[Formulating and assessing evaluation indictors of administrative reform: a case study]

Introduction: The administrative reform is one of the means to achieve economic social and cultural policy development. Given the necessity of administrative reform monitoring, this study aimed to identify and measure the indicators of administrative reform in the medical school of Tehran University of Medical Sciences

Methods: A mixed sequential qualitative-quantitative approach was employed. The indicators of evaluation were identified through document analysis. In the first phase, 8 semi-structured interviews and the views of 5 experts were collected. Then, we used a researcher- developed checklist to evaluate the current status of the selected school. The checklist was completed through on-site visiting, observation, interview and document review which were then analyzed manually

Results: A set of 150 indicators of administrative reform evaluation, categorized in 10 domains and 36 areas was identified. The total score of evaluation was 28%. The employment equity and payment system domain showed the highest score [55%] and the organizing of human resources domain lowest score

Conclusion: Given the relatively poor results of the administrative reform and the continuity of the reform in Iran development plans, we recommend accelerating the efforts of defining and implementing the administrative reform. Our developed checklist can be used by policy makers and managers

Relationship between post-kidney transplantation antithymocyte globulin therapy and wound healing complications

Wound healing disorders are probably the most common post-transplantation surgical complications. It is thought that wound healing disturbance occurs due to antiproliferative effects of immunosuppressive drugs. On the other hand, success of transplantation is dependent on immunosuppressive therapies. Antihuman thymocyte globulin [ATG] has been widely used as induction therapy but the impact of this treatment on wound healing is not fully understood. To investigate wound healing complications after ATG therapy in renal transplant recipients. The medical records of 333 kidney transplant recipients were assessed for wound healing disorders. Among these patients, 92 received ATG and 5 doses of 1.5 mg/kg ATG along with the standard protocol of drugs. The mean age of patients was 38.9 years. Of 333 recipients, 92 [23.7%] received ATG; 21 [6.3%] developed wound healing complications. There was a significant relationship between ATG therapy and wound complications [p=0.034]. Also, women were more likely to develop wound healing disorders than men [p=0.002]. No statistical difference was observed between age and wound healing complication [p=0.28]. There was no significant difference between the mean duration of hospitalization between ATG and Non-ATG group [p=0.9]. ATG increases the risk of overall wound complications. It is needed to pay more attention to the patients treated with this immunosuppressant to avoid the risk of re-interventions, lessen the duration of hospitalization and decrease the impairment of graft function

[Results of penetrating keratoplasty in macular corneal dystrophy]

Purpose: to evaluate the outcomes of penetrating keratoplasty [PIS] in macular corneal dystrophy [MCD] at Labbafinejad Medical Center, Tehran-Iran [1986-2002]

Methods: in a descriptive study, records of patients with MCD who had undergone PK were reviewed. All cases were recalled for a complete ocular examination. Patients who participated in the recall examination with at least 6 months follow up were enrolled in the study

Results: sixty-two eyes of 39 patients were included. The age of patients at first examination [before keratoplasty] was 30 +/- 12 [12-58] and at the time of keratoplasty was 34 +/- 10.3 [13-58] years. Duration of follow up after PK was 52 +/- 47.3[6-190] months. Best corrected vision before surgery in LogMAR notation was 1.4 +/- 0.4 [4/100]. After PK, uncorrected visual acuity improved to 0.6 +/- 0.44 LogMAR [20/28] [P<0.0001] and best spectacle corrected visual acuity [BSCVA] at the end of follow up was 0.2 +/- 0.32 LogMAR [20/32]. Spherical equivalent refractive error after surgery was -2.28 +/- 3.24 diopters and refractive astigmatism was 3.32 +/- 2.05 diopters. Suturing technique had no effect on final astigmatism after PK [P=0.9]. BSCVA in 36 eyes who were operated before 35 years of age was 0.16 +/- 0.37 LogMAR and in 26 eyes operated at or after age 35 was 0.26 +/- 0.25 [P=0.005]. Immunologic graft rejection occurred in 12 eyes [1 9.4%] during the follow up period. The first rejection occurred at 6.1 +/- 3.5 [2-14] months after PK. Graft opacification and failure occurred only in one eye following ocular trauma and wound dehiscence. The rest of the grafts [98.4%] were clear at the end of follow up

Conclusion: PK in patients with MCD improves vision significantly with excellent graft survival rates. In this study, patients who underwent PK before 35 years of age had better final visual acuity