Covid-19 hotlines, helplines and call centers: a systematic review of characteristics, challenges and lessons learned.

BACKGROUND: During the Covid-19 pandemic, a number of hotlines/helplines/call centers was implemented to provide remote services and support public health. The objective of this study was to investigate the characteristics, challenges and lessons learned of implementing Covid-19 hotlines/helplines/call centers during the pandemic. METHODS: PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest databases as well as Google Scholar were searched between 1st January 2020 and 31st December 2023 to retrieve relevant articles published in English. The quality and risk of bias of the studies were assessed using the Appraisal tool for Cross-Sectional Studies (AXIS), the Mixed Methods Appraisal Tool (MMAT), and Critical Appraisal Skills Programme (CASP) Checklist. RESULTS: In total, 43 out of 1440 articles were included in this study. About half of the hotlines/helplines/call centers were launched in March 2020 (n = 19). Providing psychological support (n = 23), reliable information about Covid-19 (n = 10), healthcare advices about Covid-19 (n = 8), and triage (n = 7) were the most common purposes of implementing these services. The most common challenges included a lack of physical examination, unavailability of hotlines/helplines/call centers at the point of need, and delay in updating Covid-19 information. The most common lessons learned were employing qualified staff, providing proper training, and getting feedback from the callers and operators. CONCLUSION: According to the results, most of the Covid-19 hotlines/helplines/call centers were launched in the early months of the pandemic, and about half of them were active seven days a week. Most of the operators were mental health providers and clinicians. The findings show the importance of continuous psychological support during crises, particularly when adequate information about the situation is not available. The challenges experienced by the callers and operators as well as the lessons learned by the service providers also need to be considered for future crises to increase the effectiveness of similar services.

An insight into the use of telemedicine technology for cancer patients during the Covid-19 pandemic: a scoping review.

BACKGROUND: The use of telemedicine technology has significantly increased in recent years, particularly during the Covid-19 pandemic. This study aimed to investigate the use of telemedicine technology for cancer patients during the Covid-19 pandemic. METHODS: This was a scoping review conducted in 2023. Various databases including PubMed, Web of Science, Scopus, Cochrane Library, Ovid, IEEE Xplore, ProQuest, Embase, and Google Scholar search engine were searched. All quantitative, qualitative, and mixed-method studies published in English between 2020 and 2022 were included. Finally, the needed data were extracted, and the results were synthesized and reported narratively. RESULTS: A total of 29 articles were included in this review. The results showed that teleconsultation, televisit, and telerehabilitation were common telemedicine services, and video conferencing and telephone were common technologies used in these studies. In most cases, patients and healthcare providers preferred these services compared to the face-to-face consultations due to their convenience and advantages. Furthermore, the findings revealed that in terms of clinical outcomes, telemedicine could effectively reduce anxiety, pain, sleep disorders, and hospital admission rates. CONCLUSION: The findings provided valuable insights into the various telemedicine technologies, services, users' perspectives, and clinical outcomes in cancer patients during the Covid-19 pandemic. Overall, the positive outcomes and users' satisfaction showed that the use of telemedicine technology can be expanded, particularly in cancer care. Future research needs to investigate both clinical and non-clinical effectiveness of using various telemedicine services and technologies for improving cancer care delivery, which can help to develop more successful strategies for implementing this technology.

Motivating and inhibiting factors influencing the application of mhealth technology in post-abortion care: a review study.

BACKGROUND: Abortion and its complications are challenges that endanger women's health, especially in developing countries. It seems that the application of mhealth technology can be useful as a safe and affordable strategy in post-abortion care. The purpose of this study was to identify factors influencing the use of mhealth technology in post-abortion care. METHODS: This was a review study conducted in 2023 and articles published in English between 2010 and 1st November 2023 were searched in PubMed, Scopus, ProQuest, Web of Science, and Embase databases as well as Google Scholar. Data were collected using a data extraction form and were analyzed narratively. RESULTS: The influencing factors could be divided into the motivating and inhibiting factors. The motivating factors included the subgroups of the individual factors (e.g., saving time), technical factors (e.g., usability), economic factors (e.g., saving costs), and ethico-legal factors (e.g., improving security and confidentiality of the information). Similarly, the inhibiting factors consisted of individual factors (e.g., fear of expressing abortion), technical factors (e.g., a lack of access to the network and the Internet), economic factors (e.g., inappropriate patient financial status), and ethico-legal (e.g., concerns over the security and confidentiality of information). CONCLUSION: This study underscores the importance of considering various technical and non-technical factors influencing the design and implementation of mHealth technology in post-abortion care. Developers need to address these factors to ensure successful technology adoption and mitigate risks. The findings contribute to the enhancement of women's health and offer insights for future technology acceptance models in the mHealth field.

Electronic patient-reported outcome (ePRO) application for patients with prostate cancer.

INTRODUCTION: Cancer patients experience different complications and outcomes during or after medical treatments. Electronic reporting of the outcomes by patients is a solution that facilitates communication with physicians and improve patient health status. The aim of this study was to develop a smartphone-based application for electronic reporting of outcomes by patients with prostate cancer. METHODS: The present research was conducted in 2021 in two phases. In the first phase, initially, users' requirements were identified based on reviewing the related literature, existing applications, and guidelines. Then, a questionnaire was designed and the specialists' opinions about the users' requirements were investigated. The specialties included urologists, hemato-oncologists, uro-oncologists, and radiotherapists (n = 15). In the second phase, the application was designed, and patients with prostate cancer (n = 21) and specialists (n = 10) evaluated it using the post-study system usability questionnaire (PSSUQ). Data were analyzed using descriptive statistics. RESULTS: The findings of the first phase of the research showed that out of 108 data elements and functions proposed for the application, 91 items were found essential by the specialists. Data elements were categorized into the patient data, general complications of prostate cancer and side effects of drug therapy, surgery, chemotherapy, cryotherapy, radiation therapy, and hormone therapy. Necessary functions for the application included presenting a patient care summary, communication between the patient and the specialist, free text explanation for complications and sides effects, generating reports, reminder and alert, completing quality of life questionnaire, and calculating the score for the questionnaire. In the second phase of the research, the application was developed and evaluated. The mean value for user satisfaction was (5.95 ± 0.55) out of 7. CONCLUSION: The developed application can help to accelerate communication with the specialists. It can improve quality of care, reduce unnecessary treatment visits and side effects, and improve timely data collection for a variety of research purposes. However, further research on the cost-effectiveness and usefulness of the collected data is recommended.

Emergency department-based injury surveillance information system: a conceptual model.

BACKGROUND: Injury data play a pivotal role in monitoring public health issues and Injury Surveillance Information Systems (ISIS) are useful for continuous data collection and analysis purposes. Since emergency department (ED) is usually the first place of referral for the injured people, the aim of this study was to develop a conceptual model for an ED-based ISIS. METHODS: This study was completed in 2020 and the Delphi technique (three rounds) was used to determine the main components of an ED-based ISIS. The participants were selected using the purposive sampling method. A 5-point Likert scale questionnaire was used for data collection and data were analyzed using descriptive statistics. RESULTS: In the first, second, and third rounds of the Delphi study, 60, 44, and 28 experts participated, respectively. In the first and second rounds, most of the items including the personal data, clinical data, data sources, and system functions were found important. In the third round of the Delphi study, 13 items which did not reach a consensus in the previous rounds were questioned again and five items were removed from the final model. CONCLUSION: According to the findings, various data elements and functions could be considered for designing an ED-based ISIS and a number of data sources should be taken into count to be integrated with this system. Although the conceptual model presented in the present study can facilitate designing the actual system, the final system needs to be implemented and used in practice to determine how it can meet users' requirements.

Data management system for diabetes clinical trials: a pre-post evaluation study.

BACKGROUND: Data management system for diabetes clinical trials is used to support clinical data management processes. The purpose of this study was to evaluate the quality and usability of this system from the users' perspectives. METHODS: This study was conducted in 2020, and the pre-post evaluation method was used to examine the quality and usability of the designed system. Initially, a questionnaire was designed and distributed among the researchers who were involved in the diabetes clinical trials (n = 30) to investigate their expectations. Then, the researchers were asked to use the system and explain their perspectives about it by completing two questionnaires. RESULTS: There was no statistically significant differences between the users' perspectives about the information quality, service quality, achievements, and communication before and after using the system. However, in terms of the system quality (P = 0.042) and users' autonomy (P = 0.026), the users' expectations were greater than the system performance. The system usability was at a good level based on the users' opinions. CONCLUSION: It seems that the designed system largely met the users' expectations in most areas. However, the system quality and users' autonomy need further attentions. In addition, the system should be used in multicenter trials and re-evaluated by a larger group of users.

Data quality assessment in emergency medical services: an objective approach.

BACKGROUND: In emergency medical services, high quality data are of great importance for patient care. Due to the unique nature of this type of services, the purpose of this study was to assess data quality in emergency medical services using an objective approach. METHODS: This was a retrospective quantitative study conducted in 2019. The research sample included the emergency medical records of patients who referred to three emergency departments by the pre-hospital emergency care services (n = 384). Initially a checklist was designed based on the data elements of the triage form, pre-hospital emergency care form, and emergency medical records. Then, data completeness, accuracy and timeliness were assessed. RESULTS: Data completeness in the triage form, pre-hospital emergency care form, and emergency medical records was 52.3%, 70% and 57.3%, respectively. Regarding data accuracy, most of the data elements were consistent. Measuring data timeliness showed that in some cases, paper-based ordering and computer-based data entry was not sequential. CONCLUSION: Data quality in emergency medical services was not satisfactory and there were some weaknesses in the documentation processes. The results of this study can inform the clinical and administrative staff to pay more attentions to these weaknesses and plan for data quality improvement.

Data Quality in Health Care: Main Concepts and Assessment Methodologies.

INTRODUCTION: In the health care environment, a huge volume of data is produced on a daily basis. However, the processes of collecting, storing, sharing, analyzing, and reporting health data usually face with numerous challenges that lead to producing incomplete, inaccurate, and untimely data. As a result, data quality issues have received more attention than before. OBJECTIVE: The purpose of this article is to provide an insight into the data quality definitions, dimensions, and assessment methodologies. METHODS: In this article, a scoping literature review approach was used to describe and summarize the main concepts related to data quality and data quality assessment methodologies. Search terms were selected to find the relevant articles published between January 1, 2012 and September 31, 2022. The retrieved articles were then reviewed and the results were reported narratively. RESULTS: In total, 23 papers were included in the study. According to the results, data quality dimensions were various and different methodologies were used to assess them. Most studies used quantitative methods to measure data quality dimensions either in paper-based or computer-based medical records. Only two studies investigated respondents' opinions about data quality. CONCLUSION: In health care, high-quality data not only are important for patient care, but also are vital for improving quality of health care services and better decision making. Therefore, using technical and nontechnical solutions as well as constant assessment and supervision is suggested to improve data quality.

Impact of telecare interventions on quality of life in older adults: a systematic review.

BACKGROUND: Recently, an increase in the older adult population, their chronic diseases, and functional disabilities have led to an increase in the need for more healthcare services. Telecare is one of the solutions for caring these people and can improve their quality of life. AIM: The objective of this study was to investigate impact of telecare interventions on quality of life in older adults. METHODS: This was a systematic review conducted in 2021. PubMed, Web of Science, Scopus, the Cochrane Library, Embase, IEEE Xplore, and ProQuest databases as well as Google Scholar were searched until the end of 2020 to retrieve relevant articles published in English. The quality of the studies was assessed using the National Institutes of Health (NIH) quality assessment checklists and the mixed-methods appraisal tool (MMAT). The risk of bias in the studies was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the risk of bias in non-randomized studies-of interventions (ROBINS-I). RESULTS: In total, ten out of 1245 articles identified in the initial search, were included in this study. Telemonitoring (n = 7) and telerehabilitation (n = 3) were the most common methods of telecare interventions. Overall, the findings showed that in most studies, different dimensions of quality of life were improved after using these interventions (p < 0.05). CONCLUSION: Evaluating impact of telecare interventions on quality of life, especially in older adults can help system developers to improve current and future telecare technologies to meet users' requirements. Future studies can focus on evaluating the impact of specific telecare systems for a particular target group using different research methodologies.

Utilization of telehealth to manage the Covid-19 pandemic in low- and middle-income countries: a scoping review.

OBJECTIVE: Recently, the coronavirus disease 2019 (Covid-19) pandemic has led to an increase in the use of telehealth technology. It seems that the application of this technology in low- and middle-income countries (LMICs) has been limited, and few studies have been undertaken to review the current state of knowledge in this area. The aim of the present study was to explore the utilization of telehealth to manage the Covid-19 pandemic in LMICs. MATERIALS AND METHODS: This scoping review was conducted in 2022. PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest were searched, and all quantitative research, qualitative studies, case reports, and case studies related to the use of telehealth to manage Covid-19 in LMICs and published since 2020 were included in the study. The findings were analyzed and reported narratively. RESULTS: In total, 18 articles were included in the research. These studies were conducted in South Asia, sub-Saharan Africa, the Middle East and North Africa, and East Asia and Oceania. Telehealth interventions included teleconsultation, telecoaching, teledermatology, televisit, mhealth applications, telerehabilitation, telepharmacy, and telepsychiatry. WhatsApp was the most common way for service delivery and in most studies, patients and health care providers were satisfied with services. CONCLUSION: Although the use of telehealth interventions was limited in LMICs during the Covid-19 pandemic, in most cases, it was an effective solution to combat the outbreak of Covid-19 and had positive outcomes. A comparison between the characteristics and clinical effectiveness of similar interventions in different countries including LMICs are worth investigation in the future studies.

Speech therapists' perspectives about using tele-speech therapy: a qualitative study.

PURPOSE: Tele-speech therapy refers to the application of telecommunication technologies to provide speech-language pathology services at a distance and establishes communication between a specialist and a patient for assessment, intervention, or consultation. Due to the shortage of speech therapists, the use of tele-speech therapy services can be helpful, especially for those who do not have access to speech-language therapists. The aim of this study was to investigate speech therapists' perspectives about using tele-speech therapy. METHODS: This was a qualitative study conducted in 2020. Data were collected through conducting in-depth semi-structured interviews with 12 faculty members who worked in three different medical universities. The interviews were recorded digitally and transcribed verbatim. The data were analysed by using framework analysis method and MAXQDA version 10. RESULTS: Having analysed the data, four themes, 10 categories, and 26 subcategories emerged. The main findings included necessary requirements for implementing and using tele-speech therapy in terms of developing academic courses, guidelines, and necessary technical infrastructure, advantages of using tele-speech therapy for specialists and patients, challenges of, and opportunities for, using tele-speech therapy. CONCLUSION: Although tele-speech therapy has several benefits for specialists and patients, challenges of using this technology should not be underestimated. There are also a number of research opportunities in this field and their results can be helpful for successful implementation of this technology in the future.Implications for rehabilitationThe clinical assessment and treatment of patients with speech-language disorders are sometimes difficult mainly due to the limited healthcare resources or the patient heath condition.Tele-speech therapy can be regarded as an alternative approach or a complementary method for face-to-face visits, especially for patients who are not able to attend clinics.Despite the advantages, the challenges of providing special groups of patients with tele-speech therapy should be taken into account.Telerehabiliation and rehabilitation research centres can support future research in the field of tele-speech therapy to present more evidence regarding the strengths and weaknesses of this technology.Implications for practiceTechnical and non-technical infrastructures should be taken into account before implementing tele-speech therapy services.Tele-speech therapy has a number of advantages for patients and specialists.Challenges of providing tele-speech therapy services, such as risk of inaccurate evaluation and difficulty in interaction with patients should not be underestimated.There are a number of research opportunities in the field of tele-speech therapy and tele-rehabilitation centres can support further research in this area.The findings of this study can facilitate utilisation of tele-speech therapy in different settings.

A clinical decision support system for diagnosing and determining severity of dry eye disease.

INTRODUCTION: Dry eye and its related symptoms are the most common causes of referrals to the ophthalmology centers. Since people with dry eye may suffer from different levels of the disease severity, this study aimed to develop a clinical decision support system for diagnosing and determining severity of dry eye disease. METHODS: This research was carried out in two phases in 2020. In the first phase, a questionnaire was designed to identify the most important diagnostic parameters from the cornea specialists' perspectives (n = 37). In the second phase of the research, a clinical decision support system was designed and implemented by using MATLAB software. Finally, the system was evaluated using patient data which were collected in a teaching hospital (n = 50). RESULTS: The diagnostic parameters for dry eye disease were filamentary keratitis, meibomian gland dysfunction, score of ocular surface disease index, Schirmer's test result, tear meniscus height, tear breakup time, and fluorescein staining score. The system output variables were the diagnosis and severity of dry eye disease at four levels for the right and left eyes, separately. The results of the evaluation study showed that the accuracy, sensitivity and specificity of the system were 96.9%, 97.5%, and 93.7%, respectively. CONCLUSION: It seems that the system designed in this study can help ophthalmologists to diagnose dry eye disease more accurately and quickly. However, it is recommended to conduct more evaluation studies and include more patients in the future research.

Development and evaluation of an e-learning course in oxygen therapy.

BACKGROUND: Respiratory problems are among the most challenging situations in emergency care services. Different oxygen therapy methods are usually used to deal with these problems. In recent years, oxygen therapy has been recognized as one of the most widely used therapeutic processes in emergency departments (ED) mainly due to the Covid-19 pandemic. The aim of this study was to develop and evaluate an e-learning course in oxygen therapy for the ED clinicians. METHODS: This was a pre-post study conducted in three phases in 2021. Initially, the educational requirements of clinicians (n = 181) were investigated using a questionnaire, and in the second phase, an interactive e-learning course was developed. In the third phase, the course was assessed in terms of maintaining the principles of developing an e-learning course, affecting participants' knowledge, and supporting usability requirements. RESULTS: The findings revealed that training in oxygen therapy was essential for the ED clinicians. Therefore, an e-learning course was developed. The content production experts and the participants evaluated the content and usability of the online course at a good level. In addition, there was a statistically significant difference between the nurses' (p < 0.001) and general practitioners' (p < 0.002) pre- and post-test scores suggesting that the course improved their knowledge. CONCLUSION: It seems that the e-learning course developed in the current study can improve health care professionals' knowledge and quality of care. However, more evaluation studies are needed to investigate the effectiveness of the course for other clinicians, such as nurses who work in intensive care units.

Effectiveness of a self-management mobile app on the quality of life of women with breast cancer: a study in a developing country.

BACKGROUND: Self-management involves taking responsibility for personal health and taking the initiative to do so. This can be accomplished by learning information and skills that will help consider the difficulties may encounter during and after cancer treatment. With this perspective, we have aimed to develop a self-management mobile app for women with breast cancer in Iran and evaluate its impact on the quality of life of patients. METHOD: This study is a methodological study in 2021. We developed the app during three phases. The first phase aimed at identifying educational content and designing user experience, the second phase aimed at developing and implementing the app, and the third phase aimed at evaluating pre-and post-implementation. RESULT: In this study, an Android app for self-management women with breast cancer was developed. According to the results of the pre-and post-implementations among the most significant changes were in the quality of life level, highest respectively: social avoidance (Pre: 6.41-Post: 3.56), negative feelings (Pre: 5.93 - Post: 3.40), sexual function (Pre: 6.80 - Post: 5.04), sexual interest (Pre: 6.41 - Post: 4.75) and pain (Pre: 6.37 - Post: 4.97). And least the changes respectively: distress-family (Pre: 7 - Post: 7), distress-recurrence (Pre: 4.49 - Post: 4.38), benefits (Pre: 2.47 - Post: 3.12), appearance (Pre: 4.10 - Post: 3.32). Also, we calculated the usability evaluation of this app with the system usability scale (SUS); the overall rating score was 83/100, an excellent level (> 80.3), and a grade A. CONCLUSION: The study shows that a breast cancer self-management app can support and improve the quality of life of women with breast cancer. We conducted this study to show that by developing a self-management app, women with breast cancer can improve their quality of life, - by increasing their self-management skills.

The 4P telehealth business framework for Iran.

BACKGROUND: Telehealth services can utilize various information technologies and improve quality and efficiency of healthcare delivery by facilitating education, treatment, follow-up, and decision-making. However, these services are not always commercialized, and in case of commercialization, there is no guarantee for their long-term sustainability in market. Therefore, business models and frameworks are used as part of commercialization processes to identify a set of factors affecting the sustainability, effectiveness, and key business activities. The current study aimed to develop a telehealth business framework for Iran. METHODS: This research was conducted in 2021, and a mixed-methods approach was used for data collection. Initially, a telehealth business framework was developed based on the findings derived from a systematic review and a qualitative research. The proposed framework was then reviewed by an expert panel (n = 9) in which the participants had at least three years of work experience in telehealth. Finally, the framework was validated using the Delphi method (three rounds). RESULTS: The expert panel believed that some components such as partners' expertise, required capital and financial resources, research and analysis, marketing and branding, tax, product registration, and marketing at scientific congresses and science and technology exhibitions needed to be added to the framework. In the Delphi study, 68 out of 74 components proposed in the initial framework were approved across four major dimensions; namely, prerequisites, production, payments and costs, and post-production services. CONCLUSIONS: It seems that the developed framework can facilitate commercializing telehealth technologies and developing business plans. In addition, telehealth start-ups can use this framework and its various components in a competitive market to be more successful in their businesses. However, it is still critical to evaluate the effectiveness of the framework in practice and in relation to the commercialization of telehealth technologies.

A Clinical Decision Support System for Assessing the Risk of Cervical Cancer: Development and Evaluation Study.

BACKGROUND: Cervical cancer has been recognized as a preventable type of cancer. As the assessment of all the risk factors of a disease is challenging for physicians, information technology and risk assessment models have been used to estimate the degree of risk. OBJECTIVE: The aim of this study was to develop a clinical decision support system to assess the risk of cervical cancer. METHODS: This study was conducted in 2 phases in 2021. In the first phase of the study, 20 gynecologists completed a questionnaire to determine the essential parameters for assessing the risk of cervical cancer, and the data were analyzed using descriptive statistics. In the second phase of the study, the prototype of the clinical decision support system was developed and evaluated. RESULTS: The findings revealed that the most important parameters for assessing the risk of cervical cancer consisted of general and specific parameters. In total, the 8 parameters that had the greatest impact on the risk of cervical cancer were selected. After developing the clinical decision support system, it was evaluated and the mean values of sensitivity, specificity, and accuracy were 85.81%, 93.82%, and 91.39%, respectively. CONCLUSIONS: The clinical decision support system developed in this study can facilitate the process of identifying people who are at risk of developing cervical cancer. In addition, it can help to increase the quality of health care and reduce the costs associated with the treatment of cervical cancer.

Staff and students' perceptions about using telehealth technology in a medical university: A qualitative study.

INTRODUCTION: The use of telehealth technology is a way to promote the health status of the community. The purpose of this study was to investigate staff and students' perceptions about using telehealth technology in a medical university. METHODS: This was a qualitative study completed in 2020. The research participants were 26 university staff and students who took part in semi-structured interviews. To analyze the data, the thematic analysis method was used. RESULTS: The findings of the present study included five themes, 20 subthemes and 58 categories. The main themes were the current status of providing healthcare services at the university, and the strengths, weaknesses, opportunities and threats of using telehealth technology for the university staff and students. CONCLUSION: According to the results, there are many opportunities for using telehealth technology in the medical university. The experiences of other institutes can be used to implement the technology successfully.

Opportunities for Using Health Information Technology for Elderly Care in the Emergency Departments: A Qualitative Study.

Introduction: Recently, several technologies have been developed for being used in the field of geriatric emergency medicine. As a large number of elderly patients visit emergency departments, the use of health information technology in this department can help to improve patient care and control the outcome of diseases. The present study aimed to identify opportunities for using various health information technologies for elderly care in the emergency department. Methods: This qualitative study was conducted in 2020. The participants included geriatricians, geriatric nurses, emergency medicine specialists, and nurses who worked in the emergency department. In total, 33 semi-structured interviews were conducted, and data were analyzed by using framework analysis method and MAXQDA software. Results: The findings of the qualitative study included four main themes, nine subthemes, and 20 categories. The main themes were the common process of elderly care in the emergency departments, data required for elderly care in the emergency departments, the elderly treatment team, and current information technologies used in the emergency departments for elderly care. Overall, the results showed that there was no specific workflow for elderly care in the emergency departments; the great workload of this department prevents the clinicians to conduct cognitive and functional assessments; geriatricians were not involved in the care process; and none of the current information systems were designed specifically for elderly patients. It seems that using specific heath information technology for elderly care in the emergency department can help to overcome current challenges. Conclusion: Identifying opportunities for using health information technologies for geriatric patients in the emergency department can lead to better use of financial, physical, and human resources, and improve staff performance. These systems can be designed and used for different purposes such as reducing work load, readmissions, and hospitalization. Improving access to data and better collaboration between different specialties are other benefits of using these systems. However, more research is required to evaluate the effectiveness of technology in this area.

A Clinical Data Management System for Diabetes Clinical Trials.

BACKGROUND: The use of novel medications and methods to prevent, diagnose, treat, and manage diabetes requires confirmation of safety and efficacy in a well-designed study prior to widespread adoption. Diabetes clinical trials are the studies that examine these issues. The aim of the present study was to develop a web-based system for data management in diabetes clinical trials. METHODS: The present research was a mixed-methods study conducted in 2019. To identify the required data elements and functions to develop the system, 60 researchers completed a questionnaire. The designed system was evaluated using two methods. The usability of the system was initially evaluated by a group of researchers (n = 6) using the think-aloud method, and after system improvement, the system functions were evaluated by other researchers (n = 30) using a questionnaire. RESULTS: The main data elements which were required to develop a case report form included "study data," "participant's personal data," and "clinical data." The functional requirements of the system were "managing the study," "creating case report forms," "data management," "data quality control," and "data security and confidentiality." After using the system, researchers rated the system functions at a "good" level (6.3 ± 0.73) on a seven-point Likert scale. CONCLUSION: Given the complexity of the data management processes in diabetes clinical trials and the widespread use of information technologies in research, the use of clinical data management systems in diabetes clinical trials seems inevitable. The system developed in the current study can facilitate and improve the process of creating and managing case report forms as well as collecting data in diabetes clinical trials.

Comparison between Single Versus Twice Application of Topical 85% Trichloroacetic Acid in the Treatment of Cervical Intraepithelial Neoplasia; A Randomized Clinical Trial on Efficacy and Tolerability.

PURPOSE: To compare the efficacy and safety of up to two-time administration of 85% TCA, as a promising alternative therapy to conservative and surgical management of grade one to three CINs. METHODS: In this two-armed randomized clinical trial, a total of 53 patients with biopsy-proven CIN lesions were allocated to two groups of TCA treatment. The first group (n=26) received a single dose of local therapy with 85% TCA while the second group (n=27) was treated on two separate occasions with a two-week interval. Two participants (one in each group) were lost to follow-up. At the two-month follow-up after TCA application, a colposcopy-guided biopsy was performed for all patients and the pathological specimens were studied by a single experienced pathologist to determine the post-intervention grading of CIN. RESULTS: Two groups were comparable in terms of age and base-line lesion grading, as CIN 1 lesions comprised the majority of cases (54%), followed by CIN 2(37%). While our sample was a poor representative of CIN3 lesions (7%), no significant difference was noticed between the single and twice TCA treated groups with a response rate of 52% and 54% respectively (either complete remission to normal histology or regression to any low-grade lesion). Either separate analysis (with respect to the base-line grading within each treatment group) or combined analysis (regardless of CIN sub-group) could not generate any statistical significance. The second dose of TCA did not increase the frequency of reported adverse events. CONCLUSION: The second dose of topical 85% TCA does not seem to increase the CIN response rate more so than its single dose. However, further controlled clinical trials with larger samples are warranted to verify current findings. The use of TCA was not limited by any major side effect, therefore, the potential to achieve an increased efficacy with more frequent TCA applications is appealing.