A home-based tele-rehabilitation exercise system for patients after knee replacement surgery.

BACKGROUND: Knee arthritis is a destructive disorder that affects the knee joints and causes pain and reduced mobility. Drug treatments, weight loss, and exercise control the symptoms of the disease, but these methods only delay the disease process and eventually, knee joint replacement surgery will be needed. After surgery, with the help of a proper physiotherapy program, full recovery takes an average of 6-12 months. However, currently, there is no similar tool to facilitate this process in Iran. OBJECTIVE: The purpose of this research is to design and develop the prototype of a rehabilitation system for patients after knee replacement surgery, which provides patients with information and appropriate physiotherapy programs. METHODS: This study was development-applied and was done in three stages. In the first stage, the needs and content of education and therapeutic exercises were prepared in the form of a checklist, and then the necessity of each item was checked in the evaluation sessions. In the second stage, the prototype of the system was developed using Adobe XD software and based on the requirements approved from the previous stage. In the third stage, the usability of the program was analyzed from the point of view of experts using the exploratory evaluation method with Nielsen's 13 principles of usability. RESULTS: At first, the system requirements were extracted and prepared in two checklists of content (51 exercises) and capabilities (60 items). Then after a survey of experts based on the Delphi technique, content information (43 exercises) and functional and non-functional requirements (53 items) were obtained. A survey of experts helped to finalize the information elements, categorize them, and prepare the final version of the checklists. Based on this, the system requirements were classified into 11 categories, and the training content was classified into 3 training periods. Finally, the design and development of the system was done. This system has admin, physician, and patient user interfaces. The result of usability showed that this system is efficient and there are only a few problems in the feature of helping users to detect and recover from errors. CONCLUSION: It seems necessary to develop a system based on the principles of usability by therapists and rehabilitation specialists to train and monitor the remote rehabilitation process of patients after knee joint replacement at home. And the importance of involving stakeholders in the design and development of remote rehabilitation systems is not hidden from anyone. Kara system has all of the above.

Technical aspects of virtual augmented reality-based rehabilitation systems for musculoskeletal disorders of the lower limbs: a systematic review.

INTRODUCTION: Musculoskeletal disorders are one of the most common causes of physical disability. The rehabilitation process after musculoskeletal disorders is long and tedious, and patients are not motivated to follow rehabilitation protocols. Therefore, new systems must be used to increase patient motivation. Virtual reality (VR) and augmented reality (AR) technologies can be used in this regard. In developing such systems, various technologies and methods of movement recognition are used; therefore, this study aims to summarize the technical aspects of using VR/AR in rehabilitation and evaluate and discuss efficient methods of investigating studies using the Statement of Standards for Reporting Implementation Studies (StaRI). METHODS: Search in four scientific databases was done systematically based on PRISMA through online search engines from inception to June 2021. These databases include Medline (PubMed), Scopus, IEEE, and Web of Science. An updated search was also conducted on 17 December 2021. The research used keywords and MeSH terms associated with VR/AR, musculoskeletal disorder, and rehabilitation. Selected articles were evaluated qualitatively using the Standards for Reporting Implementation Studies (StaRI) statement. RESULTS: A total of 2343 articles were found, and 20 studies were included. We found that 11 (55%) studies used Kinect technology as input tools, and 15 (75%) studies have described the techniques used to analyze human movements, such as dynamic time warping (DTW) and support vector machines (SVM). In 10 (50%) studies, the Unity game engine was used for visualization. In 8 studies (40%), usability was assessed, and high usability was reported. Similarly, the results of the review of studies according to the StaRI checklist showed poor reporting in the title and discussion of the studies. CONCLUSIONS: We found that academic studies did not describe the technical aspects of rehabilitation systems. Therefore, a good description of the technical aspects of the system in such studies should be considered to provide repeatability and generalizability of these systems for investigations by other researchers.

Better monitoring of abused children by designing a child abuse surveillance system: Determining national child abuse minimum data set.

BACKGROUND: Monitoring the trend of child abuse can significantly help in measuring the magnitude of the problem and understanding its recurrence. The minimum data set (MDS) is a set of elements of each domain that provides the basis for decision-making. This study was conducted to determine the comprehensive national minimum data set for child abuse surveillance system (CASS) in Iran. METHODS: This is a cross-sectional descriptive study. Data were gathered from the selected countries and child abuse registry and surveillance systems. The MDS questionnaire was designed based on a review of the publications and experts' opinions. The final data elements of the CASS were determined using the Delphi technique by visiting pediatricians. RESULTS: In total, 147 data elements were included in the Delphi survey. The data elements of the CASS were classified into seven categories as follows: demographic data, incident related data, medical history, diagnostic tests, incident nature, therapeutic measures, and other required data. CONCLUSION: The existence of national MDS as the core of the child abuse surveillance program is essential and leads to appropriate decisions in this regard. The MDS can meet the needs of professionals, decision makers, researchers, and policymakers who decide on reducing the incidence of child abuse.

Exploring patient perspectives on Iran's Electronic Prescription System: a Qualitative Inquiry.

Background: Electronic prescriptions represent a fundamental shift in service delivery, healthcare management, and associated costs, offering numerous advantages. However, akin to other electronic systems, they also present challenges. This study aimed to investigate patients' understanding of the challenges associated with electronic prescriptions in Iran. Methods: This study used a qualitative research design, utilizing individual and semi-structured interviews with patients referred to selected pharmacies across all 11 districts of Shiraz City. The data were analyzed using MAXQDA software (version 10), and descriptive statistics for demographic data were calculated using SPSS version 19. Results: The study revealed that the participants generally demonstrated a certain level of familiarity with electronic prescribing systems. However, it was evident that many were unaware of the potential implications of such technology for their relationships with healthcare providers. This underscores the urgent need for patient understanding in the context of the electronic prescription system. While patients were relatively familiar with the functionality of electronic prescribing systems, they lacked a comprehensive understanding of how using these systems could affect their interactions with healthcare providers. Conclusion: Patients are significant beneficiaries of the electronic prescribing system. By addressing their needs and concerns, they can develop a positive attitude toward this system. Their active engagement can pave the way for the system's ease of use, increase its acceptance, and ultimately enhance the quality of healthcare services.

Tele-mental health during the COVID-19 pandemic: A systematic review of the literature focused on technical aspects and challenges.

Introduction: Mental disorders are the leading cause of disability and the second leading cause of death worldwide, which leads to the death of more than 9 million people annually. The global impact of the Coronavirus epidemic on mental health includes insomnia, anxiety, and depression. Therefore, given the current situation, innovations such as telemedicine to provide prevention and treatment services for people with mental disorders seem necessary. Methods: A literature review was performed according to the preferred items to report in systematic reviews and meta-analyses (PRISMA). Covering a period from January 2020 to July 2023, we conducted a systematic literature search on five electronic databases (PubMed-Mesh, Scopus, Web of Science, Science direct, and PsycInfo). The search strategy included three categories of keywords: Mental health, Tele, COVID-19. Results: A total of 112 articles were identified by searching the databases of published articles, 13 articles met our inclusion criteria. A total of 76.2% of them were related to patients with stress, anxiety, and depression issues. We found that the real-time method has been the most common method used to communicate between the physician and the patient (92.3%). The communication technologies used also included telephone, video call, video conference, and E-mail. During these communications, data was exchanged in text, voice, and video formats. In three studies (27%), interoperability with other systems was mentioned. In addition, 69.2% of the studies reported challenges, the most important of which were access to electronic and communication devices, network connection problems, audio and video problems, and privacy issues. Conclusions: Considering the many advantages of telemedicine technology in the field of mental health, the need to use this technology in developing countries, including our country, is obvious. But the application of these technologies requires the investigation of technical aspects and challenges related to them as much as possible, which have been seen in few studies.

Internet of Things and healthcare system: A systematic review of ethical issues.

Background and Aims: The Internet of Things (IoTs) is a set of connected objects and devices that share data and pursue a common goal in different areas. IoT technology can significantly help the healthcare system by enabling the monitoring of elderly and chronic disease patients. Along with the growth of this technology, its challenges and limitations such as Connectivity, Compatibility, Standards, cost, legal, and ethical also increase. One of the most critical and challenging issues in the IoT is ethical issues. This study aims to explore the key ethical aspects of the IoT and Categorize them based on the executive phases of IoT in healthcare. Methods: The current study was conducted in two phases using the mixed-method approach. In the first phase, a systematic review was conducted in relevant databases to identify ethical issues of the IoT. In the second phase, a focus group discussion was conducted to classify the extracted data elements based on executive phases of IoT by medical informatics experts and computer engineerings. Results: Among the 138 papers retrieved through the search strategy, 11 articles were selected, and 12 ethical issues related to IoT were identified. The obtained results revealed the importance of ethical issues of IoT, including security, confidentiality, privacy, anonymity, freedom to withdraw, informed consent, integrity, availability, authorization, access control, censoring, and eavesdropping. They were classified into five main categories of executive phases of IoT based on the five experts' opinions affiliated with SUMS, including data collection, data storage, data process, data transmission, and data delivery. Conclusion: Because of the key role of the IoT in disease prevention, real-time tele-monitoring of patient's functions, testing of treatments, health management, and health research, considering the risks relating to Health care and patient data is essential. Moreover, health policymakers should be aware of the ethical commitment to using IoT technology.

Development and validation of the Neonatal Abstinence Syndrome Minimum Data Set (NAS-MDS): a systematic review, focus group discussion, and Delphi technique.

OBJECTIVES: Neonatal abstinence syndrome (NAS) is a combination of symptoms in infants exposed to any variety of substances in utero. Information systems and registries help to collect information about these patients; however, there is always a deep gap between complete and accurate information to be collected, understood, and applied in the health care system; thus, defining a minimum data sets (MDS) as one of the primarily steps of designing a registry system is essential. The aim of this study was to develop an MDS of the registry for infants with NAS in Iran. METHODS: This research is a descriptive cross-sectional study. In this study, three steps were carried out to develop the MDS including systematic review, Delphi technique, and focus group discussion. A systematic review was conducted in relevant databases to identify appropriate related data. In the second phase, a focus group discussion was used to classify the extracted data elements by contributing neonatologists. Finally, data elements were chosen through the decision Delphi technique in two distinct rounds. Collected data were analyzed using SPSS 22 (SPSS Inc., Chicago, IL). RESULTS: By reviewing related papers and available NAS registries in other countries, 145 essential data elements were identified. They were classified into two main categories based on the eight experts' opinions including maternal with two sections and infant with two sections. After applying two rounds of Delphi technique, the final data elements for maternal and infant categories were 42 and 31, respectively. Thus, on completion of the survey, 73 data elements were approved. CONCLUSION: The proposed MDS for NAS can help to store an accurate and comprehensive data, document medical records, integrate them with other information systems and registries, and communicate with other healthcare providers and healthcare centers. This MDS can contribute to the provision of high-quality care and better clinical decisions.

A Smartphone Remote Monitoring App to Follow Up Colorectal Cancer Survivors: Requirement Analysis.

BACKGROUND: Colorectal cancer survivors face multiple challenges after discharge. eHealth may potentially support them by providing tools such as smartphone apps. They have lots of capabilities to exchange information and could be used for remote monitoring of these patients. OBJECTIVE: In this study, we addressed the required features for apps designed to follow up colorectal cancer patients based on survivors' and clinical experts' views. METHODS: A mixed methods study was conducted. Features of related apps were extracted through the literature; the features were categorized, and then, they were modified. A questionnaire was designed containing the features listed and prioritized based on the MoSCoW (Must have, Should have, Could have, Won't have) technique and an open question for each category. The link to the questionnaire was shared among clinical experts in Iran. The answers were analyzed using the content validity ratio (CVR), and based on the value of this measure, the minimum feature set of a monitoring app to follow up patients with colorectal cancer was addressed. In addition, a telephone interview with colorectal cancer survivors was conducted to collect their viewpoints regarding a remote monitoring system for colorectal cancer cases. RESULTS: The questionnaire contained 10 sections evaluating 9 categories of features. The questionnaire was completed by 18 experts. The minimum set of features in the app was identified as patient information registration, sign and symptom monitoring, education, reminders, and patient evaluation (0.42 < CVR < 0.85). Features including physical activity, personalized advice, and social network did not achieve the minimum score (-0.11 < CVR < 0.39). We interviewed 9 colorectal cancer survivors. Information registration, sign and symptom monitoring, education, and personalized advice were the features with high priority from the survivors' perspectives. Scheduling, shopping, and financial support features were emphasized by survivors in the interview. CONCLUSIONS: The requirement set could be used to design an app for the targeted population or patients affected by other cancers. As the views from both survivors and clinical experts were considered in this study, the remote system may more adequately fulfill the need for follow-up of survivors. This eases the patients' and health care providers' communication and interaction.

Mobile Health Technology and Healthcare Providers: Systemic Barriers to Adoption.

OBJECTIVES: Despite the growing use of mobile health (mHealth), certain barriers seem to be hindering the use of mHealth applications in healthcare. This article presents a systematic review of the literature on barriers associated with mHealth reported by healthcare professionals. METHODS: This systematic review was carried out to identify studies published from January 2015 to December 2019 by searching four electronic databases (PubMed/MEDLINE, Web of Science, Embase, and Google Scholar). Studies were included if they reported perceived barriers to the adoption of mHealth from healthcare providers' perspectives. Content analysis and categorization of barriers were performed based on a focus group discussion that explored researchers' knowledge and experiences. RESULTS: Among the 273 papers retrieved through the search strategy, 18 works were selected and 18 barriers were identified. The relevant barriers were categorized into three main groups: technical, individual, and healthcare system. Security and privacy concerns from the category of technical barriers, knowledge and limited literacy from the category of individual barriers, and economic and financial factors from the category of healthcare system barriers were chosen as three of the most important challenges related to the adoption of mHealth described in the included publications. CONCLUSIONS: mHealth adoption is a complex and multi-dimensional process that is widely implemented to increase access to healthcare services. However, it is influenced by various factors and barriers. Understanding the barriers to adoption of mHealth applications among providers, and engaging them in the adoption process will be important for the successful deployment of these applications.

The use of mobile health interventions for gestational diabetes mellitus: a descriptive literature review.

This study attempted to review the evidence for or against the effectiveness of mobile health (m-health) interventions on health outcomes improvement and/or gestational diabetes mellitus (GDM) management. PubMed, Web of Science, Scopus, and Embase databases were searched from 2000 to 10 July 2018 to find studies investigating the effect of m-health on GDM management. After removing duplications, a total of 27 articles met our defined inclusion criteria. m-health interventions were implemented by smartphone, without referring to its type, in 26% (7/27) of selected studies, short message service (SMS) in 14.9% (4/27), mobile-based applications in 33.3% (9/27), telemedicine-based on smartphones in 18.5% (5/27), and SMS reminder system in 7.1% (2/27). Most of the included studies (n=23) supported the effectiveness of m-health interventions on GDM management and 14.3% (n=4) reported no association between m-health interventions and pregnancy outcomes. Based on our findings, m-health interventions could enhance GDM patients' pregnancy outcomes. A majority of the included studies suggested positive outcomes. M-health can be one of the most prominent technologies for the management of GDM.

Neonatal abstinence syndrome: a systematic review of current databases and registries.

OBJECTIVES: Registries are considered as rich sources of data for determination of infants with neonatal abstinence syndrome (NAS), the improvement of provided care and research. The aims of this study were: (1) to investigate the existing studies including NAS registries, (2) to identify and extract the required data elements. METHODS: The following electronic databases were searched: PubMed, Scopus, Web of Science, ProQuest, Embase/Medline, and Psych Info. In addition, a review of gray literature was undertaken to identify relevant studies in English covering the period from 1 January 2009 to 1 November 2018 including registries and databases. Screening of titles, abstracts, and full-texts were conducted independently by two researchers based on PRISMA guidelines. The basic registry information, scope, registry type, data source, the purpose of registry, important variables were extracted and analyzed. RESULTS: Twenty-five articles were eligible and included in the review; they reported 37 registries and databases related to NAS at the national and state levels in 11 countries from 1876 to 2013. We proposed a NAS registry design framework based on well-known data-information-knowledge (DIK) structure due to Ackoff's DIK hierarchy has a defined role as a central model of information systems, information management, and knowledge management. CONCLUSIONS: To the best of our knowledge, this is the first study which has systematically reviewed NAS-related registries. Since there are no international standards to develop new NAS registries, the proposed framework in this article can be beneficial. This framework is essential not only to facilitate the NAS registry design but also to help the collection of high-value clinical data necessary for the acquisition of better clinical knowledge.

Study of challenges to utilise mobile-based health care monitoring systems: A descriptive literature review.

Mobile health encompasses remote and wireless applications to provide health services. Despite the advantages of applying mobile-based monitoring systems, there are challenges and limitations; understanding the challenges may assist in identifying available solutions and optimising decision-making to apply mHealth technologies more practically. This study aimed to investigate the main challenges related to mHealth-based systems for health monitoring purposes. This review was carried out through investigation of English evidence from four databases, including Scopus, PubMed, Embase, and Web of Science, using a defined search strategy from 2013 to 2017. Two independent researchers reviewed the results based on PRISMA guidelines, and data was categorised using a bottom-up approach to reach a framework for the most general challenges. Among the 105 papers obtained, eight works were selected. The revealed challenges were categorised into six main branches across a tree (with 55 nodes, four levels) including user-related, infrastructure, process, management, resource and training challenges. Identifying the resolvable and preventable challenges, such as those related to training, design might play a crucial role in preventing loss of resources and in growing the success rate of a project, particularly if considered in national level projects.