed, ScienceDirect, and Springer electronic databases from January 2005 to November 2013. A search strategy was developed using a combination of the following search keywords: impact, effect, telehealth, telemedicine, telecare, hospitalization, length of stay, and resource utilization. Both randomized controlled trials and observational studies were included in the review. To be included in the review, articles had to be written in English. The results of study were compiled, reviewed, and analyzed on the basis of the review aims. RESULTS: This systematic review examined 22 existing studies with a total population of 19,086 patients. The effect of telehealth on all-cause hospitalization was statistically significant in 40 percent of the related studies, whereas it was not statistically significant in 60 percent. Similarly, the effect of telehealth on the all-cause length of stay was statistically significant in 36 percent of the studies and nonsignificant in 64 percent. CONCLUSION: Considering the fact that hospitalization rate and length of stay can be confounded by factors other than telehealth intervention, studies examining the effect of the intervention on these indicators must take into account all other factors influencing them. Otherwise any judgment on the effect of telehealth on these indicators cannot be valid.

Validity of the Electronic Triage System in Predicting Patient Outcomes in Tabriz, Iran: A Cross-Sectional Study.

OBJECTIVE: To validate the triage ratings performed by the Electronic Triage System (ETS) using hospitalization, length of stay, resource use, in-hospital mortality and patient bills as outcome measures. METHODS: In this retrospective cross-sectional study the medical records of 387 patients were reviewed in a one-week period. The data included triage category and the outcome measures were hospitalization, length of stay, in-hospital mortality, patient bill, and used resources. The association between the triage category and hospitalization and death was assessed. The association between the triage category and the number of resources, length of stay, and the bill was also assessed. RESULTS: The mean age of the patients was 43.65 ±21.17 years. Women comprised 40% (n=155) of 387 people who were included in the study. The frequency of Emergency Severity Index (ESI) 1, 2, 3, 4 and 5 categories were 18, 61, 127, 181 and 0 respectively. Phi and Cramer's V for hospitalization and death were 0.365 (p<0.001) and 0.305 (p<0.001). Spearman's rho for bill, length of stay, and resource use were -0.483 (p<0.001), -0.228 (p<0.001) and -0.490 (p<0.001). The association between triage category and resource consumption was stronger than other outcomes. CONCLUSION: The ETS was valid in predicting all studied patient outcomes. The ETS has also the advantages of providing quick reports, giving feedback and providing data for research purposes.

Design and Development of a Clinical Risk Management Tool Using Radio Frequency Identification (RFID).

BACKGROUND: Patient safety is one of the most important elements of quality of healthcare. It means preventing any harm to the patients during medical care process. OBJECTIVE: This paper introduces a cost-effective tool in which the Radio Frequency Identification (RFID) technology is used to identify medical errors in hospital. METHODS: The proposed clinical error management system (CEMS) is consisted of a reader device, a transfer/receiver device, a database and managing software. The reader device works using radio waves and is wireless. The reader sends and receives data to/from the database via the transfer/receiver device which is connected to the computer via USB port. The database contains data about patients' medication orders. RESULTS: The CEMS has the ability to identify the clinical errors before they occur and then warns the care-giver with voice and visual messages to prevent the error. This device reduces the errors and thus improves the patient safety. CONCLUSION: A new tool including software and hardware was developed in this study. Application of this tool in clinical settings can help the nurses prevent medical errors. It can also be a useful tool for clinical risk management. Using this device can improve the patient safety to a considerable extent and thus improve the quality of healthcare.

Designing of Intelligent Multilingual Patient Reported Outcome System (IMPROS).

BACKGROUND: By self-reporting outcome procedure the patients themselves record disease symptoms outside medical centers and then report them to medical staff in specific periods of time. One of the self-reporting methods is the application of interactive voice response (IVR), in which some pre-designed questions in the form of voice tracks would be played and then the caller responses the questions by pressing phone's keypad bottoms. AIM: The present research explains the main framework of such system designing according to IVR technology that is for the first time designed and administered in Iran. METHODS: Interactive Voice Response system was composed by two main parts of hardware and software. Hardware section includes one or several digital phone lines, a modem card with voice playing capability and a PC. IVR software on the other hand, acts as an intelligent control center, records call information and controls incoming data. RESULTS: One of the main features of the system is its capability to be administered in common PCs, utilizing simple and cheap modems, high speed to take responses and it's appropriateness to low literate patients. The system is applicable for monitoring chronic diseases, cancer and also in psychological diseases and can be suitable for taking care of elders and Children who require long term cares. Other features include user-friendly, decrease in direct and indirect costs of disease treatment and enjoying from high level of security to access patients' profiles. CONCLUSIONS: Intelligent multilingual patient reported outcome system (IMPROS) by controlling diseases gives the opportunity to patients to have more participation during treatment and it improves mutual interaction between patient and medical staff. Moreover it increases the quality of medical services, Additional to empowering patients and their followers.

Depiction of Trends in Administrative Healthcare Data from Hospital Information System.

BACKGROUND: administrative healthcare data are among main components of hospital information system. Such data can be analyzed and deployed for a variety of purposes. The principal aim of this research was to depict trends of administrative healthcare data from HIS in a general hospital from March 2011 to March 2014. METHODS: data set used for this research was extracted from the SQL database of the hospital information system in Razi general hospital located in Marand. The data were saved as CSV (Comma Separated Values) in order to facilitate data cleaning and analysis. The variables of data set included patient's age, gender, final diagnosis, final diagnosis code based on ICD-10 classification system, date of hospitalization, date of discharge, LOS(Length of Stay), ward, and survival status of the patient. Data were analyzed and visualized after applying appropriate cleansing and preparing techniques. RESULTS: morbidity showed a constant trend over three years. Pregnancy, childbirth and the puerperium were the leading category of final diagnosis (about 32.8 %). The diseases of the circulatory system were the second class accounting for 13 percent of the hospitalization cases. The diseases of the digestive system had the third rank (10%). Patients aged between 14 and 44 constituted a higher proportion of total cases. Diseases of the circulatory system was the most common class of diseases among elderly patients (age≥65). The highest rate of mortality was observed among patients with final diagnosis of the circulatory system diseases followed by those with diseases of the respiratory system, and neoplasms. Mortality rate for the ICU and the CCU patients were 62% and 33% respectively. The longest average of LOS (7.3 days) was observed among patients hospitalized in the ICU while patients in the Obstetrics and Gynecology ward had the shortest average of LOS (2.4 days). Multiple regression analysis revealed that LOS was correlated with variables of surgery, gender, and type of payment, ward, the class of final diagnosis and age. CONCLUSION: this study presents trends in administrative health care data residing in hospital information system of a general public hospital. Patterns in morbidity, mortality and length of stay can inform decision making in health care management. Mining trends in administrative healthcare data can add value to the health care management.

Inter-rater Reliability of Triages Performed by the Electronic Triage System.

OBJECTIVE: To examine the inter-rater reliability of triages performed by the Electronic Triage System (ETS) which has recently developed and used in hospital emergency department (ED). METHODS: This cross-sectional study was conducted prospectively and studied 408 visitors of Tabriz Imam Reza hospital's ED. The variables of interest were age, sex, nurse-assigned triage category, physician-assigned triage category, disease type (trauma, non-trauma), and the referred room within the ED. Cohen's un-weighted kappa, linear weighted kappa, and quadratic weighted kappa were used to describe the reliability. RESULTS: Un-weighted kappa observed to be 0.186 (95% CI: 0.123-0.249). Linear weighted kappa observed as 0.317 (95% CI: 0.251-0.384) and quadratic weighted kappa as 0.462 (95% CI: 0.336-0.589). In general, low agreement was seen between the triage nurses and ED physicians. For trauma patients and for those who were referred to the cardiopulmonary resuscitation room (CPR), all three types of kappa were higher than other visitors of the ED. CONCLUSION: Inter-rater reliability of the triages performed by the ETS observed as ranging from poor to moderate. Implementing interventions that would create a common language between nurses and physicians about the triage of the ED visitors seems necessary. The more agreement on the triage of trauma and CPR patients might be due to their condition and the more attention to them.

The effect of Computerized Physician Order Entry and decision support system on medication errors in the neonatal ward: experiences from an Iranian teaching hospital.

Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three periods to compare the effect of Computerized Physician Order Entry (CPOE) without and with decision support functionalities in reducing non-intercepted medication dosing errors in antibiotics and anticonvulsants. Before intervention (Period 1), error rate was 53%, which did not significantly change after the implementation of CPOE without decision support (Period 2). However, errors were significantly reduced to 34% after that the decision support was added to the CPOE (Period 3; P < 0.001). Dose errors were more often intercepted than frequency errors. Over-dose was the most frequent type of medication errors and curtailed-interval was the least. Transcription errors did not reduce after the CPOE implementation. Physicians ignored alerts when they could not understand why they appeared. A suggestion is to add explanations about these reasons to increase physicians' compliance with the system's recommendations.

Factors influencing the quality of medical documentation when a paper-based medical records system is replaced with an electronic medical records system: an Iranian case study.

OBJECTIVES: Information technology is a rapidly expanding branch of science which has affected other sciences. One example of using information technology in medicine is the Electronic Medical Records system. One medical university in Iran decided to introduce such system in its hospital. This study was designed to identify the factors which influence the quality of medical documentation when paper-based records are replaced with electronic records. METHODS: A set of 300 electronic medical records was randomly selected and evaluated against eleven checklists in terms of documentation of medical information, availability, accuracy and ease of use. To get the opinion of the care-providers on the electronic medical records system, ten physicians and ten nurses were interviewed by using of semi-structured guidelines. The results were also compared with a prior study with 300 paper-based medical records. RESULTS: The quality of documentation of the medical records was improved in areas where nurses were involved, but those parts which needed physicians' involvement were actually worse. High workloads, shortage of bedside hardware and lack of software features were prominent influential factors in the quality of documentation. The results also indicate that the retrieval of information from the electronic medical records is easier and faster, especially in emergency situations. CONCLUSIONS: The electronic medical records system can be a good substitute for the paper-based medical records system. However, according to this study, some factors such as low physician acceptance of the electronic medical record system, lack of administrative mechanisms (for instance supervision, neglecting physicians and/or nurses in the development and implementation phases and also continuous training), availability of hardware as well as lack of specific software features can negatively affect transition from a paper-based system to an electronic system.

What they fill in today, may not be useful tomorrow: lessons learned from studying Medical Records at the Women hospital in Tabriz, Iran.

BACKGROUND: The medical record is used to document patient's medical history, illnesses and treatment procedures. The information inside is useful when all needed information is documented properly. Medical care providers in Iran have complained of low quality of Medical Records. This study was designed to evaluate the quality of the Medical Records at the university hospital in Tabriz, Iran. METHODS: In order to get a background of the quality of documentation, 300 Medical Records were randomly selected among all hospitalized patient during September 23, 2003 and September 22, 2004. Documentation of all records was evaluated using checklists. Then, in order to combine objective data with subjective, 10 physicians and 10 nurses who were involved in documentation of Medical Records were randomly selected and interviewed using two semi structured guidelines. RESULTS: Almost all 300 Medical Records had problems in terms of quality of documentation. There was no record in which all information was documented correctly and compatible with the official format in Medical Records provided by Ministry of Health and Medical Education. Interviewees believed that poor handwriting, missing of sheets and imperfect documentation are major problems of the Paper-based Medical Records, and the main reason was believed to be high workload of both physicians and nurses. CONCLUSION: The Medical Records are expected to be complete and accurate. Our study has unveiled that the Medical Records are not documented properly in the university hospital where the Medical Records are also used for educational purposes. Such incomplete Medical Records are not reliable resources for medical care too. Some influencing factors external to the structure of the Medical Records (i.e. human factors and work conditions) are involved.