Issues facing the application of telemedicine in developing countries: Hashemite Kingdom of Jordan and Syrian Arab Republic

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Telemedicine delivers healthcare between geographically separated locations using medical expertise supported by communication technology. Physicians and specialists from one site can provide diagnosis, treatment and consultation to patients at a remote site. This makes the use of telemedicine particularly affective in rural and remote areas that have limited access to healthcare services. This study identifies the factors that affect the use and adoption of telemedicine in developing countries and rural areas in general, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as cases studies. We have developed two guideline frameworks to be applied to telemedicine projects at the pre- implementation phase. The main purpose of the guideline frameworks is to assess the readiness of the Jordanian and Syrian health care system to use telemedicine and to assist any healthcare provider who is considering implementing a telemedicine project in either of these two countries. The guideline framework can be transferred and applied to any other country for which similar circumstances apply. Our guideline frameworks are based on interviews with key stakeholders including doctors, technicians, engineers, and decision makers, and administering questionnaires to further key stakeholders including patients, ensuring that we gain opinion from people from different backgrounds and with different roles in the healthcare system. Our research has identified specific key issues which inhibit the use of telemedicine: poor technology infrastructure; lack of funding; lack of IT education; insufficient training for clinicians; doctors’ resistance; patients’ resistance; and lack of knowledge about healthcare and technology. This work provides a clear idea of the current readiness in both countries and proposes two guideline frameworks that will aid the use of telemedicine. Their dissemination will create awareness and spread knowledge, which will help the decision makers to appreciate the potential role of telemedicine and help them to facilitate the process of introduction and so spread telemedicine in both Jordan and Syria

Effect of culture on acceptance of telemedicine in Middle Eastern countries: Case study of Jordan and Syria

© Mary Ann Liebert, INC.We investigated issues that affect the use and adoption of telemedicine in Middle Eastern countries, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as case studies. Our study is based on interviews with key stakeholders (including doctors, technicians, engineers, and decision makers) and questionnaires administered to key stakeholders (including patients), ensuring opinion was gained from people from a full range of backgrounds and roles in the healthcare system. We found doctor and patient resistance was a major issue preventing the adoption of telemedicine in both countries, followed by poor infrastructure, lack of funding, and lack of information technology training. Our research identifies that culture is a greater issue than technical matters for the adoption of telemedicine in Middle Eastern countries. Based on our preliminary results we developed a guideline framework for each country that might be applied to telemedicine projects at the pre-implementation phase. The proposed guideline framework was validated through a return visit to the stakeholders and seeking further opinion

Measuring Market Valuation of Amman Stock Exchange Industrial Sectors: Tobin’s Q Ratio as Investors’ Market Performance Indicator

This research investigation purported to present the market valuation of Amman Stock Exchange Industrial Sectors utilizing the Tobin’s Q ratio to serve as performance indicator among Jordanian industrial firms. The most specific research objectives addressed in this research work were to evaluate the Amman Stock Exchange Industry market performance, present the trend in Q ratio valuation during the study period, and to recommend some guiding principles to enrich investors in making the right investment decisions. The research paper is anchored on the concepts of Chung and Pruitt (1994) who have developed a simple approximation of Tobin’s q. For the methodology, the researchers made use of the 49 sample companies from all industrial public traded company sectors listed in the Amman Stock Exchange (ASE) clustered based on the Amman Stock Exchange classification as published in their publications inclusive of 2008-2015. The sectors included the Pharmaceutical & Medical Industries, Chemical Industries, Paper & Cartoon Industries, Food & Beverage, Tobacco & Cigarettes, Mining & Extraction Industries, Engineering & Construction, Electrical Industries, Textile, and Leather & Clothing......

Adeptness in Conflict Management of Expatriates deployed in Government, Semi-Government and Private Service Operations in the United Arab Emirates

The purpose of this research investigation is to verbalize the conflict management of expatriates deployed in service operations in government, semi-government and private organizations in UAE, their maturity level, length of work experience, type of industry, location of workplace: Abu Dhabi, Ajman, Dubai, Fujairah, Um Al Quwain, Ras Al Khaimah, and Sharjah; and the length of business operation of the company.     The research design employed was descriptive- correlational, and generally quantitative, as this investigation used post-positivist claims for developing knowledge to test the hypotheses formulated. Data were collected from the group of expatriates who were working in different emirates in UAE, and were deployed in service operations. A questionnaire -survey form was the data collection method utilized with subparts on indicators and respondents’ profiles and comprised of closed-ended questions gleaned from readings and other learning resources. The items were subjected to validity and reliability testing techniques, its validity index established, and the reliability index was generated using the Cronbach Alpha. The Statistical Package for Social Sciences (SPSS) based on the specific research objectives was used to analyze the data gathered. Findings of the study showed that the conflict management skills of expats deployed in the service operations of government, semi-government and private organizations in UAE were High. Expatriates in service operations in the United Arab Emirates have the very high emotional maturity, high in communication skills, and creativity in problem-solving but only have Moderate skill in empathy. Moreover, results showed that the conflict management skills of the expats are significantly influenced by their maturity level, length of work experience and length of service operations of the organizations where the expatriates were employed but the locations of the workplace where the expats were assigned to, do not significantly influence their conflict management skills as expressed in their communication skills, empathy, maturity and creative problem-solving skills. The purpose of this research investigation is to verbalize the conflict management of expatriates deployed in service operations in government, semi-government and private organizations in UAE, their maturity level, length of work experience, type of industry, location of work place, and the length of business operation of the company. Keywords: Adeptness, Conflict Management, Communication Skills, Emotional Maturity, Empathy, Creative Problem Solvin

Issues facing the application of telemedicine in developing countries : Hashemite Kingdom of Jordan and Syrian Arab Republic

Telemedicine delivers healthcare between geographically separated locations using medical expertise supported by communication technology. Physicians and specialists from one site can provide diagnosis, treatment and consultation to patients at a remote site. This makes the use of telemedicine particularly affective in rural and remote areas that have limited access to healthcare services. This study identifies the factors that affect the use and adoption of telemedicine in developing countries and rural areas in general, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as cases studies. We have developed two guideline frameworks to be applied to telemedicine projects at the pre- implementation phase. The main purpose of the guideline frameworks is to assess the readiness of the Jordanian and Syrian health care system to use telemedicine and to assist any healthcare provider who is considering implementing a telemedicine project in either of these two countries. The guideline framework can be transferred and applied to any other country for which similar circumstances apply. Our guideline frameworks are based on interviews with key stakeholders including doctors, technicians, engineers, and decision makers, and administering questionnaires to further key stakeholders including patients, ensuring that we gain opinion from people from different backgrounds and with different roles in the healthcare system. Our research has identified specific key issues which inhibit the use of telemedicine: poor technology infrastructure; lack of funding; lack of IT education; insufficient training for clinicians; doctors’ resistance; patients’ resistance; and lack of knowledge about healthcare and technology. This work provides a clear idea of the current readiness in both countries and proposes two guideline frameworks that will aid the use of telemedicine. Their dissemination will create awareness and spread knowledge, which will help the decision makers to appreciate the potential role of telemedicine and help them to facilitate the process of introduction and so spread telemedicine in both Jordan and Syria.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Establishing the Relation Between Market-Based Performance Measure and Accounting Performance Measure

The purpose of this study is to examine the relationship between market-based and accounting-based performances. Sample was comprised of 49 companies listed on Amman Stock Exchange (ASE) was taken. Data was collected from financial statements and official bulletins of stock market prices published between 2008 to 2016. The sectors included the Pharmaceutical & Medical Industries, Chemical Industries, Paper & Cartoon Industries, Food & Beverage, Tobacco & Cigarettes, Mining & Extraction Industries, Engineering & Construction, Electrical Industries, Textile, and Leather & Clothing. This study employed panel data analysis using fixed‐effect estimation, random‐effect estimation, and a pooled regression model. The results of this investigation demonstrated that a firm's accounting performance measures (ROA and P/E) had a significant positive relationship with the firm's market performance measure of Q ratio during the 9 years of the research as well as there was no significant relation between Q Ratio and P/E, P/B, ATO, and PM. An interesting finding further showed that the ROE measures have negatives and have a highly significant relationship with Tobin's Q ratio. Keywords: Accounting performance ratio, Tobin’s Q, Market Performance ratio. DOI: 10.7176/RJFA/10-20-04 Publication date:October 31st 201

An overview of the features of chatbots in mental health: A scoping review

Background: Chatbots are systems that are able to converse and interact with human users using spoken, written, and visual languages. Chatbots have the potential to be useful tools for individuals with mental disorders, especially those who are reluctant to seek mental health advice due to stigmatization. While numerous studies have been conducted about using chatbots for mental health, there is a need to systematically bring this evidence together in order to inform mental health providers and potential users about the main features of chatbots and their potential uses, and to inform future research about the main gaps of the previous literature. Objective: We aimed to provide an overview of the features of chatbots used by individuals for their mental health as reported in the empirical literature. Methods: Seven bibliographic databases (Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, IEEE Xplore, ACM Digital Library, and Google Scholar) were used in our search. In addition, backward and forward reference list checking of the included studies and relevant reviews was conducted. Study selection and data extraction were carried out by two reviewers independently. Extracted data were synthesised using a narrative approach. Chatbots were classified according to their purposes, platforms, response generation, dialogue initiative, input and output modalities, embodiment, and targeted disorders. Results: Of 1039 citations retrieved, 53 unique studies were included in this review. Those studies assessed 41 different chatbots. Common uses of chatbots were: therapy (n = 17), training (n = 12), and screening (n = 10). Chatbots in most studies were rule-based (n = 49) and implemented in stand-alone software (n = 37). In 46 studies, chatbots controlled and led the conversations. While the most frequently used input modality was writing language only (n = 26), the most frequently used output modality was a combination of written, spoken and visual languages (n = 28). In the majority of studies, chatbots included virtual representations (n = 44). The most common focus of chatbots was depression (n = 16) or autism (n = 10). Conclusion: Research regarding chatbots in mental health is nascent. There are numerous chatbots that are used for various mental disorders and purposes. Healthcare providers should compare chatbots found in this review to help guide potential users to the most appropriate chatbot to support their mental health needs. More reviews are needed to summarise the evidence regarding the effectiveness and acceptability of chatbots in mental health

Technical Metrics Used to Evaluate Health Care Chatbots: Scoping Review

Dialog agents (chatbots) have a long history of application in health care, where they have been used for tasks such as supporting patient self-management and providing counseling. Their use is expected to grow with increasing demands on health systems and improving artificial intelligence (AI) capability. Approaches to the evaluation of health care chatbots, however, appear to be diverse and haphazard, resulting in a potential barrier to the advancement of the field. This study aims to identify the technical (nonclinical) metrics used by previous studies to evaluate health care chatbots. Studies were identified by searching 7 bibliographic databases (eg, MEDLINE and PsycINFO) in addition to conducting backward and forward reference list checking of the included studies and relevant reviews. The studies were independently selected by two reviewers who then extracted data from the included studies. Extracted data were synthesized narratively by grouping the identified metrics into categories based on the aspect of chatbots that the metrics evaluated. Of the 1498 citations retrieved, 65 studies were included in this review. Chatbots were evaluated using 27 technical metrics, which were related to chatbots as a whole (eg, usability, classifier performance, speed), response generation (eg, comprehensibility, realism, repetitiveness), response understanding (eg, chatbot understanding as assessed by users, word error rate, concept error rate), and esthetics (eg, appearance of the virtual agent, background color, and content). The technical metrics of health chatbot studies were diverse, with survey designs and global usability metrics dominating. The lack of standardization and paucity of objective measures make it difficult to compare the performance of health chatbots and could inhibit advancement of the field. We suggest that researchers more frequently include metrics computed from conversation logs. In addition, we recommend the development of a framework of technical metrics with recommendations for specific circumstances for their inclusion in chatbot studies

Clinicians perceptions of a telemedicine system : a mixed method study of Makassar City, Indonesia

Background: This case study in Makassar City, Indonesia aims to investigate the clinicians’ perceptions, including both satisfaction and barriers in using telemedicine in a large, established program which supported 3974 consultations in 2017. Methods: A mixed methodology was used in this research utilizing a questionnaire with 12 questions, and semi-structured interviews. A purposeful sample of clinicians using the telemedicine system at the 39 primary care clinics in Makassar City were surveyed. A total of 100 clinicians participated in this study. All of them completed the questionnaires (76.9% response rate) and 15 of them were interviewed. Results: The result showed that 78% of the clinicians were satisfied with the telemedicine system. In free text responses 69% said that telemedicine allowed quicker diagnosis and treatment, 47% said poor internet connectivity was a significant obstacle in using the system, and 40% suggested improvement to the infrastructure including internet connection and electricity. Conclusion: Overall, the clinicians were satisfied with the system, with the main benefit of rendering the diagnosis faster and easier for patients. However, poor internet connectivity was indicated as the main barrier. Most of the clinicians suggested improving the infrastructure especially the internet network