Publications by authors named "Abbas Sheikhtaheri"

56 Publications

A Survey of implementation status of child nutrition surveillance systems, registry systems and information systems: a scoping literature review protocol.

BMJ Paediatr Open 2021 17;5(1):e001164. Epub 2021 Aug 17.

Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Child malnutrition in all forms is known globally as the leading cause of poor health. Planning and solving this challenge require sources that collect data accurately. Nutrition surveillance systems (NSS), nutrition registry systems (NRS) and nutrition information systems (NIS) collect and analyse data on nutrition status. Unfortunately, these systems only exist in a few countries. The methods that these systems use significantly differ and their effectiveness is also scarcely researched. This scoping literature review aimed to conduct a survey on NSS, NRS and NIS that collect data on children's nutrition at national and international levels, along with their attributes.

Methods And Analysis: The methods and analyses of this scoping review follow the Arksey and O'Malley's methodology. This scoping literature review will be conducted in five stages based on this method. (1) The main research question and subquestions are identified. (2) Relevant studies are extracted. In this step, we will search electronic databases including PubMed, Scopus and ISI Web of Science. A manual search will also be performed in Google Scholar, grey literature, and the websites of organisations such as WHO, UNICEF, Centers for Disease Control and Prevention, National Health Service, International Food Policy Research Institute, Food and Agriculture Organization, Food and Nutrition Technical Assistance, United Nations World Food Programme, and United Nations System Standing Committee on Nutrition. (3) Extracted studies are separately reviewed by two reviewers based on inclusion and exclusion criteria, and eligible studies are then selected. A third reviewer resolves disagreements. (4) A checklist is developed to extract the features. Data of included systems are separately extracted and entered into a checklist by two reviewers. A third reviewer then resolves any disagreement. (5) Data are summarised and analysed and are presented in tables and figures.

Discussion: This scoping literature review provides strong evidence of the status of systems that collect data on the status of child nutrition. This evidence can help select best practices which can be applied to develop future systems. It can also be a positive step towards achieving an integrated system.
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http://dx.doi.org/10.1136/bmjpo-2021-001164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8372877PMC
August 2021

The Development and Usability Assessment of an mHealth Application to Encourage Self-Care in Pregnant Women against COVID-19.

J Healthc Eng 2021 20;2021:9968451. Epub 2021 Jul 20.

Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

The coronavirus disease 2019 (COVID-19) pandemic has caused serious concerns in pregnant women. Self-care mHealth applications can provide helpful guidelines for COVID-19 prevention or management in case of infection. This study aimed to develop and then assess a self-care smartphone-based application to provide self-care for pregnant women against COVID-19. The present study was conducted in two phases. First, a needs assessment was performed based on the opinions of 30 obstetricians and pregnant women. Then, relying on the results, a smartphone-based application was prototyped and assessed in terms of its usability and user satisfaction. To assess the application, 36 pregnant women (11 infected with COVID-19) were asked to use the application for a week. The QUIS questionnaire 5.5 was used for assessment, and the results were analyzed via descriptive statistics in SPSS 23. According to the obstetricians and pregnant women, of the 41 information requirements, 35 data elements were noted to be essential in the needs assessment. Features of the application were placed in four categories of User's Profile, Lifestyle, Disease Management and Control, and Application Functions (e.g., introducing high-risk places in terms of COVID-19 prevalence in each city, introducing specialized COVID-19 medical centers to pregnant women to receive services, medication management, stress management and control, nutrition and diet management, sleep management, contacting physicians, doctor's appointment reminder, searching the available educational materials, and making application adjustments such as text font, size, and color). With an average score of 7.94 (out of 9), pregnant women rated the application at a good level. The application can be used to reduce anxiety and stress about COVID-19 in mothers, provide access to reliable information to answer possible questions, identify high-risk locations, and provide pregnant women with instant access to healthcare facilities and information related to COVID-19 self-care processes.
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http://dx.doi.org/10.1155/2021/9968451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292075PMC
August 2021

Clinical and Epidemiological Characteristics of Hospitalized COVID-19 Patients in Hormozgan, Iran: A Retrospective, Multicenter Study.

Arch Iran Med 2021 05 1;24(5):434-444. Epub 2021 May 1.

Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.

Background: To better manage the COVID-19 pandemic, it is necessary to carefully study information about patients with COVID-19. To report clinical and epidemiological characteristics of COVID-19 patients in southern Iran.

Methods: This cross-sectional retrospective study was conducted based on data extracted from the COVID-19 registry of Hormozgan. Data from patients with confirmed COVID-19 based on CT-scan results or real-time reverse transcriptase-polymerase chain reaction (RT-PCR) results until September 25, 2020, were analyzed for this study (2351 inpatients). We reported demographics, signs and symptoms on admission, comorbidities, and treatments, as well as clinical outcomes, hospital stay, and intensive care unit (ICU) admission.

Results: Most of patients were men (1235/2351; 52.5%) and the most common signs and symptoms included cough (1343/2351; 57.1%), shortness of breath (1224/2351; 52.1%) and fever. The most common comorbidities included hypertension (410/2351 (17.4%), diabetes (343/2351; 14.6%) and chronic cardiac disease (282/2351; 12%). Also, 228 patients (9.7%) were hospitalized in the ICU. The mortality rate was 12.5% (295/2351) among all patients and 64.5% (147/228) in ICU wards, respectively. The number of cases with comorbidities including hypertension, chronic cardiac disease, diabetes, chronic neurological disorders, chronic kidney disease, chronic hematologic disease, malignant neoplasm, moderate or severe liver disease, dementia and fauvism in the ICU was significantly higher than the general wards.

Conclusion: Most characteristics of our patients were similar to those reported in other studies; however, our patients were younger and suffered from a less severe disease. The mortality rate in the ICU was higher than other studies.
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http://dx.doi.org/10.34172/aim.2021.62DOI Listing
May 2021

Lessons learned from hemolytic uremic syndrome registries: recommendations for implementation.

Orphanet J Rare Dis 2021 05 25;16(1):240. Epub 2021 May 25.

Pediatric Nephrology Department, Aliasghar Clinical Research Development Center (AACRDC), Aliasghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran.

Background: Hemolytic uremic syndrome (HUS) is a rare condition which diagnosed with the triad of thrombocytopenia, microangiopathic hemolytic anemia, and acute renal injury. There is a high requirement for research to discover treatments. HUS registries can be used as an important information infrastructure. In this study, we identified and compared the different features of HUS registries to present a guide for the development and implementation of HUS registries.

Results: The purposes of registries were classified as clinical (9 registries), research (7 registries), and epidemiological (5 registries), and only 3 registries pursued all three types of purposes. The data set included demographic data, medical and family history, para-clinical and diagnostic measures, treatment and pharmacological data, complications, and outcomes. The assessment strategies of data quality included monthly evaluation and data audit, the participation of physicians to collect data, editing and correcting data errors, increasing the rate of data completion, following guidelines and data quality training, using specific data quality indicators, and real-time evaluation of data at the time of data entry. 8 registries include atypical HUS patients, and 7 registries include all patients regardless of age. Only two registries focused on children. 4 registries apply prospective and 4 applied both prospective, and retrospective data collection. Finally, specialized hospitals were the main data source for these registries.

Conclusion: Based on the findings, we suggested a learning framework for developing and implementing an HUS registry. This framework includes lessons learned and suggestions for HUS registry purposes, minimum data set, data quality assurance, data collection methods, inclusion and exclusion criteria as well as data sources. This framework can help researchers develop HUS registries.
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http://dx.doi.org/10.1186/s13023-021-01871-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146148PMC
May 2021

Topic Discovery on Farsi, English, French, and Arabic Tweets Related to COVID-19 Using Text Mining Techniques.

Stud Health Technol Inform 2021 May;279:26-33

Department of Computer Science, Metropolitan College, Boston University, MA, USA.

Background: Social networks are a good source for monitoring public health during the outbreak of COVID-19, these networks play an important role in identifying useful information.

Objectives: This study aims to draw a comparison of the public's reaction in Twitter among the countries of West Asia (a.k.a Middle East) and North Africa in order to make an understanding of their response regarding the same global threat.

Methods: 766,630 tweets in four languages (Arabic, English French, and Farsi) tweeted in March 2020, were investigated.

Results: The results indicate that the only common theme among all languages is "government responsibilities (political)" which indicates the importance of this subject for all nations.

Conclusion: Although nations react similarly in some aspects, they respond differently in others and therefore, policy localization is a vital step in confronting problems such as COVID-19 pandemic.
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http://dx.doi.org/10.3233/SHTI210084DOI Listing
May 2021

Prediction of neonatal deaths in NICUs: development and validation of machine learning models.

BMC Med Inform Decis Mak 2021 04 19;21(1):131. Epub 2021 Apr 19.

Health Information Technology Department, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran.

Background: Prediction of neonatal deaths in NICUs is important for benchmarking and evaluating healthcare services in NICUs. Application of machine learning techniques can improve physicians' ability to predict the neonatal deaths. The aim of this study was to present a neonatal death risk prediction model using machine learning techniques.

Methods: This study was conducted in Tehran, Iran in two phases. Initially, important risk factors in neonatal death were identified and then several machine learning models including Artificial Neural Network (ANN), decision tree (Random Forest (RF), C5.0 and CHART tree), Support Vector Machine (SVM), Bayesian Network and Ensemble models were developed. Finally, we prospectively applied these models to predict neonatal death in a NICU and followed up the neonates to compare the outcomes of these neonates with real outcomes.

Results: 17 factors were considered important in neonatal mortality prediction. The highest Area Under the Curve (AUC) was achieved for the SVM and Ensemble models with 0.98. The best precision and specificity were 0.98 and 0.94, respectively for the RF model. The highest accuracy, sensitivity and F-score were achieved for the SVM model with 0.94, 0.95 and 0.96, respectively. The best performance of models in prospective evaluation was for the ANN, C5.0 and CHAID tree models.

Conclusion: Using the developed machine learning models can help physicians predict the neonatal deaths in NICUs.
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http://dx.doi.org/10.1186/s12911-021-01497-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056638PMC
April 2021

Mobile apps for weight management in children and adolescents; An updated systematic review.

Patient Educ Couns 2021 09 2;104(9):2181-2188. Epub 2021 Feb 2.

Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

Objective: Considering inconclusive data regarding the possible effects of mobile applications on anthropometric measures (e.g. body mass index (BMI), body weight, waist circumference, fat mass) and physical activity (e.g. steps or METS) in paediatric subjects, the present systematic review was conducted to clarify this issue.

Methods: Online databases including PubMed, Scopus, ISI Web of Science, Embase, and Ovid were searched, and also a hand search through Google Scholar, PsycINFO, and grey literature was done up to December 2020 to find all relevant studies.

Results: Nine studies were included in this review (n = 978 participants). Five of the studies utilized a mobile app as an independent intervention. Using mobile applications resulted in a lower body mass index in two studies, while only one study reported a decrease in body weight. Besides, significant improvement in physical activity as evidenced by higher step count was reported by only one study.

Conclusion: Nevertheless, the findings from these primary studies, although slightly mixed, provide support for further research with the implementation of mobile apps as an additional approach for combating childhood obesity.

Practice Implications: We recommend to raise attention towards and interest in the mobile app for childhood obesity prevention and treatment.
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http://dx.doi.org/10.1016/j.pec.2021.01.035DOI Listing
September 2021

Regional COVID-19 registry in Khuzestan, Iran: A study protocol and lessons learned from a pilot implementation.

Inform Med Unlocked 2021 19;23:100520. Epub 2021 Jan 19.

Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Disease registry systems provide a strong information infrastructure for decision-making and research. The purpose of this study is to describe the implementation method and protocol of the COVID-19 registry in Khuzestan province, Iran. We established a steering committee and formulated the purposes of the registry. Then, based on reviewing the literature, and expert panels, the minimum data set, the data collection forms and the web-based software were developed. Data collection is done retrospectively through Hospital Information Systems, Medical Care Monitoring Center system (MCMC), Management of Communicable Disease Prevention and Control system (MCDPC) as well as, patients' records. For prospective data collection, the data collection forms are compiled with patients' medical records by the medical staff and are then entered into the registry system. We collect patients' administrative and demographic data, history and physical examinations, test and imaging results, disease progression, treatment, outcomes, and follow-ups of the confirmed and suspected inpatients and outpatients. From April 20 to December 5, 2020, the data of 4,812 confirmed cases and 7,113 suspected cases were collected from two COVID-19 referral hospitals. Based on our experience, recording information along with providing care for patients and putting patients' data registration in the medical staff's routine, structuring data, having a flexible technical team and rapid software development for multiple and continuous updates, automating data collection by connecting the registry to existing information systems and having different incentives, the registration process can be strengthened.
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http://dx.doi.org/10.1016/j.imu.2021.100520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816600PMC
January 2021

Implementation of regional COVID-19 registry in Hormozgan (RCovidRH), Iran: Rationale and study protocol.

Med J Islam Repub Iran 2020 11;34:96. Epub 2020 Aug 11.

Health Management and Economics Research Center, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

The rapid outbreak of COVID-19 has resulted in a global pandemic in 2020. Information sources such as disease registries through accessing quality, valid, accurate, and timely data empower researchers and health authorities to study and develop appropriate actions. Our study describes the protocol for implementation of regional COVID-19 registry in Hormozgan province (RCovidRH). We followed approved phases for the development of RCovidRH to cover the population in Hormozgan. Missioned to develop and implement the protocol, the registry's steering committee was made up of 10 members from subject fields of the registry at the core and 5 subgroups. The main purpose of the registry is to provide a comprehensive information profile of demographic, clinical, laboratory, imaging, and treatment data of confirmed and probable COVID-19 patients in Hormozgan. The data is retrospectively and prospectively collected. Case report form (CRF) was mainly based on International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) CRF. A web-based, 2-language software was also developed to facilitate data collection and storage. Data analysis is to be conducted with collaboration of clinical physicians, data-mining specialists, and epidemiologists after reaching appropriate sample size. We included data related to demographic and identification, onset and admission, signs and symptoms at hospital admission, admission signs and symptoms, comorbidities, pathogen testing, assessment, laboratory, imaging, complications, treatment and medication, and outcomes. We found this registry was limited by incomplete clinical data for small fraction of outpatients, incomplete or inaccurate address by referred people due to fear of social rejection, delay in data entry at the facilities due to workload. This registry via organizing clinical and epidemiological COVID-19 data increases the potentiality of joint studies. Recognition and coordination of a registry is highly important to solve its limitations to collect data. Other universities and provinces can apply our model to develop COVID-19 registries or data sets for this disease.
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http://dx.doi.org/10.34171/mjiri.34.96DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722977PMC
August 2020

A smart wearable device for monitoring and self-management of diabetic foot: A proof of concept study.

Int J Med Inform 2021 02 19;146:104343. Epub 2020 Nov 19.

Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

Background And Objective: Diabetic foot is one of the important complications of diabetes, which is occurred due to the destructive parameters in different anatomical sites of feet. Management and monitoring of these parameters are very important to decrease or prevent foot ulcers. We aimed to develop a smart wearable device to monitor these parameters to prevent diabetic foot.

Methods: Following literature review and expert panel discussions, we considered pressure, temperature and humidity to develop the system. During these sessions, we also developed the system architecture and determined the required technologies. We also developed a mobile application. Finally, all sensors were evaluated for accurate monitoring of pressure, temperature and humidity. A standard protocol was used to evaluate each of these sensors. To this end, five people (four with diabetes and one healthy person) participated. They did a series of movements including walking, sitting, and standing. We considered the pressure measured by Pedar system as the gold standard. Furthermore, we changed the environment temperature and humidity during several experiments and considered the environment temperature and humidity as gold standard. We compared the measured values by sensors with these gold standards.

Results: The evaluation indicated the accurate performance of pressure, humidity and temperature sensors. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the system to provide alarms based on the pressure measured using Pedar were 100, 50, 92.5, 91.8, and 100 %, respectively. The performance of temperature sensors in smart shoes was confirmed by slight differences compared to thermometers. Relatively equal values of humidity measured by two sensors on the left and right feet and the increased difference with the environment humidity showed the exact humidity measured using these sensors.

Conclusion: This smart shoes monitors pressure, humidity, and temperature of patients' feet and sends this data to their smart phone by the Bluetooth module. Furthermore, it controls these parameters; as each of these parameters exceeds the defined threshold, alerts are given to patients for self-management.
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http://dx.doi.org/10.1016/j.ijmedinf.2020.104343DOI Listing
February 2021

Electronic health record-based disease surveillance systems: A systematic literature review on challenges and solutions.

J Am Med Inform Assoc 2020 12;27(12):1977-1986

Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran.

Objective: Disease surveillance systems are expanding using electronic health records (EHRs). However, there are many challenges in this regard. In the present study, the solutions and challenges of implementing EHR-based disease surveillance systems (EHR-DS) have been reviewed.

Materials And Methods: We searched the related keywords in ProQuest, PubMed, Web of Science, Cochrane Library, Embase, and Scopus. Then, we assessed and selected articles using the inclusion and exclusion criteria and, finally, classified the identified solutions and challenges.

Results: Finally, 50 studies were included, and 52 unique solutions and 47 challenges were organized into 6 main themes (policy and regulatory, technical, management, standardization, financial, and data quality). The results indicate that due to the multifaceted nature of the challenges, the implementation of EHR-DS is not low cost and easy to implement and requires a variety of interventions. On the one hand, the most common challenges include the need to invest significant time and resources; the poor data quality in EHRs; difficulty in analyzing, cleaning, and accessing unstructured data; data privacy and security; and the lack of interoperability standards. On the other hand, the most common solutions are the use of natural language processing and machine learning algorithms for unstructured data; the use of appropriate technical solutions for data retrieval, extraction, identification, and visualization; the collaboration of health and clinical departments to access data; standardizing EHR content for public health; and using a unique health identifier for individuals.

Conclusions: EHR systems have an important role in modernizing disease surveillance systems. However, there are many problems and challenges facing the development and implementation of EHR-DS that need to be appropriately addressed.
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http://dx.doi.org/10.1093/jamia/ocaa186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727341PMC
December 2020

The First Inherited Retinal Disease Registry in Iran: Research Protocol and Results of a Pilot Study.

Arch Iran Med 2020 07 1;23(7):445-454. Epub 2020 Jul 1.

Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: To describe the protocol for developing a national inherited retinal disease (IRD) registry in Iran and present its initial report.

Methods: This community-based participatory research was approved by the Ministry of Health and Medical Education of Iran in 2016. To provide the minimum data set (MDS), several focus group meetings were held. The final MDS was handed over to an engineering team to develop a web-based software. In the pilot phase, the software was set up in two referral centers in Iran. Final IRD diagnosis was made based on clinical manifestations and genetic findings. Ultimately, patient registration was done based on all clinical and non-clinical manifestations.

Results: Initially, a total of 151 data elements were approved with Delphi technique. The registry software went live at www. IRDReg.org based on DHIS2 open source license agreement since February 2016. So far, a total of 1001 patients have been registered with a mean age of 32.41±15.60 years (range, 3 months to 74 years). The majority of the registered patients had retinitis pigmentosa (42%, 95% CI: 38.9% to 45%). Genetic testing was done for approximately 20% of the registered individuals.

Conclusion: Our study shows successful web-based software design and data collection as a proof of concept for the first IRD registry in Iran. Multicenter integration of the IRD registry in medical centers throughout the country is well underway as planned. These data will assist researchers to rapidly access information about the distribution and genetic patterns of this disease.
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http://dx.doi.org/10.34172/aim.2020.41DOI Listing
July 2020

Effects of Using Hospital Information Systems on Nurses' Individual Performance: A Study on Influential Factors.

Stud Health Technol Inform 2020 Jun;271:161-167

Iranian Social Security Organization, Tehran, Iran.

We investigated the use of hospital information systems (HIS) among nurses and its effect on their individual performance. We combined UTAUT and Delone & McLean models and developed a questionaire and collected 173 questionaires from nurses. We found that effort expectancy, information quality, performance expectancy and system quality positively influence nurses' intention to use HIS. In addition, nurses' intention to use and facilitators conditions positively direct their actual use. Information quality, service quality and system quality significantly increase nurses' satisfaction with HIS. Lastly, nurses' satisfaction with HIS and their actual use positively improves their individual performance in working with HIS.
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http://dx.doi.org/10.3233/SHTI200092DOI Listing
June 2020

Nurses' Viewpoints on Barriers and Facilitators to Use Hospital Information Systems.

Stud Health Technol Inform 2020 Jun;271:145-152

Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

In this qualitative study, we explored the nurses' experience in using hospital information systems (HIS) to identify barriers and facilitators of using this system. We interviewed twenty one purposefully-selected nurses who have experience in using HIS and analyzed the data using conventional content analysis. We identified 17 facilitators and 12 barriers classified into main themes. Lack of support for nurses, their resistance, any force for using HIS, perceived difficulty of using HIS, inadequate system quality, data loss, discontinuity of information in different systems are the main barriers. However, considering nurses' perspectives, pilot implementation of HIS, training, planned implementation, appropriate financial and non-financial incentives, adding new and appropriate functionalities, increased ease of use and usability, easy access to information, improved data quality in HIS, and saving nurses' working time through using HIS result in increased adoption the system to use.
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http://dx.doi.org/10.3233/SHTI200090DOI Listing
June 2020

Teleoncology for children with cancer: A scoping review on applications and outcomes.

Int J Med Inform 2020 07 13;139:104118. Epub 2020 Mar 13.

Health Management and Economics Research Center, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

Background And Objectives: Teleoncology can be used to reduce the limitations due to the lack of access to specialists, inadequate resources and training, and reducing unnecessary travels and arising of the costs. The purpose of this study was to review the literatures to identify and classify the areas of application and outcomes of using teleoncology in diagnosis, management, and treatment of children with cancer.

Methods: This scoping review of the published literatures was conducted by searching the Web of Science, PubMed/Medline, Scopus, and Cochrane Library databases in October 2019. Studies investigated telemedicine in diagnosis, management, and treatment of cancer in children were also included. We identified and classified different applications and the reported outcomes of this technology.

Results: In this study, 1834 articles were retrieved, and after removing the unrelated and duplicated articles, 20 articles were reviewed ultimately. We found that, teleoncology services were provided to the patients with cancer, their parents, and nurses in various clinical fields such as telepathology, telemental care (telepsychology), teleneurology, teledermatology, telehematology, and teleophthalmology. The findings also showed that, the outcomes of using telemedicine in children with cancer can be classified into six general categories (five primary and 14 secondary outcomes). Primary outcomes including diagnosis accuracy, reduced costs as well as mortality and secondary outcomes consist of improved relationship and training, better care management, satisfaction, and workload.

Conclusion: The use of telemedicine for children with cancer is growing, and there is a tendency for using this technology for families and clinical staff. Providing teleoncology services to children with cancer may improve diagnosis accuracy and reduce the cost and mortality rate. Also, better care management, appropriate relationships and training, increased satisfaction, and decreased workload may be achieved.
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http://dx.doi.org/10.1016/j.ijmedinf.2020.104118DOI Listing
July 2020

Clinical decision support system to predict chronic kidney disease: A fuzzy expert system approach.

Int J Med Inform 2020 06 30;138:104134. Epub 2020 Mar 30.

Health Management and Economics Research Center, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran. Electronic address:

Background And Objectives: Diagnosis and early intervention of chronic kidney disease are essential to prevent loss of kidney function and a large amount of financial resources. To this end, we developed a fuzzy logic-based expert system for diagnosis and prediction of chronic kidney disease and evaluate its robustness against noisy data.

Methods: At first, we identified the diagnostic parameters and risk factors through a literature review and a survey of 18 nephrologists. Depending on the features selected, a set of fuzzy rules for the prediction of chronic kidney disease was determined by reviewing the literature, guidelines and consulting with nephrologists. Fuzzy expert system was developed using MATLAB software and Mamdani Inference System. Finally, the fuzzy expert system was evaluated using data extracted from 216 randomly selected medical records of patients with and without chronic kidney disease. We added noisy data to our dataset and compare the performance of the system on original and noisy datasets.

Results: We selected 16 parameters for the prediction of chronic kidney disease. The accuracy, sensitivity, and specificity of the final system were 92.13 %, 95.37 %, and 88.88 %, respectively. The area under the curve was 0.92 and the Kappa coefficient was 0.84, indicating a very high correlation between the system diagnosis and the final diagnosis recorded in the medical records. The performance of the system on noisy input variables indicated that in the worse scenario, the accuracy, sensitivity, and specificity of the system decreased only by 4.43 %, 7.48 %, and 5.41 %, respectively.

Conclusion: Considering the desirable performance of the proposed expert system, the system can be useful in the prediction of chronic kidney disease.
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http://dx.doi.org/10.1016/j.ijmedinf.2020.104134DOI Listing
June 2020

Monitoring of external predisposing factors for Diabetic Foot: A literature review and physicians' perspectives.

Med J Islam Repub Iran 2019 31;33:159. Epub 2019 Dec 31.

Health Management and Economics Research Center, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Diabetic foot is one of the most important complications of diabetes caused by the existence of some destructive factors in different anatomical locations of feet. Management and monitoring of these factors are very important to decrease or avoid ulcerating lesions of the foot. The purpose of this study is to identify and introduce the predisposing factors and anatomical locations associated with these destructive factors. First, we conducted a comprehensive review of different databases to identify the factors and associated anatomical locations from the previous studies. Then, we designed a questionnaire and invited physicians and specialists to express their perspectives on these factors and locations. The data were analyzed using SPSS version 23. Frequency, percentage, mean and standard deviation of these variables were calculated. Based on the literature review, four factors, including pressure, moisture and sweat, temperature, and acceleration were identified as factors destructive to the tissues of the diabetic foot and worsen ulcers. The view of specialists approved the results of the literature review. Besides, there was an insignificant difference between the results of the literature review and the specialists' view in terms of anatomical locations that need to be continuously monitored. Monitoring the pressure in heel, first metatarsal, and first metatarsal head; moisture and sweat under the fingers, hallux and heels as well as the temperature at the first metatarsal, first metatarsal head, and the third metatarsal head are important in preventing ulceration, destructing the foot tissue, and accelerating the treatment process.
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http://dx.doi.org/10.34171/mjiri.33.159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137813PMC
December 2019

Effect of Implementation of Picture Archiving and Communication System on Radiologist Reporting Time and Utilization of Radiology Services: A Case Study in Iran.

J Digit Imaging 2020 06;33(3):595-601

Health Management and Economics Research Center, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran.

We aimed to determine the effect of PACS implementation on the radiologist reporting time and utilization of radiology services in a hospital in Iran. This study was conducted in three 6-month periods (before PACS implementation, immediately after the implementation, and 1 year after implementation). Data related to reporting time of CT examinations were collected from 5074 patients with 6613 examinations and compared using the Friedman test. The utilization rate of radiology services was conducted about CT scans and radiographies. Therefore, 17,862 patients with 36,321 radiographies and 7155 patients with 10,571 CT scans were evaluated, and the ratio of the number of examinations to the number of patients and patient days was compared in three periods. The mean of reporting time on CT scan examinations in the period of immediately after PACS was changed compared to the period of before PACS from 13.05 to 24.18 days and compared to 1 year after PACS implementation, to 4.14 days (P value < 0.05). The utilization rate in CT scans, 1 year after PACS increased at least 10% to 25% compared to the immediately after PACS and before implementing PACS. The utilization rate in radiographies, 1 year after PACS, increased at least 16% to 78% compared to the immediately after PACS and before PACS implementation. In conclusion, the mean of the radiologist reporting time for CT scans is significantly decreased by PACS in the long-term. Additionally, the utilization rate of radiology services is increased in the short- and long-term after PACS implementation in most examinations of CT scan and radiography examinations.
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http://dx.doi.org/10.1007/s10278-019-00314-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256163PMC
June 2020

Performance of Hospitals in Protecting the Confidentiality and Information Security of Patients in Health Information Departments.

Stud Health Technol Inform 2019 ;260:202-209

Islamic Azad University, Tehran North Branch, Tehran, Iran.

Keeping health information confidential is an important aspect of managing health information. This study aimed at determining the performance of health information management departments (HIMD) to identify the policies of these hospitals, their similarities, and differences in their procedures in this respect. Managers of the departments and information disclosure and medical record staff in 22 teaching hospitals were invited to complete a questionnaire regarding their practices in four axes including confidentiality principles, principles of disclosure consent, disclosure information to external and internal users. We found that there are no specific national framework and guidelines for the disclosure of health information. Hospitals are undertaking different ways in this regard. In most cases, patients' consent is not considered necessary for disclosure and only hospital managers' or physicians' consent is sufficient.
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September 2019

Electronic Medical Records for Mental Disorders: What Data Elements Should These Systems Contain?

Stud Health Technol Inform 2019 ;260:25-32

Department of Computer Science, metropolitan college, Boston University, US.

Identifying data elements of electronic medical record systems (EMRs) is one of the essential steps for the comprehensive and proper health data collection. The aim of this study was to determine the data elements required for EMRs in the field of mental disorders. We conducted a literature review and also we randomly selected 50 medical records of patients with mental disorders to identify a preliminary list of essential data elements for EMRs for mental disorders. Then, 33 mental health specialists were surveyed to validate the list of data elements through a questionnaire. We identified that health data elements of EMRs for patients with mental disorders can be categorized into seven classes (demographic data of patients, administrative data of physicians, administrative data of patients, history, clinical data, treatment, and financial data) and 10 subclasses. After the validation process, 140 essential data elements for EMRs for patients with mental disorders were introduced.
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September 2019

A Clinical Decision Support System for Predicting the Early Complications of One-Anastomosis Gastric Bypass Surgery.

Obes Surg 2019 07;29(7):2276-2286

Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background/objective: One of the most effective treatments for patients with obesity, albeit with some complications, is obesity surgery. The aim of this study was to develop a clinical decision support system (CDSS) to predict the early complications of one-anastomosis gastric bypass (OAGB) surgery.

Subjects/methods: This study was conducted in Tehran, Iran on patients who underwent OAGB surgery in 2011-2014 in five hospitals. Initially, variables affecting the OAGB early complications were identified using the literature review. Patients' data were extracted from an existing database of obesity surgery. Then, different artificial neural networks (ANNs) (multilayer perceptron (MLP) network) were developed and evaluated for prediction of 10-day, 1-month, and 3-month complications.

Results: Factors including age, BMI, smoking status, intra-operative complications, comorbidities, laboratory tests, sonography results, and endoscopy results were considered important factors for predicting early complications of OAGB. A CDSS was developed with these variables. The accuracy, specificity, and sensitivity of the 10-day prediction system in the test data were 98.4%, 98.6%, and 98.3%, respectively. These figures for 1-month system were 96%, 93%, and 98.4% and for the 3-month system were 89.3%, 86.6%, and 91.5%, respectively.

Conclusions: Using the CDSS designed, we could accurately predict the early complications of OAGB surgery.
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http://dx.doi.org/10.1007/s11695-019-03849-wDOI Listing
July 2019

Standardization of Health Terminology Systems and the Roles of Responsible Organizations.

Iran J Public Health 2018 Oct;47(10):1613-1614

Dept. of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277718PMC
October 2018

Development of a tool for comprehensive evaluation of population-based cancer registries.

Int J Med Inform 2018 09 10;117:26-32. Epub 2018 Jun 10.

Cancer Research Center of Cancer Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran. Electronic address:

Objective: Several methods have been suggested for evaluation of population-based cancer registries (PBCR) worldwide. However, most of these methods evaluate the data and outputs of the cancer registries. This study aimed to develop a comprehensive tool and protocol for evaluation of inputs, processes and outputs of a PBCR.

Methods: The standards of the North American Association of Central Cancer Registries (NAACCR) were used to draft a comprehensive checklist. In addition, the national guidelines of PBCR were used to develop a questionnaire for evaluation of knowledge and practice of the PBCR personnel. Furthermore, a protocol for evaluation of the completeness and validity of the PBCR data was developed according to the International Agency for Research on Cancer (IARC) and the NAACCR guidelines. A 0-4 Likert based score and expert opinions (10 experts) were used to assess validity of the eight questionnaires/checklists. A modified Delphi method was applied to validate the checklists and questionnaires. Questions with a score higher than 3 remained in the final tools.

Results: The final package consists of 546 questions including 108 (19.8%) for evaluation of guidelines, 54 (9.9%) for analysis and reports, 87 (15.9%) for governance and infrastructure, 155 (28.4%) for information technology, 21 (3.8%) for personnel knowledge and 121 (22.2%) for their practice. Additionally, data quality indicators were also considered for evaluation of PBCRs.

Conclusion: This comprehensive tool can be used to show the gaps and limitations of the PBCR programs and provide informative clues for their improvement.
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http://dx.doi.org/10.1016/j.ijmedinf.2018.06.006DOI Listing
September 2018

Benefits of Using Mobile Technologies in Education from the Viewpoints of Medical and Nursing Students.

Stud Health Technol Inform 2018 ;251:289-292

Human Resources Supervisor at Hiweb Company, Tehran, Iran.

Increasing the use of mobile phones in education depends on the understanding of its benefits. The purpose of this study was to assess the vision of medical and nursing students about the benefits of using mobile technology in education. This study was conducted on medical and nursing students in 8 hospitals affiliated to Tehran University of Medical Sciences in 2016. 372 students participated in the study. Data were collected by a questionnaire consisting of 11 questions in Likert scale. Students' efficiency, improvement in quality of care, faster access to information and the positive effect on education were emphasized. Nursing students have more positive attitude regarding the use of this technology to save time at the time of providing services, faster access to patient information and influence on education. In summary, students considered mobile technology to be useful for educational purposes, so by eliminating the barriers in this field, it is possible to promote mobile learning for medical and nursing students.
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November 2018

Barriers for Implementation and Use of Health Information Systems from the Physicians' Perspectives.

Stud Health Technol Inform 2018 ;251:269-272

Islamic Azad University, North Tehran Branch, Tehran, Iran.

This study aimed to investigate barriers to the implementation and use of health information systems (HIS) in Iran by physician's view. This cross-sectional study was conducted in 2016 on 163 physicians employed in 10 teaching hospitals. Data collection was carried out through a questionnaire with questions about the technical, organizational, ethical and personal barrier categories. Data analysis demonstrated that technical (e.g. inadequate planning for implementation and use of HIS) (3.56±1.32), organizational (e.g. inadequate facilities for fast and easy access to the Internet) (3.67±1.91), personal (e.g. inadequate awareness of healthcare providers about the benefits of HIS) (3.33±1.28), as well as legal and ethical (e.g. concern about the security and confidentially of HIS) (3.15±1.31) were the most important barriers to the implementation and use of HIS. Reducing barriers, especially technical and personal ones will increase the implementation and use of HIS based on the physicians' perspectives.
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November 2018

Physicians' Perspectives on Causes of Health Care Errors and Preventive Strategies: A Study in a Developing Country.

Iran J Public Health 2018 May;47(5):720-728

Dept. of Management and Accounting, School of Management, Islamic Azad University, South Tehran Branch, Tehran, Iran.

Background: To prevent health care errors, the main causes and preventive strategies should be identified. The purpose of this study was to identify the causes and preventive strategies of health care errors from the perspectives of physicians.

Methods: We surveyed 250 randomly selected physicians in five teaching hospitals in Tehran, Iran, in 2015. We used a questionnaire with 29 questions regarding causes and 17 ones regarding the preventive strategies. The participants were asked to answer the questions based on Likert's five-point score (1=very low to 5= very high). The data was analyzed using descriptive (frequency, and mean scores) and inferential statistics in SPSS.

Results: Managerial factors (3.6±0.7), personal factors of providers (3.5±0.6), factors related to the patients (3.4±0.71), and the factors pertinent to laboratory and pharmacy (3.2±0.8) were the main causes respectively. The most important preventive strategies were improvement of academic education, better taking past medical history, implementing electronic prescription and increasing healthcare budget.

Conclusion: Heavy workloads, long work shifts, failure to do thorough examination and to collect detailed history information, providers' fatigue, patients' reluctance to follow orders or to give their complete information, failure to give detailed instruction to patients about the medications, lack or insufficient monitoring and supervising systems, and lack of enough budget were some of the most important causes of errors. Using IT to access patients' information, improving patients' adherence, reducing workload, developing efficient methods for collecting patients' information, dedicating adequate budget for improvement programs are recommended.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005985PMC
May 2018

Nurses' Attitude for Using Barcode Medication Administration System in a Developing Country.

Stud Health Technol Inform 2018 ;248:220-225

Health Information Technology Dept., School of Allied Medical Sciences, Zabol University of Medical Sciences, Zabol, Iran.

Medication errors are common in healthcare settings. To prevent these errors, use of modern technology is suggested. Improvement of medication administration system particularly at the time of drug administration is mandated in Iran. Barcode medication administration (BCMA) systems are useful in this regard. This study was conducted to assess nurses' attitude for the use of BCMA systems. To this end, 283 randomly selected nurses working in teaching hospitals were surveyed using a five point Likert scale questionnaire. The most positive attitudes were related to the role of BCMA in reducing medication errors (4.02±0.8), improving performance (3.8±0.99), productivity (3.8±0.97) and making patient care easier (3.83±0.9). Only 9.9 percent of nurses did not like to use the technology. There was no significant difference between nurses in terms of their age, experience, education, and hospitals. In conclusion, nurses' attitude about BCMA was in a relatively good level. However, there is a need to train nurses for the use of this technology.
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June 2018

Evaluation of SNOMED CT Content Coverage: A Systematic Literature Review.

Stud Health Technol Inform 2018 ;248:212-219

Dept. of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: One of the most important features studied for adoption of terminologies is content coverage. The content coverage of SNOMED CT as a large scale terminology system has been evaluated in different domains by various methods.

Objectives: This study provided an overview of studies evaluating SNOMED CT content coverage.

Methods: This systematic literature review covered Scopus, Embase, PubMed and Web of Science. It included studies in English language with accessible full-text from the beginning of 2002 to November 2017.

Results: Reviewing 62 studies revealed that 76 percent of studies were carried out in the US and other countries started to study in this regard from 2007. Most of the studies focused on the comparison of SNOMED CT with disease classifications in the domain of "diagnosis and problem list".

Conclusion: Studying the trend of studies in different countries shows that SNOMED CT content coverage is not limited to the early stages of SNOMED CT adoption. However, evaluation methods are likely different due to the stage of SNOMED CT implementation. Therefore, it is recommended to identify and compare evaluation methods of SNOMED CT content coverage in future studies.
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June 2018

Telemedicine in Diagnosis, Treatment and Management of Diseases in Children.

Stud Health Technol Inform 2018 ;248:148-155

Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.

The purpose of this study was to review different telemedicine services in diagnosis, treatment and management of various children diseases and providing an overview of systematic reviews conducted in this regard. We searched English articles published in peer-reviewed journals between 2000 to 2016. We found that tele-pediatric services have been reported in various areas such as cardiology, burn, diabetes, obesity, emergency medicine, speech and hearing loss, Ear, Nose and Throat, psychology and psychiatry, radiology, oncology, home healthcare, asthma, genetics and dentistry. These studies mainly reported positive results. However, systematic reviews in tele-pediatric showed that these studies have not proven the clinical effectiveness or suggested further studies to assess the clinical outcomes of services provided through telemedicine technologies.
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June 2018

Effectiveness of Anonymization Methods in Preserving Patients' Privacy: A Systematic Literature Review.

Stud Health Technol Inform 2018 ;248:80-87

Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: An ever growing for application of electronic health records (EHRs) has improved healthcare providers' communications, access to data for secondary use and promoted the quality of services. Patient's privacy has been changed to a great issue today since there are large loads of critical information in EHRs. Therefore, many privacy preservation techniques have been proposed and anonymization is a common one.

Objectives: This study aimed to investigate the effectiveness of anonymization in preserving patients' privacy.

Methods: The articles published in the 2005-2016 were included. Pubmed, Cochrane, IEEE and ScienceDirect were searched with a variety of related keywords. Finally, 18 articles were included.

Results: In the present study, the relevant anonymization issues were investigated in four categories: secondary use of anonymized data, re-identification risk, anonymization effect on information extraction and inadequacy of current methods for different document types.

Conclusion: The results revealed that though anonymization cannot reduce the risk of re-identification to zero, if implemented correctly, can manage to help preserve patient's privacy.
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June 2018
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