Factors affecting long-survival of patients with esophageal cancer using non-mixture cure fraction model

Objective: Esophageal cancer (EC) is one of the gastrointestinal malignancies with a very high morbidity and mortality rate due to poor prognosis. This study aims to assess the effects of risk factors on survival and cure fraction of patients with EC in a population of Iranian patients using a non-mixture cure fraction model. Methods: This retrospective cohort study was conducted on 127 patients with EC who were diagnosed during 2009-2010 and were followed up for 5 years in East-Azarbaijan, Iran. Stepwise selection and non-mixture cure fraction model were used to find the risk factors of EC survival patients. Results: The mean (±standard deviation) diagnosis age of the EC was 66.92(±11.95). One, three and five-year survival probabilities were 0.44 (95% confidence interval (CI): 0.36-0.54), 0.2 (95% CI: 0.14-0.28) and 0.13 (95% CI: 0.08-0.2) respectively. Female sex (Estimate=-0.99; 95% confidence interval (CI): -1.41,-0.58; p-value<0.001), low level socioeconomic status (Estimate=0.39; 95%CI: 0.12,0.66; p-value=0.043), the group who did not do esophagectomy surgery (Estimate=0.58; 95%CI: 0.17,0.99; p-value=0.005) and unmarried group (Estimate=0.58; 95%CI: 0.11-1.05; p-value=0.015) were found as the significant predictor of survival and cure fraction of the EC patients. Population cure rate was 0.11 (95%CI: 0.07-0.19) and Cure fraction was estimated 5.11 percent. Conclusion: This study found gender, socioeconomic status, Esophagectomy surgery and marital status as the potential risk factors for survival and cure fraction of Iranian EC patients. Moreover, non- mixture cure fraction provides more accurate and more reliable insight into long-term advantages of EC therapy compared to standard classic survival analysis alternatives

QUANTITATIVE EVALUATION OF MEDICAL RECORD DOCUMENTATION IN IMAM REZA HOSPITAL, MASHHAD, IRAN

Introduction: Diabetes is the&nbsp;most common endocrine disease. Given the importance of medical record documentation for diabetic patients and its significant impact on accurate treatment process, as well as early diagnosis and treatment of acute and chronic complications, this study aimed to qualitatively evaluate medical record documentation of diabetic patients. Methods: This descriptive and cross-sectional study was conducted on all medical records of diabetic patients (1200 cases) in the comprehensive Diabetes Center of Imam Reza Hospital. A checklist was prepared according to the main sectors and their sub-data elements to conduct a qualitative evaluation on documentation of medical records of diabetic patients.&nbsp; Descriptive statistics were used to report the results. Results: In this study, 1200 (710 women and 490 men) cases were evaluated. Mean documentation of main sectors of diabetic patients’ records were as follows: 49% demographic characteristics, 14% patient referral, 4% diagnosis, 50% lab tests, 25% diabetes medications,13% nephropathy screening test, 10% diabetic neuropathy, 41% specialty and subspecialty consultations and internal medicine physicians visits did not complete for all the patients. Conclusion: According to the results of this study, qualitative evaluation of medical record documentation of diabetic patients Showed poor documentation in this regard. It is suggested that results of this study be accessible to physicians of healthcare centers to take a positive step toward improved documentation of medical records. In addition, it seems necessary to modify diabetic medical records

Systematic extraction of diagnostic data items for common high-risk pregnancies using Delphi technique

Introduction The quality of clinical decisions being made every day by on-call physicians are totally based on the quality of medical information they receive during telephone consultations with residents. Some basic factors such as the right selection of medical items, type and format, and also the volume of such information may highly affect the quality of remote consultations. Therefore, developing a trusted standard model for such clinical communication seems vital. In this research, we used Delphi technique to develop a set of information items in form of clinical decision archetypes to standardize teleconsultation in high-risk pregnancies. Methods A multi-stage cross-sectional study was conducted to exploit the diagnostic items for the most common high-risk pregnancies in three obstetrics and gynecology department of educational hospitals, Mashhad, Iran.&nbsp; &nbsp; &nbsp; Results Our study revealed eclampsia/preeclampsia, hemorrhage, PROM, pre-term and post-term delivery as the most common high-risk pregnancies in the hospitals being studied. 189 clinically-important items were extracted from scientific references and then hand-filtered to 128 items by the participating gynecology and obstetrics experts. The final items were categorized into five classes including general information, chief complaint / current problem, medical history, clinical examination, and paraclinic tests. Conclusion &nbsp;In this study, a set of clinical decision archetype was developed to improve the decisions being made in high risk pregnancies

Comparing potential spatial access with self-reported travel times and cost analysis to haemodialysis facilities in North-eastern Iran

End-stage renal disease patients regularly need haemodialysis three times a week. Their poor access to haemodialysis facilities is significantly associated with a high mortality rate. The present cross-sectional study aimed to measure the potential spatial access to dialysis services at a small area level (census tract level) in North Khorasan Province, Iran. The patients were interviewed to obtain their travel information. The two-step floating catchment area (2SFCA) method was used to measure the spatial accessibility of patients to the dialysis centres. The capacity of the dialysis centre was defined as the number of active dialysis facilities in each centre and the haemodialysis patients in each area were considered as the users of dialysis services. The travel cost from each patient’s residence to the haemodialysis facilities was visualized by the Kriging interpolation algorithm in the study area. Spatial accessibility to the dialysis centre was poor in the northern part of the study area. Fortunately, there were not many haemodialysis patients in that area. Patients’ travel costs were high in the northern areas compared to the rest of study area. We observed a statistically significant reverse correlation between the self-reported travel time and computed spatial accessibility (-0.570, P value <0.01, two-tailed spearman test). This study supports the notion that the 2SFCA method could be associated with revealed access time to dialysis facilities, especially in low traffic and in flat areas such as northern Khorasan. The mapping of patients’ distribution and interpolated travel cost to the haemodialysis facilities could help policymakers to allocate health resources to the areas where the need is greater

Investigating Evaluation Frameworks for Electronic Health Record: A Literature Review

BACKGROUND: There are various electronic health records (EHRs) evaluation frameworks with multiple dimensions and numerous sets of evaluation measures, while the coverage rate of evaluation measures in a common framework varies in different studies. AIM: This study provides a literature review of the current EHR evaluation frameworks and a model for measuring the coverage rate of evaluation measures in EHR frameworks. METHODS: The current study was a comprehensive literature review and a critical appraisal study. The study was conducted in three phases. In Phase 1, a literature review of EHR evaluation frameworks was conducted. In Phase 2, a three-level hierarchical structure was developed, which includes three aspects, 12 dimensions, and 110 evaluation measures. Subsequently, evaluation measures in the identified studies were categorized based on the hierarchical structure. In Phase 3, relative frequency (RF) of evaluation measures in different dimensions and aspects for each of the identified studies were determined and categorized as follows: Appropriate, moderate, and low coverage. RESULTS: Out of a total of 8276 retrieved articles, 62 studies were considered relevant. The RF range in the second and third level of the hierarchical structure was between 8.6%–91.94% and 0.2%–61%, respectively. “Ease of use” and “system quality” were the most frequent evaluation measure and dimension. Our results indicate that identified studies cover at least one and at most nine evaluation dimensions and current evaluation frameworks focus more on the technology aspect. Almost in all identified studies, evaluation measures related to the technology aspect were covered. However, evaluation measures related to human and organization aspects were covered in 68% and 84% of the identified studies, respectively. CONCLUSION: In this study, we systematically reviewed all literature presenting any type of EHR evaluation framework and analyzed and discussed their aspects and features. We believe that the findings of this study can help researchers to review and adopt the EHR evaluation frameworks for their own particular field of usage

Comparing potential spatial access with self-reported travel times and cost analysis to haemodialysis facilities in north-eastern Iran

End-stage renal disease patients regularly need haemodialysis three times a week. Their poor access to haemodialysis facilities is significantly associated with a high mortality rate. The present cross-sectional study aimed to measure the potential spatial access to dialysis services at a small area level (census tract level) in North Khorasan Province, Iran. The patients were interviewed to obtain their travel information. The two-step floating catchment area (2SFCA) method was used to measure the spatial accessibility of patients to the dialysis centres. The capacity of the dialysis centre was defined as the number of active dialysis facilities in each centre and the haemodialysis patients in each area were considered as the users of dialysis services. The travel cost from each patient's residence to the haemodialysis facilities was visualized by the Kriging interpolation algorithm in the study area. Spatial accessibility to the dialysis centre was poor in the northern part of the study area. Fortunately, there were not many haemodialysis patients in that area. Patients' travel costs were high in the northern areas compared to the rest of study area. We observed a statistically significant reverse correlation between the self-reported travel time and computed spatial accessibility (-0.570, P value <0.01, two-tailed spearman test). This study supports the notion that the 2SFCA method could be associated with revealed access time to dialysis facilities, especially in low traffic and in flat areas such as northern Khorasan. The mapping of patients' distribution and interpolated travel cost to the haemodialysis facilities could help policymakers to allocate health resources to the areas where the need is greater.n. 931059 from Mashhad University of Medical Sciences, Iran

Towards developing an integrated index of access to dialysis facilities: A systematic review

Background: The equitable Access to Healthcare Services (AHS) constitutes one of the main priorities of the healthcare providers. Access to Dialysis Facilities (ADF) has an important impact on the renal dialysis patients. There are many spatial and non-spatial factors that potentially can affect ADF. Objectives: We aimed to review available literature on factors affecting ADF. We have also tried to identify knowledge gaps in current studies in order to use those elicited factors to cover these gaps in developing an integrated index of ADF. Methods: In May 2016, the literature was systematically searched using the following electronic databases: PubMed, Embase, Web of science, Scopus, Science Direct, and IEEE Xplore. A 3-step method to identify studies related to ADF was used. Study selection processes were performed by two independent reviewers. The quality of studies was assessed using a mixed approach scoring system. Results: Initially, 975 literature were identified searching the selected databases. After removing duplicates, study screening, and applying inclusion/exclusion criteria, 34 studies were identified for final review. Given the content of selected studies, three groups of studies were identified and 42 factors with the potential effect on ADF were determined. Conclusion: Our systematic research revealed that most of the factors with the potential effect on ADF are non-spatial. Such factors were underseen in many studies focusing mainly on the spatial dimensions of ADF. We recommended that all possible spatial and non-spatial factors together should be taken into account as part of an integrated index of ADF

Aspects of User Profiling in Computer-based Health Information Tailoring Systems: A Narrative Review

Introduction: The recent shift from the conventional physician-centered approach to the more polpular approach that with the focuse on patient as the center of healthcare, emphaizes on the critical role of informing and educating patients. Studies shown that tailoring health information to the needs of individuals is more effective than generic materials. Recent improvements in the fields of computer science and Information Communication Technology have made it possible to computerize such an adaptation process. Information tailoring systems use an internal representation of user conditions and needs, which is referred to as a “user model” or “user profile.” A user profile represents the system’s beliefs about the user. Hence, it may simply contain demographic information or sophisticated factors such as the state of the disease, user’s attitude, interest, preference, and knowledge. The user profile is known as the basis for designing other system components and has a great impact on the acceptance of the system by the user and the quality of the tailored information. To the best of our knowledge, no studies have been conducted so far to analyze and classify user profile aspects and characteristics. In this systematic narrative review, we aim to provide aspects of profiling in health information tailoring systems based on literature from different disciplines. Methods: comprehensive searches of the PubMed and Scopus databases have been conducted. We searched among English papers with publishing dates ranging from 1990 onward; since that is when computer-tailoring first appeared within the literature. we have devised a list of terms pertinent to the main concepts of computer-tailoring and used a qualitative–interpretive approach for data extraction. Results: Analyzing the data from 32 eligible studies, we found three aspects in designing a tailoring user profile. Each aspect with its characteristics are provided below: 1-Identifying common factors used in profiles and classifying these factors thematically, which has three attributes: The number of factors used to design the user profile and their diversity (e.g. demographic,clinical,behavioral information, learning style and so forth) The approaches used to Identify effective factors in tailoring (e.g. evidence-based, avalible data sources) Attributes of the factors (e.g. long-term/short-term, static/dynamic) &nbsp;2-Data collection tools and methods, which has two attributes: Data collection methods (e.g. explicit, implicit, mixed) Assessment tool (e.g. questionnaire, patient record) 3-Data interpretation that demonstrates to what extent the collected data needs to be analyzed to use in tailoring. we have also identified two main approaches regarding tailoring: public health and computational tailoring. Public Health communication researcher has relied greatly on health behavior models but generally has used simpler technological approaches, whereas computer science employed more advanced technological approaches but integrated behavior theory to a lesser extent. These two approaches complete each other to provide the necessary requirements for designing a practical tailoring system in future studies. Conclusion: In this study we investigate different aspects of designing a user profile in health information tailoring systems. The proposed model is a valuable guide for new researchers in the field. Results from this review provide a comprehensive overview of the field and will help researchers to combine effective methods from across the disciplines in future research

Usability Evaluation of an Admission, Discharge, and Transfer Information System: A Heuristic Evaluation

BACKGROUND: Admission, discharge and, transfer (ADT) process is one of the most important hospital workflows. ADT system is a part of a hospital information system (HIS). AIM: The objective of this study was to evaluate the usability of the ADT system. METHODS: The study performed at Mashhad University of Medical Sciences (MUMS) hospitals. Data collection instrument was a validated checklist of Pierotti heuristic evaluation. To determine the severity of usability problems, a hybrid of Nielson and Tampere unit for computer-human interaction (TAUCHI) severity scaling algorithm was used. Usability problems were divided into five categories (major, severe, minor, cosmetic, and technical). Six experts evaluated the ADT system independently. According to TAUCHI severity scale, if a feature has not yet been implemented in the ADT system, evaluators considered it a technical usability problem. Therefore, usability problems due to non-design feature in the ADT system were identified. Finally, the mean severity of each usability problems was calculated. RESULTS: A total of 186 usability problems were identified. The frequency of major, sever, minor and cosmetic usability problems were 2, 65, 69 and 50, respectively. A total of 55 usability problems by the evaluators were recognised as technical problems. The highest mismatch with usability principles was related to the “recognition rather than recallâ€. The range of the mean severity of usability problems was between 0-2.31. CONCLUSIONS: Our result showed that although implementation of IHIS on a large scale, it still suffered from unresolved usability problems. Identification of usability problems and evaluation of their level of severity, which was simultaneously performed in this study, can be used as a guide to evaluate the usability of other HISs

Determining Risk Factors for Gastric and Esophageal Cancers between 2009-2015 in East-Azarbayjan, Iran Using Parametric Survival Models

BACKGROUND: Esophageal cancer (EC) and Gastric cancer (GC) have been identified as two of the most common cancers in the northeastern regions of Iran. The increasing rates of these types of cancers requires attention. This study aims to assess the potential risk factors for these two cancers and then determine shared risk factors between them in a population of Iranian patients using parametric survival models. METHODS: This retrospective cohort study was conducted using 127 patients with EC and 184 patients with GC in East Azarbaijan, Iran who were diagnosed and registered during the years 2009-2010 in Iran’s National Cancer Control Registration Program and were followed for five years. Parametric survival models were used to find the risk factors of the patients. Akaike Information Criteria was used to identify the best parametric model in this study. Interaction analysis was used to determine shared risk factors between EC and GC. RESULTS: The mean (±standard deviation) age of diagnoses for EC and GC were 66.92(±11.95) and 66.5(±11.5) respectively. The survival time ranges of GC patients was (0.07-70.33) and the survival time ranges were from 0.10 to 69.03 months for EC patients. Multivariable Log- logistic model showed that being married (OR=2.25, 95% CI: 1.33 - 3.81) for EC patients and Esophagectomy surgery for EC (OR: 1.62, 95% CI: 1.04 – 2.55) and GC (OR: 1.60, 95% CI: 1.02 – 2.53) had significant effects on survival. Age at the time of diagnosis, job status, and Esophagectomy surgery were statistically comparable regarding their magnitude of effect on survival of two cancers (all Ps>0.05). CONCLUSION: Esophagectomy surgery and being married were important risk factors in EC and GC. The log-logistic model was the most appropriate statistical approach to identify significant risk factors on survival of both cancers. Creative Commons Attribution License KEYWORDS: Esophageal neoplasm; stomach neoplasm; survival analysi