Mobile phone usage in patients with type II diabetes and their intention to use it for self-management: A cross-sectional study in Iran

Background: Mobile health has potential for promotion of self-management in patients with chronic diseases. This study was conducted to investigate smartphone usage in patients with type II diabetes and their intention to use it for self-management. Methods: This cross-sectional study was conducted in 2018 with 176 patients with type II diabetes visiting a specialized diabetes clinic or one of two endocrinology and metabolism specialists in north of Iran. Data were collected using a validated questionnaire containing items on demographic characteristics, disease information, use of mobile phones, smartphones and the internet, and intention to use mobile phones for diabetes self-management. Results: The majority of the participants had mobile phones (94.9), smartphones (61.1), and daily access to the internet (81.3), and used phones two hours per day on average (80.1). They mostly used mobile phones to contact friends (89.2) and search for information (50.6), and their greatest intention for using smartphones and the internet for self-management was related to dietary planning (96), checking blood glucose (90.9), and contacting specialists (87.5). Younger participants were more interested in using smartphone applications (apps) (P < 0.001). About half of the participants argued that using apps can be interesting (54) and useful (50) for diabetes management, and intended to use apps much more in future (48.3). Conclusions: The majority of patients with type II diabetes are inclined to use mobile phone and the Internet, especially to plan their diet, check blood glucose, and contact their doctors. The present study provides valuable information for designing and implementing interventions based on mHealth to promote self-management in type II diabetes. © 2020 The Author(s)

Technical requirements framework of hospital information systems: Design and evaluation

Background: Implementing the health information system (HIS) is more complex and costly than implementing other information systems. The present study was conducted to design and evaluate technical requirements for the HIS. Methods: The present study was conducted in 2016 by determining technical requirements for the HIS using the Delphi technique and then evaluating this system using a checklist based on the approved requirements. Results: The first part of the study designed a 73-item final list of technical requirements for the HIS in four domains, i.e. communication service, system architecture, security service and system response time. The evaluation results obtained in the second part showed that communication service was met in 63.8 of the HIS programs, system architecture in 65.5, security service in 72.4 and system response time in 76.3. Conclusions: A technical evaluation tool was designed and used to select and evaluate the HIS. The evaluation results suggested the study HIS was poorer in terms of communication service and system architecture than in the other two dimensions. © 2020 The Author(s)

Risk factors of regression and undercorrection in photorefractive keratectomy: A case-control study

�AIM: To determine risk factors of regression and undercorrection following photorefractive keratectomy (PRK) in myopia or myopic astigmatism. �METHODS: A case-control study was designed in which eyes with an indication for re-treatment (RT) were defined as cases; primary criteria for RT indication, as assessed at least 9mo postoperatively, included an uncorrected distance visual acuity (UDVA) of 20/30 or worse and a stable refraction for more than 3mo. Additional considerations included optical quality symptoms and significant higher order aberrations (HOAs). Controls were chosen from the same cohort of operated eyes which had complete post-operative follow up data beyond 9mo and did not need RT. The cohort included patients who had undergone PRK by the Tissue-Saving (TS) ablation profile of Technolas 217z100 excimer laser (Bausch & Lomb, Rochester, NY, USA). Mitomycin C had been used in all of the primary procedures. �RESULTS: We had 70 case eyes and 158 control eyes, and they were comparable in terms of age, sex and follow-up time (P values:0.58, 1.00 and 0.89, respectively). Pre-operative spherical equivalent of more than -5.00 diopter (D), intended optical zone (OZ) diameter of less than 6.00 mm and ocular fixation instability during laser ablation were associated with RT indications (all P values -5.00 D), smaller OZ (<6.00 mm) and unstable fixation during laser ablation of PRK for myopia and myopic astigmatism were found to be strong predictors of undercorrection and regression. © 2015 International Journal of Ophthalmology (c/o Editorial Office). All Rights Reserved

A survey of attitudes, practices, and knowledge regarding drug-drug interactions among medical residents in Iran

Background When prescribing medications, physicians should recognize clinically relevant potential drug–drug interactions (DDIs). To improve medication safety, it is important to understand prescribers’ knowledge and opinions pertaining to DDIs. Objective To determine the current DDI information sources used by medical residents, their knowledge of DDIs, their opinions about performance feedback on co-prescription of interacting drugs. Setting Academic hospitals of Mashhad University of Medical Sciences (MUMS) in Iran. Methods A questionnaire containing questions regarding demographic and practice characteristics, DDI information sources, ability to recognize DDIs, and opinions about performance feedback was distributed to medical residents of 22 specialties in eight academic hospitals in Iran. We analyzed their perception pertaining to DDIs, their performance on classifying drug pairs, and we used a linear regression model to assess the association of potential determinants on their DDI knowledge. Main Outcome Measure prescribers’ knowledge and opinions pertaining to DDIs. Results The overall response rate and completion rate for 315 distributed questionnaires were 90% (n = 295) and 86% (n = 281), respectively. Among DDI information sources, books, software on mobile phone or tablet, and Internet were the most commonly-used references. Residents could correctly classify only 41% (5.7/14) of the drug pairs. The regression model showed no significant association between residents’ characteristics and their DDI knowledge. An overwhelming majority of the respondents (n = 268, 95.4%) wished to receive performance feedback on co-prescription of interacting drugs in their prescriptions. They mostly selected information technology-based tools (i.e. short text message and email) as their preferred method of receiving feedback. Conclusion Our findings indicate that prescribers may have poor ability to prevent clinically relevant potential DDI occurrence, and they perceive the need for performance feedback. These findings underline the importance of well-designed computerized alerting systems and delivering performance feedback to improve patient safety

Fuzzy decision support systems to diagnose musculoskeletal disorders: A systematic literature review

Abstract Background and objective Musculoskeletal disorders (MSDs) are one of the most important causes of disability with a high prevalence. The accurate and timely diagnosis of these disorders is often difficult. Clinical decision support systems (CDSSs) can help physicians to diagnose diseases quickly and accurately. Given the ambiguous nature of MSDs, fuzzy logic can be helpful in designing the CDSSs knowledge bases. The present study aimed to review the studies on fuzzy CDSSs to diagnose MSDs. Methods A comprehensive search was conducted in Medline, Scopus, Cochrane Library, and ISI Web of Science databases to identify relevant studies published until March 15, 2016. Studies were included in which CDSSs were developed using fuzzy logic to diagnose MSDs, and tested their accuracy using real data from patients. Results Of the 3188 papers examined, 23 papers included according to the inclusion criteria. The results showed that among all the designed CDSSs only one (CADIAG-2) was implemented in the clinical environment. In about half of the included studies (52%), CDSSs were designed to diagnose inflammatory/infectious disorder of the bone and joint. In most of the included studies (70%), the knowledge was extracted using a combination of three methods (acquiring from experts, analyzing the data, and reviewing the literature). The median accuracy of fuzzy rule-based CDSSs was 91% and it was 90% for other fuzzy models. The most frequently used membership functions were triangular and trapezoidal functions, and the most used method for inference was the Mamdani. Conclusions In general, fuzzy CDSSs have a high accuracy to diagnose MSDs. Despite the high accuracy, these systems have been used to a limited extent in the clinical environments. To design of knowledge base for CDSSs to diagnose MSDs, rule-based methods are used more than other fuzzy methods. Keywords Musculoskeletal disorders Decision support systems Fuzzy logic Diagnose Revie

Effects of Computerized Decision Support Systems on Management of Atrial Fibrillation: A Scoping Review

Background: Potential role of computerized decision support system on management of atrial fibrillation is not well understood. Objectives: To systematically review studies that evaluate the effects of computerized decision support systems and decision aids on aspects pertaining to atrial fibrillation. Data sources: We searched Medline, Scopus and Cochrane database. Last date of search was 2016, January 10. Selection criteria: Computerized decision support systems that help manage atrial fibrillation and decision aids that provide useful knowledge for patients with atrial fibrillation and help them to self-care. Data collection and analysis: Two reviewers extracted data and summarized findings. Due to heterogeneity, meta-analysis was not feasible; mean differences of outcomes and confidence intervals for a difference between two Means were reported. Results: Seven eligible studies were included in the final review. There were one observational study without controls, three observational studies with controls, one Non-Randomized Controlled Trial and two Randomized Controlled Trials. The interventions were three decision aids that were used by patients and four computerized decision support systems. Main outcomes of studies were: stroke events and major bleeding (one article), Changing doctor-nurse behavior (three articles), Time in therapeutic International Normalized Ratio range (one article), decision conflict scale (two articles), patient knowledge and anxiety about stroke and bleeding (two articles). Conclusions: A computerized decision support system may decrease decision conflict and increase knowledge of patients with atrial fibrillation (AF) about risks of AF and AF treatments. Effect of computerized decision support system on outcomes such as changing doctor-nurse behavior, anxiety about stroke and bleeding and stroke events could not be shown.We need more studies to evaluate the role of computerized decision support system in patients with atrial fibrillation

Corrigendum to �Usability evaluation of a comprehensive national health information system: A heuristic evaluation� Inf Med Unlocked 19 (2020) 100332(S2352914820301064)(10.1016/j.imu.2020.100332)

The authors regret for the inconvenience. After reviewing the article, we determined that the grant number is not mentioned in the fund section. Please add the grant number 96049 to this section. Funding This study was funded by The Research Deputy of Kashan University of Medical Sciences under Grant (Number: 96049). The authors would like to apologise for any inconvenience caused. © 2020 The Author(s

Usability evaluation of a comprehensive national health information system: A heuristic evaluation

Aim: to evaluate the usability of a comprehensive national health information system by the heuristic method. Introduction: Presently, information systems are widely being used in healthcare settings. Methods: Five independent evaluators assessed the user interface design of this system in terms of its compliance with a set of predetermined standard principles, also known as Jakob Nielsen's 10 general principles. Problems were reassessed in the presence of all evaluators, and similar cases were merged and a single list of unique problems was prepared. After a second assessment, the evaluators determined and categorized problem severity in five domains, including: the absence of a problem (zero point), a cosmetic problem (1 point), a minor problem (2 points), a major problem (3 points) and a catastrophic problem (4 points). Data were then analyzed in a spreadsheet using descriptive statistical tests. Results: The “recognition rather than recall” principle with 13 problems (21.3 of all cases) had the greatest frequency among all problems, while the “match between system and the real world” and “help and documentation” principles with 1 problem (1.6 of all cases) had the least frequency. Moreover, principles such as “help users recognize, diagnose and recover from errors”, “error prevention”, and “help and documentation” had a mean severity of 2.8, 2.8, and 3.4, respectively. Consequently, they were considered as catastrophic and major problems. Conclusions: Based on the viewpoint of evaluation experts, a large portion of problems in this system were classified into major and catastrophic categories, which primarily indicates the poor usability of this system. Therefore, it is highly recommended that authorities be notified of the issues in writing in order to resolve them in a future update. Finally, special consideration should be given to the meticulous evaluation of these systems during preliminary stages of design and development, so as to encounter fewer issues on a national level at the time of implementation. © 2020 The Author

High prevalence of refractive errors in 7 year old children in Iran

Background: The latest WHO report indicates that refractive errors are the leading cause of visual impairment throughout the world. The aim of this study was to determine the prevalence of myopia, hyperopia, and astigmatism in 7 yr old children in Iran. Methods: In a cross-sectional study in 2013 with multistage cluster sampling, first graders were randomly selected from 8 cities in Iran. All children were tested by an optometrist for uncorrected and corrected vision, and non-cycloplegic and cycloplegic refraction. Refractive errors in this study were determined based on spherical equivalent (SE) cyloplegic refraction. Results: From 4614 selected children, 89.0 participated in the study, and 4072 were eligible. The prevalence rates of myopia, hyperopia and astigmatism were 3.04 (95 CI: 2.30-3.78), 6.20 (95 CI: 5.27-7.14), and 17.43 (95 CI: 15.39-19.46), respectively. Prevalence of myopia (P=0.925) and astigmatism (P=0.056) were not statistically significantly different between the two genders, but the odds of hyperopia were 1.11 (95 CI: 1.01-2.05) times higher in girls (P=0.011). The prevalence of with-the-rule astigmatism was 12.59, against-the-rule was 2.07, and oblique 2.65. Overall, 22.8 (95 CI: 19.7-24.9) of the schoolchildren in this study had at least one type of refractive error. Conclusion: One out of every 5 schoolchildren had some refractive error. Conducting multicenter studies throughout the Middle East can be very helpful in understanding the current distribution patterns and etiology of refractive errors compared to the previous decade. © 2016. Iranian Journal of Public Health. All Right Reserved

Usability evaluation of three admission and medical records subsystems integrated into nationwide hospital information systems: Heuristic evaluation

Introduction: Usability is one of the quality criteria for information systems and its weakness is one of the main barriers to the adoption of these systems. The purpose of this study was to evaluate the usability of admission and medical records module of three widely used hospital information systems (HISs). Methods: In this descriptive study the usability of admission and medical records module of three HISs (HIS1, HIS2, and HIS3) was evaluated using heuristic evaluation method. For each HIS, three expert users of the same system assessed the user interface independently, completed a usability evaluation checklist, and rated severity of each identified problem. The checklist was based on Nielsen's heuristics. For each HIS, three heuristics that have the highest and lowest problem rates and greatest severity of problems were categorized into three separate groups. The results were analyzed using descriptive statistics. Results: Although HIS1 and HIS2 were used in more hospitals than HIS3, the results showed that the usability problem rates of them were significantly higher than HIS3. The heuristics of "help and documentation", "flexibility and efficiency of use", and "visibility of system status" in the three HISs were categorized into the "highest rate of problems", "lowest rate of problems", and "highest severity of problems" groups, respectively. The heuristics of "diagnose and recover from errors", "error prevention", and "help and documentation" in HIS1 and HIS2 were categorized into the "highest rate of problems" group. Conclusions: The results of this study and previous studies show that the most common usability problems with HISs are related to heuristics of "help and documentation", "error prevention", and "help users recognize, diagnose and recover from errors." Also, the large number of hospitals using one HIS does not demonstrate its high usability to others. © 2018 Mehrdad Farzandipour, Ehsan Nabovati, Gholam-Hosein Zaeimi, Reza Khajouei