Background: Collecting quality and timely healthcare data is crucial to improve health service performance. Objective: This study aimed at assessing data management practice and associated factors among health extension workers in East Gojjam zone, Northwest Ethiopia. Materials and Methods: An institution based cross-sectional study was conducted in 2014 among 302 health extension workers. Data were collected using a self-administered questionnaire and analyzed using SPSS version 20. The study objectives were described by descriptive statistics, and factors in data management were identified by multivariable logistic regression analysis. Results: A total of 302 health extension workers participated in the study. About 47.4% and 53.3% of respondents had good data management knowledge and practice, respectively. Inaccessibility of transportation, communication services, reference materials, and data collection/reporting formats were the mentioned challenges. Workload, data management knowledge, supervision, urban residence, reference materials access and clarity of formats were positively associated with better data management practice (p <0.05). Conclusion: Based on this study, the data management practice of health extension workers was low. Factors for low data management practice were organizational and technical related. Addressing knowledge gaps through professional development and improving supportive supervision are crucial to solve the problem.
Objective: Ventilator-Associated Pneumonia (VAP), a lung infection developing in patients on a ventilator in Intensive Care Units (ICU), is the second most common nosocomial infection and a leading cause of morbidity and mortality in ICUs. To reduce the incidence rate of VAP complication, many healthcare organizations have already developed certain strategies and guidelines. However, there are still high rates of VAP infections mainly due to: conflicting guidelines from different sources, implementing the guidelines at different times and conditions, different ICU caregivers at different shifts, and of course the human mistakes. Methods: The present study aimed to develop a dashboard to help reducing VAP incidences in ICUs. To achieve the objective of the research, first, the VAP prevention guidelines were compiled. The object-oriented analysis approach was adopted for designing of the dashboard software. To assess the impact of the developed dashboard on the reduction of VAP events, a pilot hospital was selected and a pilot project was prepared. For the dashboard usability assessment based on user satisfaction, a questionnaire was developed as the survey tool. Conclusion: The dashboard was developed and put into operation in a pilot ICU. The results from the t-test (with a probable error of 0.05 percent) indicated a meaningful difference between the number of VAP patients before and after the dashboard implementation with p-value ˂ 0.02. Also, the developed software was evaluated from a usability point of view based on user satisfaction, with health professionals and caregivers of the pilot ICU as the users of the software. The total score was equivalent to 95 percent, falling within the acceptable range of 75-100 percent.
Introduction: Data quality is an important issue in emergency medicine. The unique characteristics of emergency care services, such as high turn-over and the speed of work may increase the possibility of making errors in the related settings. Therefore, regular data quality assessment is necessary to avoid the consequences of low quality data. This study aimed to identify the main dimensions of data quality which had been assessed, the assessment approaches, and generally, the status of data quality in the emergency medical services. Methods: The review was conducted in 2016. Related articles were identified by searching databases, including Scopus, Science Direct, PubMed and Web of Science. All of the review and research papers related to data quality assessment in the emergency care services and published between 2000 and 2015 (n=34) were included in the study. Results: The findings showed that the five dimensions of data quality; namely, data completeness, accuracy, consistency, accessibility, and timeliness had been investigated in the field of emergency medical services. Regarding the assessment methods, quantitative research methods were used more than the qualitative or the mixed methods. Overall, the results of these studies showed that data completeness and data accuracy requires more attention to be improved. Conclusion: In the future studies, choosing a clear and a consistent definition of data quality is required. Moreover, the use of qualitative research methods or the mixed methods is suggested, as data users’ perspectives can provide a broader picture of the reasons for poor quality data.
Background: Due to the increasing rate of the burn injuries and a limited number of specialized treatment centers, providing medical advice and medical care at the point of need is necessary. The aim of the present study was to design and implement a teleburn system to enhance the quality of care for the burn patients. Methods: This study was completed in 2016. In order to design the system, information needs assessment was conducted by using a questionnaire. The participants of this phase were five specialists, five general practitioners, and 12 nurses. The setting of the study was the burn department of a public hospital and a burn center. The prototype of the system was designed based on the findings derived from the first phase, and the usability of the system was evaluated later. Results: The teleburn system was a web-based system with different sections for GPs/nurses and specialists. In total, 28 burn consultations were made successfully by using the system. The findings of the usability testing showed that most of the participants evaluated the system at a good level. The mean score for the specialists, general practitioners and nurses was 8.4±0.46, 7.7±0.39, and 7.5±0.51, respectively. Conclusion: Although it was the first time in the country that the teleburn system was designed and introduced to the clinicians, they seemed to be satisfied with using the system. This system could help general practitioners and nurses to receive specialist's advice on a timely manner to improve the treatment of the burn patients. However, more research should be conducted to determine the effectiveness of using this technology in the real work environment.
Background and Objective:Planning for the future of Health Information Technology (HIT) requires applying a systematic approach when conducting foresight studies. The aim of this study was to identify key health information technologies and related issues for Iran until 2025.Methods:This was a qualitative study and the participants included experts and policy makers in the field of health information technology. In-depth semi-structured interviews were conducted and data were analyzed by using framework analysis and MAXQDA software.Results:The findings revealed that the development of national health information network, electronic health records, patient health records, a cloud-based service center, interoperability standards, patient monitoring technologies, telehealth, mhealth, clinical decision support systems, health information technology and mhealth infrastructure were found to be the key technologies for the future. These technologies could influence the economic, organizational and individual levels. To achieve them, the economic and organizational obstacles need to be overcome.Conclusion:In this study, a number of key technologies and related issues were identified. This approach can help to focus on the most important technologies in the future and to priorities these technologies for better resource allocation and policy making.
Background: Variable use of phrases expressing diagnostic uncertainty can lead to ambiguous radiology reports, a concern for information processing. Objective: This study aimed to quantify the usage of phrases conveying diagnostic certainty for abdominal imaging findings and assess factors that impact use of phrases with “good agreement” between radiologists and referring providers. Methods: This retrospective, Institutional Review Board-Approved study included all diagnostic reports generated by the Abdominal Radiology Division at an academic medical center July-September 2016. We assessed the use of 16 diagnostic certainty phrases using information retrieval from the Impression section of radiology reports. Phrases with good provider agreement for conveying the level of certainty are defined as “good agreement” phrases - including “diagnostic of”, “represents” and “unlikely.” We assessed the impact of imaging modality, trainee contribution to report generation, and individual radiologists. Results: In 5,598 radiology reports, 2,071 (37%) contained diagnostic certainty phrases, 119 (6%) of which were “good agreement” phrases. There was a significant difference between how frequently “good agreement” phrases were used in Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and X-ray reports (p=0.0003). There was a significant variation among attending radiologists on the use of “good agreement” phrases (p<0.0019). There was no difference in the use of “good agreement” phrases in reports generated by attending radiologists alone compared to reports with trainees. Conclusion: Although phrases to convey diagnostic certainty were commonly used in radiology reports, the use of phrases with a good agreement was uncommon. Standardizing terminology to convey diagnostic certainty may reduce ambiguity in radiology reports and generate more accurate information processing tools.
In the future studies, choosing a clear and a consistent definition of data quality is required. Moreover, the use of qualitative research methods or the mixed methods is suggested, as data users' perspectives can provide a broader picture of the reasons for poor quality data.
Background: Antiretroviral Therapy(ART) remarkably reduced HIV-1 infection-related mortality in children. The efficacy and safety of different ART regimen in pediatric age groups remained issues of debates and available evidence were scarce especially among children taking the of one the two prototypes (NVP or EFV) Non-Nucleoside Reverse Transcriptase Inhibitor(NNRTI) as backbone of ART regimen. Therefore, the objective of this study was to compare clinical, immunological and virological responses of zidovudine-lamivudine-nevirapine (AZT+3TC+ NVP) versus zidovudine-lamivudine-efavirenz (AZT+3TC+EFV) ART regimen among HIV-1 infected children. Methods: A retrospective cross-sectional study was done by reviewing medical records of the patients to evaluate clinical, immunological and virological outcomes of NVP+AZT+3TC versus EFV+AZT+3TC ART regimen among HIV-1 infected children. Data were entered into Epi-info version 7.2.2 for clean up and exported to SPSS version 17 for analysis. Paired and Independent t-tests were used to compare the CD4 cell count, weight and virologic level at six months with corresponding baseline value; and the mean weight, CD4 gain and viral suppression across the two ART regimens at six months of ART respectively. Results: Medical records of 122 patients from NVP-based regimen and 61 patients from EFV group were reviewed. After six months of NVP+AZT+3TC treatment, the mean CD4 cell count difference from baseline was 215(95% CI, 175.414-245.613, p<0.001). From EFV+AZT+3TC group, the mean CD4 cell count difference from baseline was 205(95% CI 155.404-235.623, p< 0.001). The mean CD4 count difference between the two regimens was comparable (p 0.145). Similarly, optimal viral suppression was achieved in 82% (100/122) of NVP+AZT+3TC regimen and 83% (44/61) of EFV+AZT+3TC regimen which was still comparable across the two groups. Conclusion: There was no difference in clinical, immunological and virological outcomes among patients taking NVP+AZT+3TC or EFV+AZT+3TC ART regimen.
INTRODUCTION:Ophthalmology is a medical specialty which may benefit from using telemedicine and teleophthalmology services. Such services are significantly important in the poor, remote, and impassable geographical areas, where there is no access to the ophthalmology services and ophthalmologists. This study aimed to design and implement a teleophthalmology system using the method of store-and-forward.METHODS:The study was conducted in 2015 and consisted of two main phases. The first phase was based requirement analysis, and in the second phase, after designing the prototype, an initial usability testing was undertaken in a teaching hospital. The participants of the study were 10 optometrists and 10 ophthalmologists (cornea specialists). For each phase of the research, a questionnaire was used to collect data, and the collected data were analyzed using descriptive statistics.RESULTS:In this study, users' requirements were initially investigated. Then, the teleophthalmology system was designed based on the literature review and the results derived from the requirements' analysis. Finally, usability testing showed that the users were relatively satisfied with the system.CONCLUSION:According to the results, it can be concluded that the teleophthalmology technology can be used in the country by optometrists and ophthalmologists to improve eye health care services and to prevent the prevalence of curable eye diseases.
BACKGROUND:Studies on nurse competence on alarm management are a few and tend to be focused on limited skills. In response to Phase II of implementing the National Patient Safety Goal on clinical alarm systems safety, this study assessed nurses' perceived competence on physiologic monitors use in intensive care units (ICUs) and developed and validated a tool for this purpose.METHODS:This descriptive study took place in a Magnet hospital in a Southwestern state of the U.S. A Nurse Competence on Philips Physiologic Monitors Use Survey was created and went through validation by 13 expert ICU nurses. The survey included 5 subscales with 59 rated items and two open-ended questions. Items on the first 4 subscales reflect most common tasks nurses perform using physiologic monitors. Items on the fifth subscale (advanced functions) reflect rarely used skills and were included to understand the scope of utilizing advanced physiologic monitors' features. Thirty nurses from 4 adult ICUs were invited to respond to the survey.RESULTS:Thirty nurses (100%) responded to the survey. The majority of nurses were from Neuro (47%) and Surgical Trauma (37%) ICUs. The data supported the high reliability and construct validity of the survey. At least one (3%) to 8 nurses (27%) reported lack of confidence on each item on the survey. On the first four subscales, 3% - 40% of the nurses reported they had never heard of or used 27 features/functions on the monitors. No relationships were found between subscales' scores and demographic characteristics (p > .05). Nurses asked for training on navigating the central-station monitor and troubleshooting alarms, and the use of unit-specific super users to tailor training to users' needs.CONCLUSION:This is the first study to create and test a list of competencies for physiologic monitors use. Rigorous, periodic and individualized training is essential for safe and appropriate use of physiologic monitors and to decrease alarm fatigue. Training should be comprehensive to include all necessary skills and should not assume proficiency on basic skills. Special attention should be focused on managing technical alarms. Increasing the number of super users is a recommended strategy for individualized and unit-specific training. There is a need for a usability testing of complex IT-equipped medical devices, such as physiologic monitors, for effective, efficient and safe navigation of the monitors.
OBJECTIVE:The aim of this study is to offer appropriate criteria to evaluate effective dashboards for healthcare organizations.METHOD:In a Delphi study, a team of information technology consultants were asked to determine a set of user interface requirements for evaluating, building or selecting the dashboard. In the first round, a list of main features or criteria to be used was determined based on the panel's rating,.RESULTS:In this study, it was revealed that a set of key criteria for evaluating the dashboards can be used for all types of dashboards. These criteria were classified into 7 main categories including user customization, knowledge discovery, security, information delivery, alerting, visual design, and integration and system connectivity.CONCLUSION:Choosing good criteria for selecting effective dashboards for healthcare organizations is very critical because these organizations follow a data-intensive and technology-driven environment. This study revealed the importance of key criteria which can guarantee development of an evaluation checklist.
Background: To date, many efforts have been made to classify information security threats, especially in the healthcare area. However, there are still many unknown risks which may threat the security of health information and their resources especially in the hospitals. Objective: The aim of this study was to assess the risks threatening information security in the hospitals located in one of the northwest cities of Iran. Method: This study was completed in 2014. The participants were information technology managers who worked in the hospitals (n=27). The research instrument was a questionnaire composed of a number of open and closed questions. The content validity of the questionnaire was confirmed, and the reliability of the closed questions was measured by using the test-retest method (r =0.78). Results: The results showed that among the information security risks, fire found to be a high probability/high impact risk factor. Human and physical/environmental threats were among the low probability risk factors. Regarding the information security safeguards used in the hospitals, the results showed that the use of the technical safeguards was the most frequent one (n =22, 91.7%) compared to the administrative (n =21, 87.5%) and the physical safeguards (n =16, 66.7%). Conclusion: The high probability risk factors require quick corrective actions to be taken. Therefore, the underlying causes of such threats should be identified and controlled before experiencing adverse effects. It is also important to note that information security in health care systems needs to be considered at a macro level with respect to the national interests and policies.
BACKGROUND:High correction bracing is the most effective conservative treatment for patients with scoliosis during growth. Still today braces for the treatment of scoliosis are made by casting patients while computer aided design (CAD) and computer aided manufacturing (CAM) is available with all possibilities to standardize pattern specific brace treatment and improve wearing comfort.OBJECTIVE:CAD / CAM brace production mainly relies on carving a polyurethane foam model which is the basis for vacuuming a polyethylene (PE) or polypropylene (PP) brace. Purpose of this short communication is to describe the workflow currently used and to outline future requirements with respect to 3D printing technology.METHOD:Description of the steps of virtual brace adjustment as available today are content of this paper as well as an outline of the great potential there is for the future 3D printing technology.RESULTS:For 3D printing of scoliosis braces it is necessary to establish easy to use software plug-ins in order to allow adding 3D printing technology to the current workflow of virtual CAD / CAM brace adjustment. Textures and structures can be added to the brace models at certain well defined locations offering the potential of more wearing comfort without losing in-brace correction.CONCLUSIONS:Advances have to be made in the field of CAD / CAM software tools with respect to design and generation of individually structured brace models based on currently well established and standardized scoliosis brace libraries.
Objective: Invasive coronary angiography remains the cornerstone for evaluation of coronary stenoses despite there being a poor correlation between luminal loss assessment by coronary luminography and myocardial ischemia. This is especially true for coronary lesions deemed moderate by visual assessment. Coronary pressure-derived fractional flow reserve (FFR) has emerged as the gold standard for the evaluation of hemodynamic significance of coronary artery stenosis, which is cost effective and leads to improved patient outcomes. There are, however, several limitations to the use of FFR including the evaluation of serial stenoses. Method: In this article, we discuss the electronic-hydraulic analogy and the utility of simple electrical modelling to mimic the coronary circulation and coronary stenoses. We exemplify the effect of tandem coronary lesions on the FFR by modelling of a patient with sequential disease segments and complex anatomy. Results: We believe that such computational modelling can serve as a powerful educational tool to help clinicians better understand the complexity of coronary hemodynamics and improve patient care.
Purpose: The initial goals of rehabilitation after knee injuries and operations are to achieve full knee extension and to activate quadriceps muscle. In addition to regular physiotherapy, an android-based knee training device is designed to help patients achieve these goals and improve compliance in the early rehabilitation period. This knee training device combines fun in a computer game with muscular training or rehabilitation. Our aim was to test the feasibility and acceptability of this new device. Methods: 50 volunteered subjects enrolled to test out the computer game aided device. The first game was the high-striker game, which recorded maximum knee extension power. The second game involved controlling quadriceps muscular power to simulate flying an aeroplane in order to record accuracy of muscle activation. The subjects evaluated this game by completing a simple questionnaire. Results: No technical problem was encountered during the usage of this device. No subjects complained of any discomfort after using this device. Measurements including maximum knee extension power, knee muscle activation and control were recorded successfully. Subjects rated their experience with the device as either excellent or very good and agreed that the device can motivate and monitor the progress of knee rehabilitation training. Conclusion: To the best of our knowledge, this is the first android-based tool available to fast track knee rehabilitation training. All subjects gave very positive feedback to this computer game aided knee device.
Providers are expressing a desire for more efficient ways to retrieve relevant clinical data from the Electronic Health Record. In an effort to improve our Electromyography and Nerve Conduction Study reports, we surveyed referring providers on the effects of having the IMPRESSION at the start of the report. Our survey respondents felt that using this format for an Electromyography and Nerve Conduction Study report significantly improved the quality of the report while saving them time and/or mouse clicks when interpreting the report. Electro diagnosticians might consider using this format for their Electromyography and Nerve Conduction Study reports to improve referring provider satisfaction.
Medical images are regarded as important and sensitive data in the medical informatics systems. For transferring medical images over an insecure network, developing a secure encryption algorithm is necessary. Among the three main properties of security services ( i.e. , confidentiality, integrity, and availability), the confidentiality is the most essential feature for exchanging medical images among physicians. The Goldreich Goldwasser Halevi (GGH) algorithm can be a good choice for encrypting medical images as both the algorithm and sensitive data are represented by numeric matrices. Additionally, the GGH algorithm does not increase the size of the image and hence, its complexity will remain as simple as O(n2 ). However, one of the disadvantages of using the GGH algorithm is the Chosen Cipher Text attack. In our strategy, this shortcoming of GGH algorithm has been taken in to consideration and has been improved by applying the padding (i.e., snail tour XORing), before the GGH encryption process. For evaluating their performances, three measurement criteria are considered including (i) Number of Pixels Change Rate (NPCR), (ii) Unified Average Changing Intensity (UACI), and (iii) Avalanche effect. The results on three different sizes of images showed that padding GGH approach has improved UACI, NPCR, and Avalanche by almost 100%, 35%, and 45%, respectively, in comparison to the standard GGH algorithm. Also, the outcomes will make the padding GGH resist against the cipher text, the chosen cipher text, and the statistical attacks. Furthermore, increasing the avalanche effect of more than 50% is a promising achievement in comparison to the increased complexities of the proposed method in terms of encryption and decryption processes.
Introduction: Any information which is generated and saved needs to be protected against accidental or intentional losses and manipulations if it is to be used by the intended users in due time. As such, information managers have adopted numerous measures to achieve data security within data storage systems, along with the spread of information technology. Background: The “data security models” presented thus far have unanimously highlighted the significance of data security management. For further clarification, the current study first introduces the “needs and improvement” cycle; the study will then present some independent definitions, together with a support umbrella, in an attempt to shed light on the data security management. Findings: Data security focuses on three features or attributes known as integrity, identity of sender(s) and identity of receiver(s). Management in data security follows an endless evolutionary process, to keep up with new developments in information technology and communication. In this process management develops new characteristics with greater capabilities to achieve better data security. The characteristics, continuously increasing in number, with a special focus on control, are as follows: private zone, confidentiality, availability, non-repudiation, possession, accountability, authenticity, authentication and auditability. Conclusion: Data security management steadily progresses, resulting in more sophisticated features. The developments are in line with new developments in information and communication technology and novel advances in intrusion detection systems (IDS). Attention to differences between data security and data security management by international organizations such as the International Standard Organization (ISO), and International Telecommunication Union (ITU) is necessary if information quality is to be enhanced.
Chromosomal translocations that results in formation and activation of fusion oncogenes are observed in numerous solid malignancies since years back. Expression of fusion kinases in these cancers drives the initiation & progression that ultimately leads to tumour development and thus comes out to be clinically imperative in terms of diagnosis and treatment of cancer. Nonetheless, molecular mechanisms beneath these translocations remained unexplored consequently limiting our knowledge of carcinogenesis and hence is the current field where further research is required. The issue of prime focus is the precision with which the chromosomes breaks and reunites within genome. Characterization of Genomic sequences located at Breakpoint region may direct us towards the thorough understanding of mechanism leading to chromosomal rearrangement. A unique computational multi-parametric analysis was performed for characterization of genomic sequence within and around breakpoint region. This study turns out to be novel as it reveals the occurrence of Segmental Duplications flanking the breakpoints of all translocation. Breakpoint Islands were also investigated for the presence of other intricate genomic architecture and various physico-chemical parameters. Our study particularly highlights the probable role of SDs and specific genomic features in precise chromosomal breakage. Additionally, it pinpoints the potential features that may be significant for double-strand breaks leading to chromosomal rearrangements.
This work deals with the development of an intelligent approach for clinical decision making in the diagnosis of the Sleep Apnea/Hypopnea Syndrome, SAHS, from the analysis of respiratory signals and oxygen saturation in arterial blood, SaO2. In order to accomplish the task the proposed approach makes use of different artificial intelligence techniques and reasoning processes being able to deal with imprecise data. These reasoning processes are based on fuzzy logic and on temporal analysis of the information. The developed approach also takes into account the possibility of artifacts in the monitored signals. Detection and characterization of signal artifacts allows detection of false positives. Identification of relevant diagnostic patterns and temporal correlation of events is performed through the implementation of temporal constraints.
