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Background: Hospitals need performance evaluation systems for development and competition in order to evaluate the effectiveness and efficiency of their plans, processes and human resources. The objective of this research is to design an evaluation system at hospitals through the use of the Balanced Scorecard. Methods and Materials: In this comparative study, the selected countries consisted of Australia, USA, Canada and New Zealand, and 34 public hospitals of Iran which were applying strategic planning. Performance evaluations were examined in terms of 6 aspects including mission, vision, strategies, perspectives, objectives and measures .A pattern was designed for performance evaluation of public hospitals in Iran and was validated using experts’ survey of DELFI method. Results: All countries had mission and vision as important aspects of their performance evaluation model while health effectiveness promotion was the most important strategy. High quality health services, resource development, innovation and guaranty in continuous services were other strategies. Perspectives of Balanced Scorecard included customer, internal processes, learning and development of staff and financial affairs. All of the countries had objectives and measures for each of the perspectives. Iranian hospitals had mission, vision, strategies and objectives but for them perspectives had not been defined and measures were not congruent with strategies and objectives. In the model, 4 perspectives were determined to describe hospital strategies and to use competition benefits as well. Conclusion: Applying measures of 4 perspectives including "Patients and Community", "Internal process and Productivity", "Growth and innovation" and "financial aspects" to doevaluation of Iranian public hospitals collates their performance, improves productivity of their resources and enhances patients and community satisfaction.

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Background: Factor XIII deficiency is an extremely rare, autosomal recessive coagulation disorder with estimated prevalence of 1/2000000 worldwide. This disorder represents with different clinical manifestations including, umbilical cord bleeding, recurrent abortion and CNS bleeding. CNS bleeding is a common but life threating complication of disease. The aim of this study was to evaluate the effect of a common polymorphism of thrombin activatable fibrinolysis inhibitor (TAFI) occurrence of CNS bleeding in patients with severe factor XIII deficiency.

Materials and Methods: This case control study was performed on 34 patients with factor XIII deficiency and history of CNS bleeding and 36 patients with factor XIII deficiency but without CNS bleeding as control group. Initially all patients were molecularly analyzed for factor XIII deficiency, then both groups were assessed for common TAFI Thr325Ile polymorphism. Finally obtained data was analyzed by SPSS software.

Results: Molecular analysis of TAFI Thr325Ile polymorphism revealed that almost all patients with CNS bleeding (89%) had this mutation that in 67% of patients was homozygote. There is a significant relationship between Thr325Ile polymorphism in homozygote manner with incidence of CNS bleeding in factor XIII deficient (OR 18.9, 95% CI 3.8 to 95.1).

Conclusion: It seems that Thr325Ile polymorphism is a suitable prognostic factor in patients with severe factor XIII deficiency and this probably polymorphism increases risk of CNS bleeding about 20 fold.