Tecnologias em saúde da hanseníase no âmbito da Atenção Primária à Saúde: revisão de escopo / Leprosy health technologies in Primary Health Care: a scoping review / Tecnologías en salud de la lepra en el ámbito de la Atención Primaria a la Salud: revisión del alcance

Objetivo: mapear as tecnologias em saúde para manejo no cuidado à pessoa com hanseníase na Atenção Primária à Saúde. Método: revisão de escopo baseada na metodologia do JBI, em seis bases de dados, seguindo a checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Foram incluídos estudos publicados em qualquer idioma, com diferentes abordagens metodológicas. Resultados: os 14 estudos incluídos na revisão mostram que a aplicabilidade de tecnologias para o manejo do cuidado a pessoa com hanseníase na Atenção Primária à Saúde, possibilitam a confirmação de diagnóstico, acompanhamento, monitoramento e prevenção de incapacidades. Conclusão: nota-se que tecnologia em saúde se apresentam como ferramentas que auxiliam no processo de cuidado na assistência a pessoas com hanseníase, a fim de permitir aos profissionais de saúde conhecimento sobre a doença, proporcionando qualidade na sua prática de saúde.

Objective: to map health technologies for managing the care of people with leprosy in Primary Health Care. Method: scoping review based on the JBI methodology in six databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Studies published in any language were included, with different methodological approaches. Results: the 14 studies included in the review show that the applicability of technologies for the management of care for people with leprosy in Primary Health Care makes it possible to confirm diagnosis, follow-up, monitoring, and prevention of disabilities. Conclusion: it has been noted that health technologies are tools that help in the process of caring for people with leprosy, to provide health professionals with knowledge about the disease, improving quality of health practice.

Objetivo: mapear las tecnologías en salud para el manejo en el cuidado a la persona con lepra en la Atención Primaria a la Salud. Método: revisión del alcance basada en la metodología del JBI, en seis bases de datos, siguiendo la checklist Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Se han incluido estudios publicados en cualquier idioma, con diferentes enfoques metodológicos. Resultados: los 14 estudios incluidos en la revisión muestran que la aplicabilidad de tecnologías para el manejo del cuidado a la persona con lepra en la Atención Primaria a la Salud posibilita la confirmación de diagnóstico, seguimiento, monitoreo y prevención de incapacidades. Conclusión: se percibe que las tecnologías en salud se presentan como herramientas que ayudan en el proceso de cuidado en la asistencia a personas con lepra, con fines de permitir a los profesionales de salud el acceso al conocimiento sobre la enfermedad, proporcionando calidad en su práctica de salud.

[Challenges to the Digital Inclusion of Women in a Vulnerable Area in ColombiaDesafios da inclusão digital das mulheres em uma área vulnerável na Colômbia]. / Desafíos de la inclusión digital de la mujer en una zona en condiciones de vulnerabilidad en Colombia.

Objective: To identify women's technological capabilities and describe their appropriation and use of technology in a community in a vulnerable area of Colombia. Method: Observational cross-sectional study conducted in the subregion of Urabá, Colombia. A survey was conducted in primary health care centers, in which 1478 women between 18 and 49 years of age responded to questions about their technological capabilities, their experience with the use of web-based information, and their appropriation of technology. Results: Access to and use of information and communication technologies (ICTs) varied according to age, educational level, and socioeconomic stratum, with observed differences in preferences and critical consumption of information. Conclusion: The women in this study faced multiple access barriers to appropriate use of ICTs for health promotion. The appropriation of these tools in Colombia, specifically in the Urabá subregion, is a complex challenge that requires a comprehensive and multidimensional approach.

Objetivo: Identificar as capacidades tecnológicas e descrever a apropriação de uso em uma comunidade de mulheres em uma área vulnerável na Colômbia. Método: Estudo observacional transversal realizado na sub-região de Urabá (Colômbia). Realizou-se uma pesquisa com 1478 mulheres de 18 a 49 anos em centros de atenção primária à saúde sobre suas capacidades tecnológicas, experiências com o uso de informações disponíveis na internet e apropriação da tecnologia. Resultados: O acesso e uso das tecnologias da informação e da comunicação (TIC) variaram de acordo com a idade, a escolaridade e o nível socioeconômico, com diferenças nas preferências quanto às informações e ao consumo crítico de informações. Conclusão: O estudo demonstra que as mulheres enfrentam várias barreiras de acesso ao uso adequado das TIC para a promoção da saúde. A apropriação dessas ferramentas na Colômbia, especificamente na sub-região de Urabá, é um desafio complexo que demanda uma abordagem integral e multidimensional.

Understanding prescribing errors for system optimisation: the technology-related error mechanism classification.

OBJECTIVES: Technology-related prescribing errors curtail the positive impacts of computerised provider order entry (CPOE) on medication safety. Understanding how technology-related errors (TREs) occur can inform CPOE optimisation. Previously, we developed a classification of the underlying mechanisms of TREs using prescribing error data from two adult hospitals. Our objective was to update the classification using paediatric prescribing error data and to assess the reliability with which reviewers could independently apply the classification. MATERIALS AND METHODS: Using data on 1696 prescribing errors identified by chart review in 2016 and 2017 at a tertiary paediatric hospital, we identified errors that were technology-related. These errors were investigated to classify their underlying mechanisms using our previously developed classification, and new categories were added based on the data. A two-step process was used to identify and classify TREs involving a review of the error in the CPOE and simulating the error in the CPOE testing environment. RESULTS: The technology-related error mechanism (TREM) classification comprises six mechanism categories, one contributing factor and 19 subcategories. The categories are as follows: (1) incorrect system configuration or system malfunction, (2) opening or using the wrong patient record, (3) selection errors, (4) construction errors, (5) editing errors, (6) errors that occur when using workflows that differ from a paper-based system (7) contributing factor: use of hybrid systems. CONCLUSION: TREs remain a critical issue for CPOE. The updated TREM classification provides a systematic means of assessing and monitoring TREs to inform and prioritise system improvements and has now been updated for the paediatric setting.

Factors Affecting Managers' Technology Adoption Decisions in Long-Term Care Homes: A Canadian Exploratory Study Post-COVID-19 Pandemic.

Health information technologies (HIT) provide opportunities to support staff as well as residents and their families in long-term care (LTC) homes. Yet, LTC homes lag behind other healthcare organizations in HIT adoption, and little is known about the factors that inform and shape LTC home managers' decisions. We conducted an exploratory Delphi study with a panel of 19 Canadian LTC managers who were surveyed through three iterative rounds (brainstorming, narrowing down, and ranking) to solicit their input on the key factors that influence HIT adoption decisions. An authoritative list of 25 factors, described and ranked in importance, was produced. The top five identified factors were (in order of importance): availability of funding, impact on workload and efficiency, value proposition, ease of use, and impact on residents' outcomes. The findings of this research may inform policies and interventions that provide training and workshop opportunities for managers in LTC and increase the awareness of the advocacy and leadership role that managers can play in advancing technology adoption in support of older adults' care. The results can also be used to support funding from LTC home governing bodies, which is tied to the technology adoption portfolio, to institutionalize the commitment to technological transformation in LTC.

Evaluating the Economic Impact of the PedAMINES App in Reducing Medication Errors in Pediatric Emergency Care: Cost-Effectiveness Analysis.

BACKGROUND: The administration of drugs in pediatric emergency care is a time-consuming process and is associated with a higher occurrence of medication errors compared with adult care. This is attributed to the intricacies of administration, which involve calculating doses based on the child's weight or age. To mitigate the occurrence of adverse drug events (ADEs), the PedAMINES (Pediatric Accurate Medication in Emergency Situations; Geneva University Hospitals) mobile app has been developed. This app offers a step-by-step guide for preparing and administering pediatric drugs during emergency interventions by automating the dose calculation process. Although previous simulation-based randomized controlled trials conducted in emergency care have demonstrated the efficacy of the PedAMINES app in reducing drug administration errors, there is a lack of evidence regarding its economic implications. OBJECTIVE: This study aims to evaluate the cost-effectiveness of implementing the PedAMINES app for 4 emergency drugs: epinephrine, norepinephrine, dopamine, and midazolam. METHODS: The economic evaluation was conducted by combining hospital data from 2019, previous trial outcomes, information extracted from existing literature, and PedAMINES maintenance costs. The cost per avoided medication error was calculated, along with the number of administrations needed to achieve a positive return on investment. Subsequently, Monte Carlo simulations were used to identify the key parameters contributing to result uncertainty. RESULTS: The study revealed the number of preventable errors per administration for the 4 examined drugs: 0.513 for epinephrine, 0.484 for norepinephrine, 0.500 for dopamine, and 0.671 for midazolam. The cost-effectiveness ratios per ADE prevented were computed as follows: US $4808 for epinephrine, US $9705 for norepinephrine, US $6957 for dopamine, and US $2074 for midazolam. Accounting for the economic impact of ADEs, the analysis estimated that 16 administrations of epinephrine, 17 of norepinephrine and dopamine, and 13 of midazolam would be required to attain a positive return on investment. This corresponds to roughly one-third of the annual administrations at a major university hospital in Switzerland. The primary factors influencing the uncertainty in the estimated cost per ADE include the cost of maintenance of the app, the likelihood of an ADE resulting from an administration error, and the frequency of underdosing in the trial's control group. CONCLUSIONS: A dedicated mobile app presents an economically viable solution to alleviate the health and economic burden of drug administration errors in in-hospital pediatric emergency care. The widespread adoption of this app is advocated to pool costs and extend the benefits on a national scale in Switzerland.

Only One Quarter of Family Physicians Are Very Satisfied with Their Electronic Health Records Platform.

Two decades into the era of Electronic Health Records (EHRs), the promise of streamlining clinical care, reducing burden, and improving patient outcomes has yet to be realized. A cross-sectional family physician census conducted by the American Board of Family Medicine in 2022 and 2023 included self-reported physician EHR satisfaction. Of the nearly 10,000 responding family physicians, only one-in-four (26.2%) report being very satisfied and one-in-three (33.8%) were not satisfied. These low levels of satisfaction point to the need for greater transparency in the marketplace and pressure to increase user-centric EHR design.

Family Medicine Must Prepare for Artificial Intelligence.

Artificial Intelligence (AI) is poised to revolutionize family medicine, offering a transformative approach to achieving the Quintuple Aim. This article examines the imperative for family medicine to adapt to the rapidly evolving field of AI, with an emphasis on its integration in clinical practice. AI's recent advancements have the potential to significantly transform health care. We argue for the proactive engagement of family medicine in directing AI technologies toward enhancing the "Quintuple Aim."The article highlights potential benefits of AI, such as improved patient outcomes through enhanced diagnostic tools, clinician well-being through reduced administrative burdens, and the promotion of health equity by analyzing diverse data sets. However, we also acknowledge the risks associated with AI, including the potential for automation to diverge from patient-centered care and exacerbate health care disparities. Our recommendations stress the need for family medicine education to incorporate AI literacy, the development of a collaborative for AI integration, and the establishment of guidelines and standards through interdisciplinary cooperation. We conclude that although AI poses challenges, its responsible and ethical implementation can revolutionize family medicine, optimizing patient care and enhancing the role of clinicians in a technology-driven future.

The Understanding America Study (UAS).

PURPOSE: The Understanding America Study (UAS) is a probability-based Internet panel housed at the Center for Economic and Social Research at the University of Southern California (USC). The UAS serves as a social and health sciences infrastructure for collecting data on the daily lives of US families and individuals. The collected information includes survey data, DNA from saliva samples, information from wearables, contextual and administrative linkages, ecological momentary assessments, self-recorded narratives and electronic records of financial transactions. The information collected focuses on a defining challenge of our time-identifying factors explaining racial, ethnic, geographic and socioeconomic disparities over the life course, including racial discrimination, inequalities in access to education and healthcare, differences in physical, economic and social environments, and, more generally, the various opportunities and obstacles one encounters over the life course. The UAS infrastructure aims to optimise engagement with the wider research community both in data dissemination and in soliciting input on content and methods. To encourage input from the research community, we have reserved 100 000 min of survey time per year for outside researchers, who can propose to add survey questions four times a year. PARTICIPANTS: The UAS currently comprises about 15 000 US residents (including a 3500-person California oversample) recruited by Address-Based Sampling and provided with Internet-enabled tablets if needed. Surveys are conducted in English and Spanish. FINDINGS TO DATE: Since the founding of the UAS in 2014, we have conducted more than 600 surveys, including a sequence of surveys collecting biennial information on health and retirement (the complete Health and Retirement Study instrument), 11 cognitive assessments, personality, knowledge and use of information on Social Security programme rules, work disability and subjective well-being. Several hundreds of papers have been published based on the collected data in the UAS. Studies include documentations of the mental health effects of the COVID-19 pandemic and how this varied across socioeconomic groups; comparisons of physical activity measured with accelerometers and by self-reports showing the dramatic biases in the latter; extensive studies have shown the power of using paradata in gauging cognitive change over time; several messaging experiments have shown the effectiveness of information provision on the quality of decision-making affecting well-being at older ages. FUTURE PLANS: The UAS national sample is planned to grow to 20 000 respondents by 2025, with subsamples of about 2500 African American, 2000 Asian and 3000 Hispanic participants and an oversample of rural areas. An increasing amount of non-interview data (contextual information, data from a suite of wearables and administrative linkages) is continually being added to the data files.

Mediation effect of knowledge management on the impact of IT capability on firm performance: exploring the moderating role of organization culture management.

Introduction: With the development of the digital economy, a multitude of firms have embarked on the path of digital transformation through information technology (IT). Scholars have called for attention to the mediating or moderating mechanisms of IT capability on firm performance. This study argues that further exploration is needed regarding the relationship between IT capability and firm performance. Methods: This study obtained questionnaire data from 152 IT senior managers of randomly selected manufacturing firms. The data was used to empirically test the proposed hypotheses using hierarchical regression analysis. Results: The results showed that IT capability has a positive effect on firm performance directly and indirectly via knowledge stock and knowledge process. Moreover, organizational culture management moderates the relationship between knowledge stock/knowledge process, and firm performance. Discussion: This study proposes the "resources-knowledge-performance" mechanism, which sheds light on the "black box" of how IT capability affects firm performance. This enriches the research on knowledge from different perspectives and the the research on organizational culture by discussing the moderating role of organizational culture management in the relationship between knowledge stock/process and firm performance. Our research also has important managerial implications to firm.

A Dynamic System to Control the Entry of Non-Authorized Visitors and Detect Superspreader Farms in Strongly Interconnected Systems.

This study explores the critical challenges the livestock sector faces, particularly those related to biosecurity, animal welfare, and antibiotic use restrictions. It highlights the need to implement advanced information and communication technologies to enhance operational sustainability and decision-making. We introduce the Biorisk® External platform, a cloud-based visit control system designed to optimize biosecurity management by accurately tracking visitor activity through QR codes and GPS geolocation. During a 6-month study period from July to December 2023, we analyzed visits to 142 different swine production sites and 30 vehicle movement patterns. The analysis revealed trends in visitation patterns and compliance with biosecurity SOPs. The software categorized visits as authorized (A), not authorized with access (NAWA), and not authorized without access (NAWOA), providing a framework to assess biosecurity risks. Additionally, network analysis identified interconnected farms, which were classified as 'superspreaders', highlighting their considerable risk of disease transmission. This study advocates for the integration of digital systems in livestock operations to improve biosecurity measures, facilitate real-time data input, and support informed decision-making. By enhancing biosecurity protocols through technology, the livestock industry can better safeguard animal health, increase operational efficiency, and reduce potential economic losses associated with disease outbreaks.

Chain community pharmacists' requests for patient information during routine care.

BACKGROUND: To optimize service provision, community pharmacists need information (e.g., laboratory values and updated medication lists), which can be difficult to obtain. Contacting prescriber offices is a common approach to obtain information but is often ineffective. Health information exchange (HIE) is one potential solution to this problem, and recent survey research has identified the information needs of independent pharmacists that could be addressed through HIE. However, the information needs of chain community pharmacists are unknown. OBJECTIVES: The objective of this study was to characterize the patient information requests made by chain community pharmacists during routine practice. METHODS: This electronic card study captured cross-sectional observational data on patient information requests made by chain pharmacists in central Indiana during routine practice. Only one pharmacist meeting eligibility criteria per pharmacy could submit data. Pharmacists were randomized to a two-week data collection period. In real-time, pharmacists recorded the following: type of information requested, reason for request, information source, whether initial or follow up request, modality of communication, and the time required to make the request. Data analysis occurred via descriptive statistics. The Indiana University Institutional Review Board approved all study procedures. RESULTS: Nineteen of the 33 eligible pharmacists (57.6%) consented to the study. Most participants held a PharmD degree (78.9%) and were the pharmacy manager (89.5%) at their location. Updated medication orders/lists (41.3%) and insurance (33.3%) were the most common type of requested information and was primarily used for prescription clarification/filling (93.4%). The prescriber office (53.6%), as well as the patient/caregiver (39.8%), were the most frequent source of this information. Requests were largely completed by telephone (61.2%) and averaged 6.0 minutes (SD: 4.8). CONCLUSION: Community pharmacists require key patient data during routine practice. There is a need to develop mechanisms, like HIE, to address gaps in needed information in the community pharmacy setting, regardless of the offered services.

Understanding Patient Portal Uses and Needs: Cross-Sectional Study in a State Fair Setting.

This study identified 22 features that are used and the needs for desired features/data in patient portals that enable online access to medical records. Data collected at a Midwestern state fair indicates that while most participants used patient portals, use and desirability of specific features varied widely. Identified needs for enhanced data access, portal functionality, and usability can be used to inform effective patient portal design.

Internet self-efficacy moderates the association of information technology ability with successful ageing among older employees in three African samples.

The literature suggests that two distinct competencies [i.e., information technology ability (ITA), and internet self-efficacy] are necessary for the effective use of information technologies for successful ageing, but no study has examined the association of these skills on successful ageing and its domains (i.e., illness avoidance, functioning, and engagement with life). This study investigated whether Internet Self-Efficacy (ISE) moderates the potential association of ITA with successful ageing. The study adopted a cross-sectional design based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and includes measures against confounding and common methods bias. The participants were 1186 older workers aged 50 years or older in three African countries (Kenya = 350; Nigeria = 260; Ghana = 576). The minimum sample size necessary was calculated, and data were analysed with hierarchical linear regression analysis. After controlling for the covariates, ITA and ISE had a positive association with successful ageing as well as illness avoidance, functioning, and engagement with life in the whole sample. ITA was also positively associated with successful ageing and its domains in Kenya and Ghana. The associations of ITA with successful ageing and its domains were positively moderated by ISE in the whole sample and within each of the three samples. Higher ITA can be associated with successful ageing among working older adults, and ITA positively influences successful ageing at different levels of ISE. Older adults with high ITA are more likely to avoid illness at a higher ISE.

Clinical Outcomes of a Novel Multidisciplinary Care Program in Advanced Kidney Disease (PEAK).

Introduction: Multidisciplinary care (MDC) for late-stage chronic kidney disease (CKD) has been associated with improved patient outcomes compared with traditional nephrology care; however, the optimal MDC model is unknown. In 2015, we implemented a novel MDC model for patients with late-stage CKD informed by the Chronic Care Model conceptual framework, including an expanded MDC team, care plan meetings, clinical risk prediction, and a patient dashboard. Methods: We conducted a single-center, retrospective cohort study of adults with late-stage CKD (estimated glomerular filtration rate [eGFR] < 30 ml/min per 1.73 m2) enrolled from May 2015 to February 2020 in the Program for Education in Advanced Kidney Disease (PEAK). Our primary composite outcome was an optimal transition to end-stage kidney disease (ESKD) defined as starting in-center hemodialysis (ICHD) as an outpatient with an arteriovenous fistula (AVF) or graft (AVG), or receiving home dialysis, or a preemptive kidney transplant. Secondary outcomes included home dialysis initiation, preemptive transplantation, vascular access at dialysis initiation, and location of ICHD initiation. We used logistic regression to examine trends in outcomes. Results were stratified by race, ethnicity, and insurance payor, and compared with national and regional averages from the United States Renal Data System (USRDS) averaged from 2015 to 2019. Results: Among 489 patients in the PEAK program, 37 (8%) died prior to ESKD and 151 (31%) never progressed to ESKD. Of the 301 patients (62%) who progressed to ESKD, 175 (58%) achieved an optimal transition to ESKD, including 54 (18%) on peritoneal dialysis, 16 (5%) on home hemodialysis, and 36 (12%) to preemptive transplant. Of the 195 patients (65%) starting ICHD, 51% started with an AVF or AVG and 52% started as an outpatient. The likelihood of starting home dialysis increased by 1.34 times per year from 2015 to 2020 (95% confidence interval [CI]: 1.05-1.71, P = 0.018) in multivariable adjusted results. Optimal transitions to ESKD and home dialysis rates were higher than the national USRDS data (58% vs. 30%; 23% vs. 11%) across patient race, ethnicity, and payor. Conclusion: Patients enrolled in a novel comprehensive MDC model coupled with risk prediction and health information technology were nearly twice as likely to achieve an optimal transition to ESKD and start dialysis at home, compared with national averages.

Categorization of mHealth Coaching Technologies for Children or Adolescents With Type 1 Diabetes: Systematic Review.

Background: Managing type 1 diabetes in children and adolescents can be difficult for parents, health care professionals, and even patients. However, over the last decades, the quality of services provided to patients with diabetes has increased due to advances in IT. Objective: This study aims to comprehensively document the range of IT tools used in the management of diabetes among children and adolescents, with a focus on identifying the technologies most commonly used based on their frequency. In addition, the study aims to explore relevant methodologies for developing diabetes technology and provide valuable information to developers by delineating essential phases of the design process. Methods: The literature search was focused on MEDLINE (PubMed), Web of Science, and Google Scholar for relevant studies. Keywords such as "type 1 diabetes," "adolescents," "kids," "mHealth," "children," and "coaching" were combined using Boolean operators. The inclusion criteria were open access, English-language papers published between 2012 and 2023 focusing on patients younger than 18 years and aligned with our research goal. The exclusion criteria included irrelevant topics and papers older than 18 years. By applying the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method, 2080 studies were recognized, and after selection, 33 papers were agreed upon between the researchers. Results: Four primary categories were defined: types of IT, methodology identification, purpose identification, and feature determination. Among these, mobile health (mHealth) apps emerged as the predominant type of information, garnering 27 mentions. In particular, user-centered design was identified as the most prevalent methodology, cited 22 times. The primary purpose of self-monitoring blood glucose values was mentioned 20 times, while patient education was the highest among common characteristics, with 23 mentions. Conclusions: Based on our research, we advocate for developers to focus on creating an mHealth app that integrates gamification techniques to develop innovative diabetes management solutions. This app should include vital functionalities such as blood glucose monitoring, strategies to improve hemoglobin A1c levels, carbohydrate tracking, and comprehensive educational materials for patients and caregivers. By prioritizing these features, developers can enhance the usability and effectiveness of the technology, thereby better supporting children or adolescents with diabetes in their daily management endeavors.

Applying Implementation Science to Advance Electronic Health Record-Driven Learning Health Systems: Case Studies, Challenges, and Recommendations.

With the widespread implementation of electronic health records (EHRs), there has been significant progress in developing learning health systems (LHSs) aimed at improving health and health care delivery through rapid and continuous knowledge generation and translation. To support LHSs in achieving these goals, implementation science (IS) and its frameworks are increasingly being leveraged to ensure that LHSs are feasible, rapid, iterative, reliable, reproducible, equitable, and sustainable. However, 6 key challenges limit the application of IS to EHR-driven LHSs: barriers to team science, limited IS experience, data and technology limitations, time and resource constraints, the appropriateness of certain IS approaches, and equity considerations. Using 3 case studies from diverse health settings and 1 IS framework, we illustrate these challenges faced by LHSs and offer solutions to overcome the bottlenecks in applying IS and utilizing EHRs, which often stymie LHS progress. We discuss the lessons learned and provide recommendations for future research and practice, including the need for more guidance on the practical application of IS methods and a renewed emphasis on generating and accessing inclusive data.

Role of nurse informaticists in the implementation of Electronic Health Records (EHRs) at resource-limited settings.

Electronic health records (EHRs) play a critical role in the management of patient information and timely decision making in health facilities. In resource-limited settings, especially low- and middle-income countries (LMICs), nurse informaticists play a pivotal role in the implementation of EHRs. This article underscores their multifaceted responsibilities, emphasising critical contributions in vendor selection, system evaluation, workflow analysis, content development, end-user device assessment, training, and post-implementation stability support. By providing nurse informaticists in lower middle-income countries with a clear understanding of their responsibilities and tailored strategies, this article aims to enhance EHR implementation success in these unique contexts.

The effect of mobile application based genetic counseling on the psychosocial well-being of thalassemia patients and caregivers: A randomized controlled trial.

OBJECTIVE: This study was carried out to investigate the effects of mobile application based genetic counseling on the psychosocial well-being of thalassemia patients and caregivers. METHODS: A randomized controlled trial was conducted with 80 patients, divided equally between the intervention and control groups. Additionally, 192 caregivers were included, with an equal distribution of 96 in the two groups. The intervention group received mobile application based genetic counseling, while the control received standard routine care. Assessments of quality of life, satisfaction, depression, and anxiety were conducted at baseline (T0), one-month post-intervention (T1), and three months post-intervention (T2). Furthermore, data analysis was performed using the Generalized Estimation Equation Model (GEE) approach in SPSS version 25.0. RESULTS: Mobile application based genetic counseling had significant effects on various aspects of the well-being of thalassemia patients and caregivers. These effects include improvements in quality of life, patient satisfaction, reduction in depression, and alleviation of anxiety (p < 0.05). CONCLUSION: Mobile application based genetic counseling showed a significant effect in improving psychosocial well-being among patients and caregivers. PRACTICE IMPLICATIONS: The results obtained practical implications for the integration of genetic counseling interventions, particularly through the application of information technology such as Cyber Gen application.