Development and evaluation of an anesthesia module for electronic medical records in the operating room: an applied developmental study.

Developing an anesthesia module in the operating room is one of the significant steps toward the implementation of electronic medical records (EMR) in health care centers. This study aimed to develop and evaluate the web based-anesthesia module of an electronic medical record Sciences, in the operating room of the Namazi Medical Training Center of Shiraz University of Medical Iran. This developmental and applied study was conducted in steps including determining the functional and non-functional requirements, designing and implementing the anesthesia module, and usability evaluation. 3 anesthesiologists, 3 anesthesiologist assistants, and 12 anesthetist nurses were included in the study as a research community. React.js, Node.js programming language to program this module, Mongo dB database, and Windows server for data management and USE standard questionnaire were used. In the anesthesia module, software quality features were determined as functional requirements and non-functional requirements included 286 data elements in 25 categories (demographic information, surgery information, laboratory results, patient graphs, consults, consent letter, physical examinations, medication history, family disease records, social record, past medical history, type of anesthesia, anesthesia induction method, airway management, monitoring, anesthesia chart, blood and fluids, blood gases, tourniquets and warmers, accessories, positions, neuromuscular reversal, transfer the patient from the operating room, complications of anesthesia and, seal/ signature). Also, after implementing the anesthesia module, results of the usability evaluation showed that 69.1% of the users agreed with the use of this module in the operating room and considered it user-friendly.

Self-help application for obsessive-compulsive disorder based on exposure and response prevention technique with prototype design and usability evaluation: A cross-sectional study.

Background and Aims: Obsessive-compulsive disorder (OCD) is a relatively common disorder that, due to its debilitating nature, significantly affects personal abilities, job performance, social adjustment, and interpersonal relationships. There are significant barriers to accessing evidence-based cognitive-behavioral therapy as a first-line treatment for obsessive-compulsive disorder. Mobile health applications (Apps) offer a promising way to improve access to evidence-based therapies while overcoming these barriers. The present study was to design and evaluate a prototype of a self-help application for people with OCD (the most common pattern of OCD) based on the exposure and response prevention (ERP) technique. Methods: This work was developed in four different phases. (1) Needs assessment: a thorough literature review, reviewing existing related programs and apps, and interviewing patients and psychiatrists; (2) Creating a paper prototype: considering the functional features identified in the previous phase using wireframe sketcher software. (3) Creating a digital prototype: developing an actual prototype using Axure RP software based on the information obtained from an expert panel's evaluation of the paper prototype. (4) Prototype usability evaluation: through a heuristic evaluation with experts and usability testing with patients using the SUS questionnaire. Results: After requirement analysis, requirements were defined in the areas of information and educational elements, and functional capabilities. Prototypes designed based on identified requirements include capabilities such as in-app online self-help groups, assessing the severity of the symptoms of the disorder, psychological training, supportive treatment strategies, setting personalized treatment plans, tracking treatment progress through weekly reports provided, anxiety assessment, and setting reminders. Conclusion: The results of the heuristic evaluation with experts made it possible to identify how to provide information and implement the capabilities in a way that is more appropriate and easier for the user.

Identifying the components and effective factors in disaster education to improve adolescents' resilience: A thematic analysis.

BACKGROUND: Education is considered one of the critical elements of behavioral changes in societies with a high risk of disasters. Meanwhile, the role of adolescents, as the key and the largest group of stakeholders in planning for disaster preparedness and response, has often been neglected. The current study aimed to extract the components and effective factors in disaster education to increase adolescents' resilience in disasters in Iran. MATERIALS AND METHODS: This qualitative study was done by inductive approach through in-depth semi-structured interviews conducted with 21 key informants and 11 adolescents selected through purposive sampling. To extract the components and factors affecting education to increase adolescents' resilience in disasters, the data were analyzed by thematic analysis. RESULTS: The effective factors in increasing adolescents' disaster resilience were classified into four categories, namely, social participation, need-based education, scope of influence, and governance perspectives, and 19 subcategories. CONCLUSION: This study provided an overview and a comprehensive understanding of disaster education to increase adolescents' resilience. Recognizing these factors can help effectively in developing disaster education programs to improve adolescents' resilience against disasters. By encouraging natural hazard habits in this age group, it can also potentially increase the society's resilience in future.

Critical Criteria and Countermeasures for Mobile Health Developers to Ensure Mobile Health Privacy and Security: Mixed Methods Study.

BACKGROUND: Despite the importance of the privacy and confidentiality of patients' information, mobile health (mHealth) apps can raise the risk of violating users' privacy and confidentiality. Research has shown that many apps provide an insecure infrastructure and that security is not a priority for developers. OBJECTIVE: This study aims to develop and validate a comprehensive tool to be considered by developers for assessing the security and privacy of mHealth apps. METHODS: A literature search was performed to identify papers on app development, and those papers reporting criteria for the security and privacy of mHealth were assessed. The criteria were extracted using content analysis and presented to experts. An expert panel was held for determining the categories and subcategories of the criteria according to meaning, repetition, and overlap; impact scores were also measured. Quantitative and qualitative methods were used for validating the criteria. The validity and reliability of the instrument were calculated to present an assessment instrument. RESULTS: The search strategy identified 8190 papers, of which 33 (0.4%) were deemed eligible. A total of 218 criteria were extracted based on the literature search; of these, 119 (54.6%) criteria were removed as duplicates and 10 (4.6%) were deemed irrelevant to the security or privacy of mHealth apps. The remaining 89 (40.8%) criteria were presented to the expert panel. After calculating impact scores, the content validity ratio (CVR), and the content validity index (CVI), 63 (70.8%) criteria were confirmed. The mean CVR and CVI of the instrument were 0.72 and 0.86, respectively. The criteria were grouped into 8 categories: authentication and authorization, access management, security, data storage, integrity, encryption and decryption, privacy, and privacy policy content. CONCLUSIONS: The proposed comprehensive criteria can be used as a guide for app designers, developers, and even researchers. The criteria and the countermeasures presented in this study can be considered to improve the privacy and security of mHealth apps before releasing the apps into the market. Regulators are recommended to consider an established standard using such criteria for the accreditation process, since the available self-certification of developers is not reliable enough.

Cost-effectiveness analysis of fractional flow reserve versus angiography among patients with coronary artery disease undergoing borderline coronary lesions treatment in Iran.

BACKGROUND: The present study aimed to examine the cost-effectiveness of fractional flow reserve (FFR) versus angiography in treating borderline coronary lesions in patients with coronary artery stenosis in Iran. Cardiovascular disease is a leading cause of morbidity, mortality, readmission and the most important cause of disability in many countries, including Iran. METHODS: This was a cost-effectiveness study conducted from the perspective of the Ministry of Health in 2019. The effectiveness was determined using four indicators: Quality Adjusted Life Years (QALYs), major adverse cardiac events (MACE), angina, and number of used stents (mean). Only direct medical costs (DMC) were estimated. To evaluate the cost-effectiveness of FFR versus angiography, A decision tree model was built by patient's level data.To coping with uncertainty Probabilistic sensitivity analysis (PSA) was performed. RESULTS: Totally, 98 cases of FFR and 238 cases of angiography were included in the analysis. The average of QALY in FFR and angiography were 0.853 and 0.787, respectively. The cost of these methods were $6128 and $8388, correspondingly. Therefore, FFR was dominant compared to angiography. Results of the scatter plots and acceptability curve showed that FFR was more cost-effective than angiography in 94% and 96% of simulations for a threshold lower than $11,000 PPP. The PSA analysis confirmed the robustness of the study results. CONCLUSION: The results indicated that FFR was more cost-effective than angiography in the cases studied in Iran. Consequently, FFR can be used as a high-priority diagnostic method and it is recommendable to be included in insurance coverage.

The effect of case-based e-learning on academic performance and problem-solving ability in nursing students: A pre- and post-test study.

BACKGROUND: Case-based learning is a modern learning approach, aims to prepare students for practical skills. In the present study, we aimed to determine the effectiveness of case-based e-learning (CBEL) on the academic performance and problem-solving ability of nursing students. MATERIALS AND METHODS: In this pre- and post-test study, census sampling method was used to select 128 nursing students who had nutrition courses during 2015-2017 at (blinded). Before and after the educational intervention, the students completed the problem-solving inventory including problem-solving confidence (PSC), approach-avoidance style (AA), and personal control (PC) and a scientific test for evaluating academic function. Continuous variables before and after the intervention and categorical variables were analyzed using paired t-test and Chi-square test, respectively. RESULTS: The mean scores of PSC, AA, and PC decreased after the intervention (P < 0.001). The mean scientific score of the students improved after the intervention (P < 0.001). CONCLUSION: This study showed that the CBEL method had a positive effect on the ability to solve the learning problems and the academic performance of the students and can be used to train nurses to improve their ability to confront clinical problems in the future.

Healthy lifestyle during pregnancy: Uncovering the role of online health information seeking experience.

In the new era, many people seek their health-related information through the Internet due to the increasing access to this technology. Searching online health information can affect the health behavior. This study aimed to investigate the correlation between online health information-seeking behavior and a healthy lifestyle during pregnancy in a sample of Iranian pregnant women. This cross-sectional study was conducted among pregnant women admitted to health centers of Eghlid city, Fars province, Iran in 2019. A total of 193 women participated in the study. The required data were gathered using two validated questionnaires to measure the online health information-seeking behavior and the healthy lifestyle practices of the participants. The collected data were analyzed through descriptive statistics and Pearson correlation coefficient using SPSS version 22. Online health information experience and its subscales showed no statistical correlation with a healthy lifestyle. Age and education did not correlate with online health information-seeking behavior. Age had a statistical correlation with a healthy lifestyle, but education had the same correlation only with some subscales of a healthy lifestyle. The findings were surprising, suggesting that online health information-seeking behavior does not affect the lifestyle of pregnant women. These finding and probable explanations are discussed, but due to the limited literature on the subject, further studies are recommended to be conducted.

Development, usability and quality evaluation of the resilient mobile application for women with breast cancer.

Introduction: Mental health problems as a consequence of cancer lower the quality of life of cancer patients. Despite increasing studies of breast cancer-focused mobile health applications (m-Health apps), there is less research on breast cancer patients' quality of life or well-being. The purpose of this study is to develop and evaluate the usability and quality of an educational m-Health app aimed at improving the resilience of breast cancer in women. Methods: This study was conducted in four phases. It included extracting the requirements of the app through the nominal group technique. Based on these results, an m-Health app was developed and evaluated in terms of usability and quality by two scales, System Usability Scale and Mobile App Rating Scale questionnaires, respectively. Finally, the role of patients' age and educational backgrounds in the use of the app was assessed. The relationship between learnability and usability of the app was measured by the T-Test. Results: The app was developed with three user interfaces. Its usability developed from the patient's point of view scored a remarkable score of 83.20 with a 95% confidence interval. This value was too indicative of high satisfaction with the usefulness and the possibility of recommending it to other cancer survivors. The results of the quality evaluation from an expert's point of view showed that this app had good functionality. Evaluation of the role of demographic information in the use of the app showed that it can be used for all age groups with different levels of education. The app did not differ significantly between learnability and usability. Conclusion: The development of m-Health apps, based on usability principles that are suitable for all age groups with different levels of education, is welcomed by cancer patients.

Explaining factors affecting the participation of nongovernmental organizations (NGOs) in disaster management: A systematic review.

BACKGROUND AND OBJECTIVE: Numerous disasters have occurred over the recent years. Moreover, there has been a considerable rise in the number of victims, injured people, and damages caused by disasters worldwide. Governments cannot meet needs alone due to the complicated nature of crises and accidents. Therefore, nongovernmental organizations (NGOs) and communities must assist the states during disasters. The present study aimed to derive the factors affecting the participation of NGOs in disaster management using a systematic review in 2022. DESIGN: This systematic review was done using ISI, Science Direct, Scopus, PubMed/MEDLINE, ProQuest, and Cochran Library based on the preferred reporting items for systematic reviews (PRISMA) standard from January 1, 2000 to December 31, 2021. The articles were selected based on the search keywords (population, intervention, comparison, outcome (PICO)). After studying the titles, abstracts, and full texts of the articles, the factors affecting the participation of NGOs in disaster management were derived. RESULTS: The final assessment was done on 13 articles. Cooperation and coordination with other organizations, education, communication between NGOs, social empowerment, access to adequate references, and flexibility were the criteria with the highest frequency. CONCLUSION: As multiple NGOs take part in responding to disasters and performing relief operations, establishing a unified command and supervision system for effective coordination and collaborations among NGOs and other stakeholders is highly suggested. Further research is needed to develop a -measurement tool for assessing the effectiveness of NGOs' activities during disasters.

Instructional Programs Influencing the Enhancement of the Knowledge Required by Volunteers in Disasters: A Systematic Review.

OBJECTIVE: To determine the instructional programs required by volunteers based on the studies carried out worldwide. METHODS: A systematic search was carried out by PubMed, Cochran Library, Scopus, EMBASE, Science Direct, Web of Science and ProQuest databases between January 1970 and the end of June 2019. The articles were selected based on the keywords chosen by the author. In the end, the volunteer's instructional titles were extracted from the articles in disasters. RESULTS: Eleven articles were chosen for final analysis after studying the titles, abstracts, and complete articles texts which 45 instructional titles were extracted. The most frequent scales in terms of repetition were ethics, kinds of exercises, personal protection instruments, general hygiene, awareness of certain disasters, accident command system, disaster triage and emergency planning. CONCLUSION: Governments should offer programs that can best serve the improvement of their performance by considering the daily increasing growth in the number of volunteers and in natural and manmade disasters. Universities and schools play determinant roles in this regard. It is hoped that the present study findings can be effective in codify an efficient instructional program for elevating the performance of the volunteers by taking part in disasters response.

Medication adherence among the elderly: applying grounded theory approach in a developing country.

BACKGROUND: Medication adherence is an important concept particularly among the elderly that can, directly and indirectly, affect the health system's costs and the elderly's health, quality of life, and functional abilities. This study aimed to determine the model of medication adherence among the Iranian elderly using the grounded theory approach. METHODS: The concept of medication adherence and the determination of its process among the elderly is a multidisciplinary social issue that can be affected by many contextual factors. Grounded theory with the approach of Strauss and Corbin (2004) was applied to determine the customized model. Data triangulation occurred through semi-structured interviews, observation, field notes, and memoing. Open coding, selective coding, and axial coding were applied to analyze the data. RESULTS: Delinquency in the medication use among the elderly was caused by factors such as doubtfulness, fear of complications, not following the patients by the physicians, and negative others and medical staff's impacts. During the process of medication adherence, the patient's lack of knowledge, lack of sufficient education, inappropriate and restricted lifestyle, difficult living conditions, and social pressures imposed on individuals could exacerbate and worsen the delinquency in medication adherence. It should not be neglected that some other factors such as lack of an effective supervision system, lack of supportive organizations, stakeholders' market-based behaviors, consumption inconvenience, consumption stress, hopelessness, and misunderstanding could also aggravate the delinquency. CONCLUSIONS: Although the proposed theory and model were customized and context-based for the Iranian elderly, in general, making positive changes in the process of adherence to the medication use among the elderly requires scientific and basic management and planning of its factors. It should be noted that making these changes requires some interventions in and cooperation of all levels of the country's health system, from the Ministry of Health and Medical Education to the individual level of the elderly.

Challenges and opportunities from the COVID-19 pandemic in medical education: a qualitative study.

INTRODUCTION: Since the onset of the COVID-19 pandemic, many higher education and health centers have faced challenges. Educational leaders have tried to manage the new situation, but the human infrastructure was not ready for such an event. This study aims to explain the challenges and opportunities of the COVID-19 pandemic for medical education. METHOD: This qualitative study used conventional content analysis to collect data from face-to-face and semi-structured interviews. The interviews continued until data saturation was reached. The participants were 12 students and 14 faculty members at Shiraz University of Medical Sciences. To ensure data rigor, we used member checks, peer checks and an external observer. RESULTS: Three main categories and 15 subcategories were extracted. The findings showed that four subcategories, e.g. perception on feasibility of e-learning, standardizing of e-learning, dedicated teaching, and networking and interdisciplinary collaborations, affected the development of medical e-learning. The main opportunities from the COVID-19 pandemic for medical education were classified into five subcategories: attitudes to e-learning and adaptability, preventing students' separation from the educational environment, documentation and monitoring education, take control of own learning, and increasing perceived usefulness. The main challenges were divided into four subcategories, e.g. noncompliance with virtual classroom etiquette, inadequate interactions, time limitations, and infrastructure defects and problems. Finally, participants believed that methods of evaluation in e-learning were more suitable for diagnosis and formative evaluations. Generally, two subcategories were extracted, e.g. formative and summative. CONCLUSION: Medical schools have necessarily moved towards e-learning to compensate for the interruption in classroom education, such that traditional classes have been replaced with e-learning. These rapid, extensive changes in teaching and learning approaches have consequences for medical schools.

Determinants affecting medication adherence in the elderly: A qualitative study.

OBJECTIVE: Due to high rates of irrational use of medicines and low rates of medication adherence among older Iranian patients, this study aimed to explore the determinants of medication adherence in the elderly. METHODS: This qualitative study was conducted in 2019 via 20 semi-structured interviews with a purposeful sample of elderly people and health-care personnel. Transcript data were analyzed applying thematic analysis. MAXQDA10 was used for thematic analysis and presenting a thematic map. RESULTS: Two main themes appeared as the main determinants of medication adherence: individual determinants and external determinants. Other results show that there were six sub-themes and 23 main categories in this regard. The sub-themes were as follows: consumption disorder, consumption acceptance, delinquency, forgetfulness, sociocultural factors, and others' impacts. CONCLUSIONS: Different individual and external factors can affect elderly people's medication adherence. Considering the significance of this issue for the health of elderly people and the whole community, positive changes are needed to manage the medication-adherence process. Basic and scientific planning, appropriate interventions, and comprehensive collaboration among all health-system levels are required for implementing such changes.

Urban Growth and urban need to fair distribution of healthcare service: a case study on Shiraz Metropolitan area.

OBJECTIVE: (1) To analyze urbanization development pattern in Shiraz after the year 1977; (2) To analyze hospital development model in Shiraz after the year 1977; (3) To review and prioritize location-allocation criteria for hospitals; and (4) To specify appropriate locations for the establishment of potential future general hospitals in Shiraz based on selected criteria. RESULTS: Although a significant expansion is seen from different geographical directions (particularly northwest and southeast of the city) in the urbanization model after the year 1977, the construction of hospitals has been limited to the central parts of the city and the areas around the city lack any hospitals. The "open access path to the hospital during incidents and disasters and a light traffic" criterion has enjoyed the highest priority amongst the 24 selected hospital location-allocation criteria. Appropriate locations for establishment of new hospitals in the future have been marked as colored maps. The present study has been able to determine and prioritize a comprehensive list of hospital location-allocation criteria. Moreover, the achieved maps from this study can be used by policy makers to develop new hospitals.

Iranian's healthcare system challenges during natural disasters: the qualitative case study of Kermanshah earthquake.

BACKGROUND: In order to the significance of lessons learned from the natural disasters for health care systems particularly in developing and under-developed countries, the main purpose of this study was to identify challenges and limitations in light of the earthquake experience in Kermanshah Province. METHODS: The present study was conducted in 2019 as a qualitative research using content analysis method. In this regard, 19 key informants were selected using snowball sampling. To enhance the accuracy of the study, the four validation criteria for qualitative studies in data coding developed by Guba and Lincoln including credibility, transferability, dependability and confirmability were used. Data was analyzed applying Graneheim and Lundman (2004) approach for analyzing the qualitative content of an interview text. RESULTS: Analysis of the data led to the identification of 2 main themes, 5 sub- themes and 17 main categories. The first main theme was health system oriented challenges containing challenges of medication supply and preparation, structural challenges, challenges in crisis-scene management and challenges of service delivery and the second main theme was non-health system oriented challenges including social and psychosocial challenges. CONCLUSION: According to the results, along with health system oriented challenges with the inter-sectoral or intra-sectoral nature, the non-health system oriented challenges the same as social, cultural and psychological factors can be considered as the major challenges of Iran's healthcare system in the face of crises. This complicated context can shed the light to policy makers that not only attention to the medicine and medical equipment supply chain, manpower preparation and service delivery system can be considered as an emergency, but also careful attention to the structural challenges and crisis-scene management should be planned and considered as a priority. Besides, the policy makers and the local managers should try to plan and act in a contingent situation according to the social and cultural characteristics of the region and the psychological condition and the mental needs of the people.

Obstructive Sleep Apnea: A Prediction Model Using Supervised Machine Learning Method.

Obstructive Sleep Apnea (OSA) is the most common breathing-related sleep disorder, leading to increased risk of health problems. In this study, we investigated and evaluated the supervised machine learning methods to predict OSA. We used popular machine learning algorithms to develop the prediction models, using a dataset with non-invasive features containing 231 records. Based on the methodology, the CRISP-DM, the dataset was checked and the blanked data were replaced with average/most frequented items. Then, the popular machine learning algorithms were applied for modeling and the 10-fold cross-validation method was used for performance comparison purposes. The dataset has 231 records, of which 152 (65.8%) were diagnosed with OSA. The majority was male (143, 61.9%). The results showed that the best prediction model with an overall AUC reached the Naïve Bayes and Logistic Regression classifier with 0.768 and 0.761, respectively. The SVM with 93.42% sensitivity and the Naïve Bayes of 59.49% specificity can be suitable for screening high-risk people with OSA. The machine learning methods with easily available features had adequate power of discrimination, and physicians can screen high-risk OSA as a supplementary tool.

Designing a thesis tele-supervision system for postgraduate medical sciences students.

INTRODUCTION: Today, progressing science and technology at all domains, including education and research, will bring new opportunities to resolve the communication and interaction problems. The aim of this study was to determine potential factors affecting the thesis supervision and provide a web-based solution. METHODS: This is a developmental study conducted in two theoretical and technical phases at the Shiraz University of Medical Sciences in 2017. The theoretical phase was performed in three stages, including literature review and investigating the existing studies and Delphi's study based experts' view as well as identifying the thesis supervision status based on 200 postgraduate students' point of view. The technical phase had two stages, including to draw processes and to design the physical and logic schemes of the system. The Thesis Tele-Supervision software named SAHPAD was designed by C# and ASP. NET programing languages. RESULTS: The results showed that out of 40 potential factors specified at the first stage of theoretical phase by using experts' opinion, 13 items were selected as the main factors. According to the results obtained from the students' views at the third stage, the factor of "accessibility" had the minimum score, i.e. 3.15 mean of four, which was the worst status. CONCLUSION: The designed system covered from the beginning to the end of the thesis workflow at its electronic frame with its various capabilities such as the interaction of the research team to decide the title, draft the proposal, prepare for thesis defense, etc.

Moving toward community based telehealth services using mhealth for hypertensive patients.

BACKGROUND: Although self-care can control and prevent complications in hypertensive patients, self-care adherence is relatively low among these patients. Community-based telehealth services through mhealth can be an effective solution. OBJECTIVE: This study aimed to evaluate the effect and acceptance of an mhealth application as a community-based telehealth intervention on self-care behavior adherence. METHOD: This clinical trial included sixty hypertensive patients and their matched controls from two heart clinics affiliated to Shiraz University of Medical Sciences (SUMS). Self-care behaviors were assessed using Hill-Bone questionnaire before and after the intervention. Acceptability was evaluated in the intervention group at the end of the study period. The data were analyzed via SPSS 18 software using descriptive and inferential statistics. RESULT: The results showed a significant difference between the intervention and control groups regarding the mean score of self-care behaviors (4.13 ± 0.23 versus 3.18 ± 0.27, p < .001). Additionally, a significant difference was observed between the two groups concerning the mean scores of the two subscales of self-care behaviors, including "medication taking" and "proper diet". However, no significant difference was observed between the two groups regarding the mean score of "appointment keeping" (p = .075). Overall, the intervention group participants were satisfied (4.27 ± 0.34) with this approach for managing hypertension. CONCLUSION: Community-based telehealth services through mhealth had the potential to improve self-care behaviors in hypertensive patients and seemed to be accepted by the patients in the intervention group.