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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: Balance is one of the basic needs for daily activities. It has an important role in static and dynamic activities. The purpose of this study is to evaluate the balance of people with peripheral neuropathy after 4-weeks of functional and balance exercise program.

Materials and methods: In this quasi-experimental study, 22 diabetic patients with diabetic peripheral neuropathy (experimental group, n=11 control group, n=11) with the mean age of 53.79 years, mean height of 163.41cm, and mean weight of 71.49 kg, were randomly selected. Berg and T.G.U.G tests were used to evaluate the balance of patients. 12 sessions of combined training (balance and functional training) were used as intervention program. A paired t-test was used for the differences of pre-post test and independent t-tests were used to compare the experimental and control groups.

Results: The paired sample t-test showed that training program has significant effect on functional and dynamic balance. The comparison between the two groups showed no significant deference between pre-functional balance tests and significant post-functional balance test after training program.

Conclusion: Patients with diabetic neuropathy may have an impaired balance. The most important reason is the damage of proprioceptive receptors as combined training (balance and functional training) may improve balance and blood circulation in this organ also putting extra load on the visual system, vestibular and proprioceptive stimulation system and improves balance. Hence, it can be recommended as exercises to improve balance.

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Background: Multiple sclerosis (MS) is a chronic progressive  disease  of the central nervous system with signs and symptoms such as fatigue and balance that are disable. The purpose of this study was to assess the effect of training which instructions focus of attention on postural sway of multiple sclerosis patients.

Materials and Methods: The present quasi-experimental study used a pretest-posttest design. The subjects with the age of 27-42, expanded disability status scale 1-4 and were purposefully and voluntarily selected and randomly allocated to the experimental and control groups. Training program for groups was carried out in 3 weeks, five sessions per week, and each session lasted about one hour. Berg Balance Scale was used to measure balance. The data was analyzed by using analysis of independent and dependent sample t-test at a significance level of p≤0.05.

Results: The results showed that significant improvements observed in balance (p≤0.05). Also significant differences observed between  post hoc scores in the experimental and control groups (p≥0.05).

Conclusion: According to research findings, the exercise walking program on textured surface resulted in considerable improvements in balance in multiple sclerosis. Also, the respective specialists can use these exercies as a complementary treatment along with the drug therapy for patiens with multiple sclerosis.

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Background: It seems that using shuttle balance which has recently been produced in Iran would be beneficial in exercise prescription for preventing sports injuries and recovery. The purpose of this study is comparing the amount of the electromyography activity of involved muscles in ankle strategy while standing on one leg on shuttle balance versus wobble board.

Materials and Methods: This study is a functional and cause-compare study. 15 female students 20-22 years of age having the enterance standards were selected meaningfully. The amount of EMG activity of selected muscles (Tibialis Anterior, Gastrocnemius, Rectus Femoris and Hamstring) was measured while standing on one leg on two devices. The difference in means of muscles activity in both of devices was estimated using multivariate analysis of variance.

Results: The results showed a significant difference between the amount of EMG activity of involved muscles (p=0.001). Also, the results of the intragroup effects showed that the electromyography activity of Tibialis Anterior, Rectus Femoris and Hamstring while standing on shuttle balance was significantly more than the activity while standing on wobble board (p<0.05). While the amount of activity on shuttle balance was higher as compared to wobble board, but there was no significant difference in Gastrocnemius EMG activity between two devices (p>0.05).

Conclusion: It seems that standing on shuttle balance can make higher electromyography activity in the muscles that are involved on ankle and thigh joints, i.e. Tibialis Anterior, Rectus Femoris and Hamstring. So it is recommended that shuttle balance can be used in balance training program.

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Background: studies in adults have shown that external focus of attention is better than internal focus in motor learning. So, the aim of this study is to evaluate the effects of focus of attention- self talk on balance of women with multiple sclerosis.

Materials and Methods: In this semi- experimental study, statistical population included women with MS referred to MS Society of Arak. Whereas balance disorder in patients was diagnosed by neurologyist, they were invited to the study. Patients were accidentally divided into 3 groups each of 15 concluding control, self tak-external focus of attention and self talk- internal focus of attention groups and were evaluated by Berg balance scale. 42 samples completed executive steps of study. ANOVA and Tukey tests were used to compare balance score between groups with significant level of less than 0.05. All patients practiced balance tasks for 9 days and then they were undergone post test.

Results: Balance was improved in all groups. Although the external- self talk group was better than the two other groups, there was no significant difference between external and internal- self talk groups.

Conclusion: The findings of this study showed the effect of practice on improvement of balance skill and superiority of the experimental groups in comparison with control group. Probably, focus of attention with self talk has effect on balance of women with MS.

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Abstract

Background: With regards to importance of the role of parents in children's life, imbalance in the roles of parents can lead to serious mental, emotional and physical damages of the child. The purpose of this study was to determine how to do parenting role's tasks in parents of children with disability (physical- mental) younger than 7 years in the city of Arak in 2016.

Materials and Methods: In this study, the parenting role's tasks questionnaire for 120 parents of children with disability was completed. The effect of demographic characteristics on how to perform the role of parents was studied.

Results: Based on data collected and analyzed using Pearson correlation coefficient for the relationship between the parents and other factors, we have found no significant relationship between role of parents with the child's age. In disabled children, between parent's role and maternal age was significant difference which its correlation coefficient was -0.18, represented the inverse association between maternal age and the parent's role with disabled children. In comparison of parent's role based on child's gender, significant difference was not seen in any of cases. The impact of the seizure on performance of parenting role's tasks implied no relationship between history of seizure and performance of parenting role's tasks. Economic situation as well as on how to do tasks was ineffective.

Conclusion: Imbalance in performance of parenting role's tasks in primary care, education, leisure and cognition promotion showed that existence of a disabled child in the family had negative impact on the parenting role's tasks in different aspects, for example further focus on one of the domains lead to ignorance of other domains. Total score confirmed the negative impact of disabled children on efficient implementation of parenting role's tasks.

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Abstract

Background: Self-talk is a psychological intervention that can affect the performance of an individulal, so the aim of this study was to investigate the effect of balance-training with educational and motivational self-talk on balance in women with MS in the city of Arak.

Materials and Methods: This study was a semi-experimental research with pre-test and post-test. The statistical population included women with MS in the city of Arak. 42 patients with the age range of 20-50 years old were chosen as samples and randomly were divided in 3 groups of individuls as control, educational self-talk and motivation self-talk and were experimented by Berg balance test.The experimental groups practiced the balance excercises for a month , 3 times a week and 45 minutes in each session. Then, post-test was performed for them. For data collecting, the demographic questionnaire, Berg balance test, one leg balance test and star test were used. Data analysis was done by using ANOVA and Tokey post-test by SPSS23 software at a significant level less than 0.05.

Results: The results of this study showed that the mean score of balance in educational self- talk group than motivational self-talk group (p = 0.045) a control group (p = 0.008) was significantly higher. Thus, the mean score balance performance test, motivational self-talk and control groups showed no significant difference (p = 0.689)

Conclusion: According the findings of this study, balance training with educational self-talk affects on balance in women with MS. Thus, balance training with educational self-talk can be a good approach to improve the balance in the women with MS. oxidative stress and DNA damage considerably. Thus, it is advisable for operating room personnel to consume green tea as a natural antioxidant supplement.

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Background:
 
This study aimed to compare the effect of cold eye irrigation solution (BSS) and viscoelastic gel with their combination in room temperature on the dosage of sedative drugs which we use in Phacoemulsification cataract surgery.
 
Material and methods:
 
190 patients scheduled for cataract surgery under sedation were randomly divided into two equal groups. During surgery we used cold (4c) and warm (room temperature) BSS and viscoelastic gel in the first and second group respectively. For all patients we started sedation with Midazolam and Fentanyl and in case we needed additional drug we used Sodium Thiopental till we reached desired sedation level. Ramsay sedation scores (before, during and after surgery) and total sedative drug consumption   were evaluated   and compared between two groups and at the end of the surgery we checked the satisfaction score of patients and surgeon about the quality of sedation.
 
Results:
The average dosage of Midazolam wasn’t significantly different between the two groups, while the average dosage of Sodium Thiopental was significantly lower in Cold group. Also the average time of which we reached desired Ramsay sedation score and the level of Ramsay score were significantly different between the two groups.
 Conclusion:
Using cold BSS and viscoelastic gel in cataract surgery in comparison of their combination in room temperature will reduce the dosage of sedative drugs which we use during surgery and help us getting a more effective sedation and gaining both a satisfied patient and surgeon.
 

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Introduction: Today, disabled sports have become one of the most important categories in the world of sports. In the meantime, exercising the blind and visually impaired is essential. Therefore, the present study aimed to examine the effect of clothing weight on the range of lower limb muscle activities during the execution of archery skills in blind people.
Methods: The current research is semi-experimental and laboratory-type. The statistical sample of the present study included 30 blind boys from Ardabil City who were selected purposefully and voluntarily. The subjects were randomly divided into two groups. The shooting target was placed at a distance of 10 meters from the subject. A two-way analysis of variance and a t-test at a significance level of 0.05 were used for statistical analysis of the data.
Results: According to the obtained results, the effect of the time factor on the electrical activity of the vastus medialis muscle when releasing the bowstring was statistically significant. The impact of the group factor on the electrical activity of the tibialis anterior muscle when releasing the bowstring had a statistically significant difference. Also, the effect of the group factor when taking the bow in the rectus femoris muscle and biceps muscle had a statistically significant difference.
Conclusions: Finally, according to all the obtained results, it can be said that probably using shooting clothes by affecting the electrical activity of the muscles of the lower limbs can improve balance during shooting, which can be one of the influential reasons, and become efficient in the success of archers.

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Introduction: Multiple sclerosis (MS) is most common nervous system disorder in young people and balance problems due to MS may result in upright posture disturbance, walking and turning limitations, and finally falls in the MS patients. Thus, the aim of this study was to investigate the effects of a combined physical exercises and cognitive - behavioral stress management intervention program on static, dynamic balance and trust in balance of patients with MS.
 Methods: Statistical population in this study were MS patients referred to Arak MS Association (with age rang 20 – 60 yrs. and disability measure score 2-4), 30 subjects selected availably and divided to two experimental and control groups randomly. Subjects tested with timed up and go and standing on one-foot tests in pretest, and completed Activities-Specific Balance Confidence Scale (ABC). Then, they participated in the combined motor and cognitive intervention program, and finally performed past – test. Data analyzed by independent and paired student t-tests, with SPSS software, version 21.
Results: According the results, mean score of experimental group in timed up and go, and standing on one-foot tests increased significantly in post-test (p≤0/05). There were not significant differences in ABC mean scores of experimental and control groups in post-test (p≤0/05).
 Conclusion: Based on the findings, that confirmed effects of the combined motor and cognitive intervention program on agility and dynamic, and static balance increase, using this program will be recommended.  It seems for balance confidence improvement, there is needed to more time than spent time in the intervention.

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^{Background and purpose: hallux valgus is one of the common foot deformities that causes external deviation of the first toe and progressive semi-dislocation of the first metatarsophalangeal joint. The purpose of this study was to investigate the effect of kinesiotype and ankle strengthening exercises with bosu ball on pain, balance and big toe angle of women with hallux valgus.
Materials and methods: This clinical trial study was conducted with a pre-test and post-test design. First, 45 women with crooked thumbs and flat feet were selected by available sampling method, then randomly divided into three kinesiotape groups (four weeks, three sessions per week, each session for 24 hours), kinesiotape with strengthening exercises. Ankles with bosu ball (four weeks, three sessions per week, each session for 30 minutes of exercises and 24 hours of band application) and control group (did not receive any intervention) were divided. Research tools including VAS index, stork test and goniometer were used to measure pain, balance and big toe angle, respectively. Data analysis was done with one-way ANOVA at a significant level (P ≥ 0.05).
Findings: After performing the exercises, comparing the data between the two groups, before and after 4 weeks, there was a significant difference in the variables of pain, balance, and hallux valgus angle in the two groups of kinesiotape and kinesiotape along with the strengthening exercises of Boussou bathop compared to The control group showed (P=0.001).
Conclusion: It seems that in order to correct hallux valgus and improve pain and balance in women, it is possible to use the combined program of tip and ankle strengthening exercises with bosu ball.}
 

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Introduction:This study aimed to investigate the effect of the backward gait training protocol on postural sway and balance in elderly men with a history of falls.
Methods: A total of 28 healthy elderly individuals with a history of falls participated in this research. The backward gait protocol was considered as the independent variable, and the mean parameters of postural deviations, including range, center of pressure displacement, center of pressure velocity, and center of pressure acceleration, were examined as dependent variables. A Kistler force platform was used to assess postural sway. A mixed-design repeated measures ANOVA was performed at a significance level of 0.05.
Results: No significant differences were found in the anterior-posterior amplitude and medio-lateral acceleration of the center of pressure between healthy elderly individuals and those with a history of falls (P > 0.05). However, individuals with a history of falls exhibited greater medio-lateral amplitude, anterior-posterior displacement, anterior-posterior velocity, and anterior-posterior acceleration of the center of pressure (P = 0.001). Conversely, they demonstrated lower medio-lateral displacement (P = 0.000) and medio-lateral velocity of the center of pressure (P = 0.005).
Conclusions: Changes in center of pressure parameters may predict fall risk in the elderly. These parameters have varying sensitivity in detecting subtle differences in postural control. The responses of various parameters are influenced by compensatory mechanisms, weaknesses, and balance disorders. The backward gait protocol serves as a targeted intervention to improve balance and stability in elderly individuals at risk of falls