Design and validation of a conceptual model regarding impact of open science on healthcare research processes.

INTRODUCTION: The development and use of digital tools in various stages of research highlight the importance of novel open science methods for an integrated and accessible research system. The objective of this study was to design and validate a conceptual model of open science on healthcare research processes. METHODS: This research was conducted in three phases using a mixed-methods approach. The first phase employed a qualitative method, namely purposive sampling and semi-structured interview guides to collect data from healthcare researchers and managers. Influential factors of open science on research processes were extracted for refining the components and developing the proposed model; the second phase utilized a panel of experts and collective agreement through purposive sampling. The final phase involved purposive sampling and Delphi technique to validate the components of the proposed model according to researchers' perspectives. FINDINGS: From the thematic analysis of 20 interview on the study topic, 385 codes, 38 sub-themes, and 14 main themes were extracted for the initial proposed model. These components were reviewed by expert panel members, resulting in 31 sub-themes, 13 main themes, and 4 approved themes. Ultimately, the agreed-upon model was assessed in four layers for validation by the expert panel, and all the components achieved a score of > 75% in two Delphi rounds. The validated model was presented based on the infrastructure and culture layers, as well as supervision, assessment, publication, and sharing. CONCLUSION: To effectively implement these methods in the research process, it is essential to create cultural and infrastructural backgrounds and predefined requirements for preventing potential abuses and privacy concerns in the healthcare system. Applying these principles will lead to greater access to outputs, increasing the credibility of research results and the utilization of collective intelligence in solving healthcare system issues.

Identifying and validating the components for the development of an information system for health grey literature in Iran: A mixed method approach.

BACKGROUND: Considering the importance and necessity of establishing a nationwide information system for health grey literature in Iran, this study aimed to identify the main dimensions and components needed for developing a health grey literature information system in Iran and validate them according to experts' opinions. MATERIALS AND METHODS: A mixed-method approach with an exploratory sequential design was used in this study. The research was done in following main steps: (1) conducting a systematic literature review to identify the potential components of the health grey literature information system suggested in the literature, (2) Interviewing 19 experts to explore further components required for designing the health grey literature system for Iran and doing a thematic analysis for analyzing the interviews, and (3) validating the identified components by a Delphi panel in two rounds for finalizing the initially-approved dimensions and components. Descriptive statistical analysis was also used for analyzing the Delphi panel's data. RESULTS: Eight dimensions were identified as necessary for developing Iran's health grey literature information system (including 31 components and 111 elements). The main dimensions included goals, data sources, minimum data set, data collection techniques, data content management procedures, quality control approaches, stakeholders, and management and policy-making. CONCLUSION: Using the identified and validated functional components in this study can be helpful In designing a health grey literature system that is of value for health policymakers and medical researchers as well as health information users.

Research impact in randomized controlled trials of diabetes: an altmetric approach.

Purpose: This study aimed to assess the impact of research in randomized controlled trials (RCTs) of diabetes and explore the various subject areas related to diabetes that receive attention on social media platforms. Altmetric measures were utilized to collect and extract relevant data, providing valuable insights into the social reach and influence of clinical research beyond traditional citation-based metrics. Methods: The research focused on RCTs of diabetes involving at least one Iranian author, indexed in Scopus. Altmetric.com was employed to extract altmetric data, and the collected articles were categorized into 14 subject areas for individual analysis using STATA. Results: The analysis revealed that a majority of the diabetes studies examined nutrition, complications, treatment, genetics, basic mechanisms, and comorbidities of the disease. Conversely, subject areas such as diagnosis, education, gestational diabetes, psychology, physical activity, prevention, dentistry, and economics had fewer studies associated with them. Among social media platforms, Twitter, Facebook, Google+, and Reddit emerged as the most frequently mentioned platforms. Furthermore, Mendeley readership was identified as the preferred platform for engagement across several subject areas. Conclusions: The substantial number of social media mentions indicates a significant level of public interest and concern regarding diabetes. Social media platforms serve as effective tools for disseminating research findings from clinical trials. Altmetric data proves valuable to researchers and funding agencies seeking to comprehend the impact of their work, enabling them to allocate resources more effectively.

A Scoping Review of Adopted Information Extraction Methods for RCTs.

Background: Randomized controlled trials (RCTs) provide the strongest evidence for therapeutic interventions and their effects on groups of subjects. However, the large amount of unstructured information in these trials makes it challenging and time-consuming to make decisions and identify important concepts and valid evidence. This study aims to explore methods for automating or semi-automating information extraction from reports of RCT studies. Methods: We conducted a systematic search of PubMed, ACM Digital Library, and Web of Science to identify relevant articles published between January 1, 2010, and 2022. We focused on published Natural Language Processing (NLP), machine learning, and deep learning methods that automate or semi-automate key elements of information extraction in the context of RCTs. Results: A total of 26 publications were included, which discussed the automatic extraction of key characteristics of RCTs using various PICO frameworks (PIBOSO and PECODR). Among these publications, 14 (53.8%) extracted key characteristics based on PICO, PIBOSO, and PECODR, while 12 (46.1%) discussed information extraction methods in RCT studies. Common approaches mentioned included word/phrase matching, machine learning algorithms such as binary classification using the Naïve Bayes algorithm and powerful BERT network for feature extraction, support vector machine for data classification, conditional random field, non-machine-dependent automation, and machine learning or deep learning approaches. Conclusion: The lack of publicly available software and limited access to existing software makes it difficult to determine the most powerful information extraction system. However, deep learning models like Transformers and BERT language models have shown better performance in natural language processing.

Cost-Effectiveness of Health Literacy Enhancement Intervention on Patients with Type II Diabetes.

Background: Type II diabetes is considered a chronic disease that influences the affected person's quality of life and imposes a high economic burden on the patient and society. The enhancement of health literacy seems essential for self-management and disease control in patients with type II diabetes. Consequently, this study was performed to evaluate the cost-effectiveness of enhanced health literacy in type II diabetes patients. Methods: This study was of quantitative and economic evaluation type. A population of 232 patients was selected among those referred to the Tafihan Shiraz clinic based on the quality of entry and exit. The health literacy educational intervention was carried out for three months. In order to collect information, researchers used the SF36 questionnaire and the checklist of costs. The Cost Effectiveness Ratio (CER) and Incremental Cost Effectiveness Ratio (ICER) were calculated. Moreover, the costs of each unit of increasing the quality of life before and after the intervention were calculated. A decision was made to determine the cost-effectiveness of the intervention. Results: According to the results, 40% of the participants were females, and 34.5% were 30-40 years old. Examination of the quality of life in patients before the intervention indicated that the mean and standard deviation of the patients' quality of life before the intervention was 18.43±44.99, and the mean and standard deviation of the quality of life after the intervention was 49.57±16.21. Moreover, the patients' quality of life increased after the educational intervention. The total direct medical costs were $717,484 and $685,620 before and after the intervention, respectively. The total indirect medical costs were $604,122 and $493,011 before and after the intervention, respectively. Moreover, the total indirect costs were $122,535 and $122,119 before and after the intervention, respectively. The study was cost-effective with CER=0.9 and ICER= - 140,000 per increase in the quality of life. Conclusion: Improving health literacy can have a range of benefits and improve the quality of life of patients with type II diabetes and reduce their treatment costs, and thereby, this may be seen as an effective step toward the recovery of patients with type II diabetes.

Citation Analysis and Mapping of Iranian's Stem Cell Research Output.

Background: This study aims to map the research trends in the field of stem cell research in Iran by presenting a systematic and analytical bibliometrics approach based on data from the Web of Science database. Methods: In this study, we provide a visualization overview of the distribution of stem cell publications in Iran. The HistCite software was used to draw and analyze the historiographical maps, based on Global Citation Score (GSC) and Local Citation Score (LCS) in order to indicate the most frequent thematic trends. The accuracy of clustering and classification of scientific fields is enhanced by the incorporation of algorithms and main bibliometric analysis. Results: A total of 5123 records were collected from the Web of Science database in 2020. The most prolific author had a GCS of 5890 and the most productive university earned GCS of 13677. "Cell Journal," with 186 records contributed the highest number of publications. The highest cited document based on GSC had a score of 646 and the highest cited article based on LCS had a score of 71. We documented regular growth in outputs. In addition, the scientific maps based on LCS and GCS have been drawn. The prominent, distinguished areas of study revolve around differentiation, generation, proliferation, and the therapeutic use of stem cells as well as "genotoxicity in stem cells", "mesenchymal stem cells" and "embryonic stem cells". Journal articles were the predominant document type. Conclusion: Research on stem cells is a biomedical venture with great scientific impact, and its development in Iran is undeniable. This study provides an overview and a framework for the weaknesses and strengths of Iranian research outputs on stem cells, representing the main clusters in scientific maps. We hope that our results help researchers to plan future studies and promote their research productions.

Iranian researchers' perspective about concept and effect of open science on research publication.

BACKGROUND: Sharing research outputs with open science methods for different stakeholders causes better access to different studies to solve problems in diverse fields, which leads to equal access conditions to research resources, as well as greater scientific productivity. Therefore, the aim of this study was to perceive the concept of openness in research among Iranian health researchers. METHODS: From the beginning of August to the middle of November 2021, twenty semi-structured interviews were held with Iranian health researchers from different fields using purposeful, snowball, and convenience sampling. The interviews continued until data saturation. Data analysis was performed with thematic analysis using MAXQDA 20. Finally, seven main issues related to open science were identified. RESULTS: Through analysis of the interviews, 235 primary codes and 173 main codes were extracted in 22 subclasses. After careful evaluation and integration of subclasses and classes, they were finally classified into nine categories and three main themes. Analysis showed that openness in research was related to three main themes: researchers' understanding of open science, the impact of open science on publication and sharing of research, concerns and reluctance to open research. CONCLUSION: The conditions of access to research output should be specified given the diversity of studies conducted in the field of health; issues like privacy as an important topic of access to data and information in the health system should also be specified. Our analysis indicated that the conditions of publication and sharing of research processes should be stated according to different scopes of health fields. The concept of open science was related to access to findings and other research items regardless of cost, political, social, or racial barriers, which could create collective wisdom in the development of knowledge. The process of publication and sharing of research related to open access applies to all types of outputs, conditions of access, increasing trust in research, creation of diverse publication paths, and broader participation of citizens in research. Open science practices should be promoted to increase the circulation and exploitation rates of knowledge while adjusting and respecting the limits of privacy, intellectual property and national security rights of countries.

The Effective Trends and Driving Forces in The Future of Research Performance Evaluation: A Qualitative Study.

Background: Performance is a multidimensional concept and is evaluated by different criteria. Definition and evaluation of research performance are always controversial and may be affected by variable conditions. Therefore, this study aimed to determine the effective trends and driving forces in the future of research performance evaluation. Methods: In this qualitative study, the trend analysis through scoping review and interview was done to identify the driving forces affecting the future of research performance evaluation. The scoping review was conducted according to PRISMA-ScR guidelines and searching of the international databases. The interviews were done face-to-face, by telephone, and on social media. MAXQDA version 10 and thematic analysis were used to analyze the interviews and documents. Results: In the scoping review step, a total of 6125 records were found through searching of the international databases and search engines. After removing 869 duplications, the title and abstract of 5256 records were screened. Finally, 42 records (41 English articles and 1 dissertation) were eligible for the study. In the interview step, 248 codes were assigned in nine main categories, 64 subcategories, and 47 dimensions. The trends included social (27 codes), technological (38 codes), economic (30 codes), environmental (5 codes), and political (44 codes) dimensions. Then, acquired information from two steps was synthesized, and the effective social, technological, economic, environmental, and political trends and driving forces were identified. Conclusion: The results showed that various social, technological, economic, environmental, and political factors and indicators must be included and normalized in the national and international research performance evaluation system.

Barriers and facilitators of implementing an information system for health grey literature in Iran: Experts' views and perspectives.

BACKGROUND: Despite the importance of health grey literature, there is not a comprehensive information system for managing these valuable resources in Iran. OBJECTIVES: This study aimed at identifying the barriers to and facilitators of implementing a comprehensive national information system for health grey literature. MATERIAL AND METHOD: This study applied the qualitative research method. Semi-structured interviews were conducted among 19 experts in related fields. A qualitative content analysis was used to analyze the data in MAXQDA. The data were codified and revised constantly and classified in some selected main and sub-categories based on their relative similarities and differences. RESULTS: Data analysis identified some barriers to the implementation of an information system for health grey literature in Iran, including two main categories (and some sub-categories): managerial issues (performance related issues, coordination issues, monitoring and supervision issues and attitudinal issues) and issues on data integration (data collecting issues, data recording issues, quality control issues, and issues on data organization, dissemination and use). CONCLUSION: Designing a national system for health grey literature in Iran needs a powerful authority, removing possible intersectional conflicts, a selection committee, written policies and strict quality control criteria, and protocols for storage, access, retrieval and metadata evaluation.

Patients' perspectives on the quality of online patient education materials: A qualitative study.

BACKGROUND: Access to online patient education information can lead to more effective self-care and disease management. However, the large amount of online information provided through unknown or unreliable sources can challenge patients to trust and use this information. This study was designed to examine the opinions of Iranian gastrointestinal patients about the quality of online information used. MATERIALS AND METHODS: A qualitative study was conducted using thematic analysis. Data were gathered via a semi-structured interview with 29 gastrointestinal patients, and data analysis was performed by qualitative content analysis using open coding with MAXQDA 2018 software. RESULTS: Based on the study, 22 codes were extracted in nine subcategories named as: "Emphasis on the identity of providers," "Nature of online information," "Distrust on online information," "Poor quality of information," "Giving misinformation," "False impact," "Improve communication," "Positive effect on the patient," "Better Diagnosis." CONCLUSIONS: In the current situation, Iranian patients are not confident enough about the quality of available online information. They believe that the use of current poor-quality information has negative consequences. However, they tend to use online patient education materials are produced in Persian by reputable scientific authorities. Using online information can increase patients' knowledge and lead to better communication with medical staff and other similar patients. They can use this information for self-care with more confidence, and such an approach can also have significant benefits for the national health system.

No study is ever flawless: A scoping review of common errors in biomedical manuscripts.

We conducted this scoping review of common errors identified by editors and reviewers of biomedical manuscripts. Errors includes items that a reviewer or editor might identify as needing correction. The errors were categorized by section of the manuscript: Introduction, Methods, Results, Discussion, and References. After screening 87 published studies, 16 papers were selected for data extraction. Of these 16 studies, the most frequently represented disciplines were Medicine (n = 5), Radiology (n = 2), and Psychiatry (n = 2). The most reported common errors included inappropriate study design, inadequate sample size, poor statistical analysis, and unclear and inadequate description of methods. Abstracts not reflecting the content of the paper were the most frequent general common error in biomedical manuscripts. The findings of this study offer one perspective on common errors in biomedical manuscripts and might be a useful guide for novice authors.

Personalization of health information prescription in diabetes clinical setting: A qualitative study.

BACKGROUND: The prevalence of diabetes makes considerable costs for health-care organizations. The increase of patient's self-care abilities by use of personalizing health information prescription can reduce these costs. This study was conducted to explore the benefits and challenges related to personalizing health information prescription in diabetes clinical settings. MATERIALS AND METHODS: The samples included diabetes education officials working in specialized diabetes clinics and Diabetes Research Centre managers of Iran and Tehran Universities of Medical Sciences. They were 21 cases and selected through purposeful sampling method. Semi-structured interview and focus discussion groups were used to collect the viewpoints of specialists. Interview guide, based on literature review and the documents of diabetes, was used in interviews and focus groups. Their validity was affirmed by specialists. The interview texts were coded in MAXQDA10 software and analyzed through content analysis method. RESULTS: The most important benefits of personalizing health information prescription were classified into five themes as follows: medical services improvement, facilitation of consumers to information resources, improvement in patients' knowledge and awareness, increase in self-care ability and disease management, reinforcing the relation between physician and patient and keeping physician in the information prescription cycle. The challenges of personalizing of health information prescription were revealed as follows: Recognition of patients' personal characteristics at the turn of entering the system, systems' functional modifiers especially bilateral interaction and relation to patient's health file, content recognition, and creating suitable protocol. CONCLUSION: This study showed that diabetes clinical settings face different organizational and process challenges for establishing the personalization of health information prescription. The most important challenges which should be considered in designing information prescription in diabetes clinical environments are as follows: reinforcing physicians' recognition of information prescription benefits, lack of integrative electronic health information system, and patient primary assessment in the first stage of entering the patient into the system in respect of clinical and personal aspects in information needs of consumer.

Opportunities and challenges of social media for health knowledge management: A narrative review.

INTRODUCTION: Social media is becoming a new tool for developing health knowledge management. However, despite the rapid growth of research in this area, few attempts have been made to review previous research. This study tried to summarize the opportunities and challenges of using social media to managing health knowledge. METHODOLOGY: This article used a narrative approach to collect and review studies. In this review, published documents during 2010-2019 were retrieved by search in the following three electronic scientific databases: Web of Knowledge, PubMed, and Google Scholar search engine using keywords including social media, public health, health knowledge, knowledge management, and health promotion. RESULTS: Social media by overcoming geographical barriers, developing health promotion, facilitating decision-making, and providing public health education has been able to enhancing health awareness and improving health behavior. Doctors' unwillingness to interact with the public, lack of compliance with the principles of medical ethics, users' privacy concerns, and difficulty of managing negative comments are the four challenges to health knowledge management in social media. CONCLUSION: Social media can be a suitable tool for developing health knowledge management processes if medical professional ethics and users' privacy managed properly.

Contribution of Iranian scholars to medical sciences: A holistic overview of 140-years publication.

Background: This study investigated the trends in the scientific output of Iran published in PubMed indexed journals. To the best of our knowledge, there was no previous study to examine the Iranian scientific output in all fields of health and biomedical sciences. Methods: Using a bibliometric approach, we tracked 140 years (between 1877 and 2016) of Iranian scientific productions in PubMed. The journals which papers widely published over them were analyzed. The metadata of journals was extracted from Web of Science (WoS), Scopus, and Scimago Journal & Country Rank. The Gross Domestic Product (GDP) data was elaborated from the World Bank to evaluate the relationship with research output. We used Pearson's correlation coefficient at p<0.01 significance level and reported the data in a scatterplot. Results: We identified 106 226 documents produced by Iranian authors in journals indexed in PubMed since 1877. The number of papers climbed dramatically in 2000 and afterward, and this was consistent with the country's GDP. Although the scientific contribution of Iranian researchers is remarkable, 67% of papers (26 978 out of 106 226) were published in local Journals categorized into quartile 3 and 4 of WoS and Scopus. The study shows that GDP growth has had a positive influence on publication output (r=0.738, p<0.001). Conclusion: This is the first study with a panorama view of Iran's contribution to biomedical literature. Based on the results of our survey, although the number of Iranian publications rose over time but they are mostly published in low ranked journals. Health policy-makers advise reconsidering the criteria for measuring research activities. Improving policies will help researchers to publish in higher ranked journals.

Factors Influencing Pregnant Women's Use of Patient Decision Aids and Decision Making on Prenatal Screening: A Qualitative Study.

Objective: We aimed to identify factors influencing pregnant women's use of patient decision aids (PtDA) and decision making on prenatal screening. Materials and methods: This qualitative study was conducted between July 2019 and June 2020 in Tehran, Iran. The sample included 26 pregnant women selected by purposive sampling. The participants used a prenatal screening PtDA, then interviewed about factors that would influence their decision making and use of decision aids. The data were analyzed by conventional content analysis. Results: Three categories were identified for the process of and factors influencing decision making, including the current decision making process, expected decision making process, and factors influencing decision making. Also, five categories were identified as factors affecting the use of PtDAs, including the content of decision aids, the appearance of decision aids, the decision aid platform, the provision of decision aids, and the sub features of decision aids. Conclusion: To design, develop, and implementation of PtDAs for pregnant women, one should identify the factors affecting pregnant women's decision making and the use of decision aids. This study helped to the identification of these factors, which is the first step towards the use of PtDAs by pregnant women and their participation in decision making.

A systematized review on diabetes gamification.

Background: Gamification is an effective tool used to enhance the quality of education and training, to create motivation and enthusiasm, and to maintain competitiveness in the targeted population. Given that, the present study is an attempt to review gamification used in the field of diabetes systematically and its effects on the target group. Methods: Articles were retrieved from eight databases via an electronic advanced search. The data were imported to Endnote; and to assess the quality of the articles, PRISMA and CASP were used. Finally, according to the inclusion criteria, the appropriate articles were selected. Results: This study indicates that physical activity and nutrition were the most frequent diabetic subgroups in diabetes gamification. In addition, all diabetes gamification programs were designed to educate, teach skills and make behavior improvement in diabetics. Conclusion: Diabetes gamification have the capacity to change health behaviors among all age groups and can create an innovative, attractive and interactive learning environment accompanied by fun and engagement. Professor, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran; Librarianship and Medical Information Science, Iran University of Medical Sciences, Tehran, Iran.

The Top 100 Articles in the Medical Informatics: a Bibliometric Analysis.

The number of citations that a research paper receives can be used as a measure of its scientific impact. The objective of this study was to identify and to examine the characteristics of top 100 cited articles in the field of Medical Informatics based on data acquired from the Thomson Reuters' Web of Science (WOS) in October, 2016. The data was collected using two procedures: first we included articles published in the 24 journals listed in the "Medical Informatics" category; second, we retrieved articles using the key words: "informatics", "medical informatics", "biomedical informatics", "clinical informatics" and "health informatics". After removing duplicate records, articles were ranked by the number of citations they received. When the 100 top cited articles had been identified, we collected the following information for each record: all WOS database citations, year of publication, journal, author names, authors' affiliation, country of origin and topics indexed for each record. Citations for the top 100 articles ranged from 346 to 7875, and citations per year ranged from 11.12 to 525. The majority of articles were published in the 2000s (n=43) and 1990s (n=38). Articles were published across 10 journals, most commonly Statistics in medicine (n=71) and Medical decision making (n=28). The articles had an average of 2.47 authors. Statistics and biostatistics modeling was the most common topic (n=71), followed by artificial intelligence (n=12), and medical errors (n=3), other topics included data mining, diagnosis, bioinformatics, information retrieval, and medical imaging. Our bibliometric analysis illustrated a historical perspective on the progress of scientific research on Medical Informatics. Moreover, the findings of the current study provide an insight on the frequency of citations for top cited articles published in Medical Informatics as well as quality of the works, journals, and the trends steering Medical Informatics.

Factors affecting smartphone adoption for accessing information in medical settings.

OBJECTIVES: This study aimed to acquire knowledge about the factors affecting smartphone adoption for accessing information in medical settings in Iranian Hospitals. METHODS: A qualitative and quantitative approach was used to conduct this study. Semi-structured interviews were conducted with 21 medical residents and interns in 2013 to identify determinant factors for smartphone adoption. Afterwards, nine relationships were hypothesised. We developed a questionnaire to test these hypotheses and to evaluate the importance of each factor. Structural equation modelling was used to analyse the causal relations between model parameters and to accurately identify determinant factors. RESULTS: Eight factors were identified in the qualitative phase of the study, including perceived usefulness, perceived ease of use, training, internal environment, personal experience, social impacts, observability and job related characteristics. Among the studied factors, perceived usefulness, personal experience and job related characteristics were significantly associated with attitude to use a smartphone which accounted for 64% of the variance in attitude. Perceived usefulness had the strongest impact on attitude to use a smartphone. CONCLUSION: The factors that emerged from interviews were consistent with the Technology Acceptance Model (TAM) and some previous studies. TAM is a reliable model for understanding the factors of smartphone acceptance in medical settings.

Ranking Iranian biomedical research centers according to H-variants (G, M, A, R) in Scopus and Web of Science.

BACKGROUND: We conducted a comprehensive bibliometrics analysis to calculate the H, G, M, A and R indicators for all Iranian biomedical research centers (IBRCs) from the output of ISI Web of Science (WoS) and Scopus between 1991 and 2010. We compared the research performance of the research centers according to these indicators. METHODS: This was a cross-sectional and descriptive-analytical study, conducted on 104 Iranian biomedical research centers between August and September 2011. We collected our data through Scopus and WoS. Pearson correlation coefficient between the scientometrics indicators was calculated using SPSS, version 16. RESULTS: The mean values of all indicators were higher in Scopus than in WoS. Drug Applied Research Center of Tabriz University of Medical Sciences had the highest number of publications in both WoS and Scopus databases. This research center along with Royan Institute received the highest number of citations in both Scopus and WoS, respectively. The highest correlation was seen between G and R (.998) in WoS and between G and R (.990) in Scopus. Furthermore, the highest overlap of the 10 top IBRCs was between G and H in WoS (100%) and between G-R (90%) and H-R (90%) in Scopus. CONCLUSION: Research centers affiliated to the top ranked Iranian medical universities obtained a better position with respect to the studied scientometrics indicators. All aforementioned indicators are important for ranking bibliometrics studies as they refer to different attributes of scientific output and citation aspects.

Assessing the Awareness of Agents Involved in Issuance of Death Certificates About Death Registration Rules in Iran.

INTRODUCTION: In the death registration system, issuance of death certificate, as a binding rule, is considered among the major necessities of preparation of death statistics. In order to prepare death statistics that are adequately valid for subsequent applications, it is necessary to properly encode death certificates and fully follow rules on causes underlying death. This study aimed to assess the awareness and performance of agents involved in issuance of death certificate in the national death records system. METHODS: It was a descriptive cross-sectional research, which was performed from September 2013 to March 2014 on 96 agents involved in issuance of death certificate Imam Khomeini, Alavi, Fatemi and BuAli education and treatment centers of Ardebil University of Medical Sciences. The population included faculty staff physicians, residents and health information management staffs. The research scale was also a researcher-made questionnaire that questioned the demographic information as well as awareness and performance of participants regarding death certificate coding rules. Research data was analyzed based on descriptive statistics and the chi-square test method in the SPSS software at a confidence level of 95%. FINDINGS: A total of 34.42% of participants were aware of the general rules on issuance of death certificates while faculty staff higher specialists (41.67%) and clinical coders (38.34%) with five years of experience demonstrated the highest awareness levels. Only 23 participants (24.6%) were trained to issue death certificates. A total of 76 participants (79.3%) announced their need for learning how to complete death certificate forms on a constant basis. The awareness of participants about the general principle was assessed to be low (30.25%). Moreover, their awareness of selection rules and modification rules was low (27.75%) and moderate (45.25%), respectively. The chi-square test revealed a significant relationship between work experience and awareness of participants about coding rules (P=0.001), but no significant relationship was observed between education and awareness of coding rules (P=0.497). CONCLUSION: The awareness of participants about rules on coding death causes and their performance in this field was so satisfactory. That is to say, the awareness of faculty staff and health information management staffs was unexpectedly low. Seemingly, lack of adequate training is an international issue that causes mistakes in the recording of information on mortality. Hence, a short-term solution is to train faculty staff and residents and also revise the training provided to health information management staffs. As a long-term solution it is possible to provide related courses to general practitioner students.