Benefits of Information Technology in Healthcare: Artificial Intelligence, Internet of Things, and Personal Health Records / 대한의료정보학회지

Objectives@#Systematic evaluations of the benefits of health information technology (HIT) play an essential role in enhancing healthcare quality by improving outcomes. However, there is limited empirical evidence regarding the benefits of IT adoption in healthcare settings. This study aimed to review the benefits of artificial intelligence (AI), the internet of things (IoT), and personal health records (PHR), based on scientific evidence. @*Methods@#The literature published in peer-reviewed journals between 2016 and 2022 was searched for systematic reviews and meta-analysis studies using the PubMed, Cochrane, and Embase databases. Manual searches were also performed using the reference lists of systematic reviews and eligible studies from major health informatics journals. The benefits of each HIT were assessed from multiple perspectives across four outcome domains. @*Results@#Twenty-four systematic review or meta-analysis studies on AI, IoT, and PHR were identified. The benefits of each HIT were assessed and summarized from a multifaceted perspective, focusing on four outcome domains: clinical, psycho-behavioral, managerial, and socioeconomic. The benefits varied depending on the nature of each type of HIT and the diseases to which they were applied. @*Conclusions@#Overall, our review indicates that AI and PHR can positively impact clinical outcomes, while IoT holds potential for improving managerial efficiency. Despite ongoing research into the benefits of health IT in line with advances in healthcare, the existing evidence is limited in both volume and scope. The findings of our study can help identify areas for further investigation.

Trajectories and Prediction Factors of Depression in Elderly Cancer Survivors:Using the Korean Longitudinal Study of Ageing

Purpose@#The purpose of this study was to identify the trajectories of depressive symptoms and the predictive factors that determine the trajectories among elderly cancer survivors in South Korea. @*Methods@#This study was a secondary data analysis using the Korean Longitudinal Study of Ageing (KLoSA). The inclusion criteria were adults who were aged 65 years or older, diagnosed with cancer, and participated in the panel survey at least three times. Data were analyzed using SPSS 25.0 and STATA 16.0 for Group-Based Trajectory Model. @*Results@#This study comprised 197 participants. Depression trajectories were derived into the three groups of ‘nondepression,’ ‘mild depression,’ and ‘depression.’ As a result of multinomial logit analysis using ‘mild depression’ as a reference group, the significant predictors that differentiated the ‘non-depression’ and ‘mild depression’ groups was whether the subject was living alone or not (p=.001). @*Conclusion@#To prevent and manage depression among the elderly cancer survivors living alone, it is necessary to first identify the social support resources from a cancer diagnosis. In addition, a social foundation should be established to enable elderly cancer survivors to utilize the supporting resources. Further studies should be conducted considering disease-specific variables such as types of cancers, stages of cancer, and treatment methods.

Factors Associated with Postoperative Recovery among Lung Cancer Patients with Walking Exercise after Lung Resection

Background@#Treatment for lung cancer, which has high incidence and mortality rates, involves lung resection; however, the risk of postoperative pulmonary complications is high. Early walking exercise is a core strategy for preventing complications and promoting postoperative recovery, which is essential for returning to everyday life. This study aims to identify the factors associated with the postoperative recovery of patients who performed walking exercises in an intensive care unit after having a lung resection. @*Methods@#This cross-sectional study collected data from 90 patients on the day before discharge at a tertiary hospital in Seoul between April and June 2019. Patients’ postoperative recovery was measured using the Postoperative Recovery Profile. @*Results@#The mean score for postoperative recovery was 0.70±0.41 out of 3, 0 being none of the problems. Among the five subcategories, the psychological dimension had the highest recovery level at 0.57±0.58, while physical symptoms were rated lowest at 0.89±0.50. As a result of regression analysis, employment status (β=4.353, P=0.005), symptoms of nausea and vomiting during walking (β=0.596, P=0.043), and perceived exertion during walking (β=1.105, P=0.007) were associated with postoperative recovery. @*Conclusions@#The study indicated unemployed patients, those with more nausea and vomiting, and those who perceived severe exertion during walking showed lower perceived postoperative recovery levels. Not only multidisciplinary, patient-tailored interventions to facilitate return to work after surgery but also interventions to control physical symptoms actively should be developed and implemented to achieve higher postoperative recovery levels. Patients also need to exercise at an appropriate subjective level of perceived exertion.

Trajectories and Prediction Factors of Depression in Elderly Cancer Survivors:Using the Korean Longitudinal Study of Ageing

Purpose@#The purpose of this study was to identify the trajectories of depressive symptoms and the predictive factors that determine the trajectories among elderly cancer survivors in South Korea. @*Methods@#This study was a secondary data analysis using the Korean Longitudinal Study of Ageing (KLoSA). The inclusion criteria were adults who were aged 65 years or older, diagnosed with cancer, and participated in the panel survey at least three times. Data were analyzed using SPSS 25.0 and STATA 16.0 for Group-Based Trajectory Model. @*Results@#This study comprised 197 participants. Depression trajectories were derived into the three groups of ‘nondepression,’ ‘mild depression,’ and ‘depression.’ As a result of multinomial logit analysis using ‘mild depression’ as a reference group, the significant predictors that differentiated the ‘non-depression’ and ‘mild depression’ groups was whether the subject was living alone or not (p=.001). @*Conclusion@#To prevent and manage depression among the elderly cancer survivors living alone, it is necessary to first identify the social support resources from a cancer diagnosis. In addition, a social foundation should be established to enable elderly cancer survivors to utilize the supporting resources. Further studies should be conducted considering disease-specific variables such as types of cancers, stages of cancer, and treatment methods.

Factor Associated with Injury Related to Home Mechanical Ventilation in General Ward Patients: A Retrospective Study / 임상간호연구

Purpose@#This study aims to describe the characteristics of safety incidents and factors associated with injury for patients with Home Mechanical Ventilation (HMV) at the hospital. @*Methods@#This is a retrospective study. Data were collected from the work log of respiratory home care nurses and the patients’ electronic medical records were investigated. In order to compare group differences, independent t-test and x 2 test were used. Associated factors with injury development were identified by generalized mixed modeling analysis controlling for age and gender. @*Results@#A total of 304 patients on HMV were included in this study, among which 129 (42.4%) experienced 352 HMV-related incidents. Mean frequency of incidents for each patient was 5.11±3.98, ranged from 1 to 15 times.In 19.0% of the incidents, injury was developed. Types of incident and persons involved in the incidents were significantly associated with the patient's injury. In the case of the safety incidents, patient’s injury was significantly higher in accidents caused by respiratory circuit problems compared to those caused by problems with the ventilator operation by the medical staff (coefficient=1.25, p=.020). In addition, in the case of those involved in the safety incidents, patient’s injury was significantly higher in the accident caused by the patient family members or caregivers than that caused by the medical personnel (coefficient=1.25, p=.019). @*Conclusion@#In order to minimize injury caused by incidents in patients with HMV, hospitals need to provide systemic education to their medical staff and caregivers to enhance awareness of the importance of reporting and safety management.

Building Consensus on the Priority-Setting for National Policies in Health Information Technology: A Delphi Survey / 대한의료정보학회지

Objectives@#With growing attention on the healthcare industry as a potential market for big data and artificial intelligence in the Fourth Industrial Revolution, countries around the world are introducing and developing various policies and projects related to health information technology (HIT). To assist prioritizing HIT topics in policy making, this study adopts the Delphi technique to garner expert opinions from various fields of health informatics. @*Methods@#Data were collected from November 2019 to February 2020 using the Delphi technique through two rounds of surveys administered via email. The Delphi panel consisted of 16 experts with a high level of experience in health informatics. They were from the Health Information Policy Advisory Committee of the Ministry of Health and Welfare of Korea, and the board of directors of the Korean Society of Medical Informatics. The experts were asked to assess the importance, urgency, and difficulty of HIT topics in three domains: technology, application, and infrastructure. @*Results@#Of the 40 topic items, a 100% agreement was reached for the importance of 6 items, including 2 items in technology, 1 item in application, and 3 items in infrastructure domains. Especially, Quadrant I of a 2×2 matrix showing high importance and high urgency included 7 items in the technology domain, 2 items in the application domain, and 13 items in the infrastructure domain. @*Conclusions@#Most items with high importance and urgency belonged to the infrastructure domain. The findings indicated that fostering an infrastructural environment should be polices with top priorities of HIT.

Association between Full Electronic Medical Record System Adoption and Drug Use: Antibiotics and Polypharmacy / 대한의료정보학회지

A Meta-Analysis on Factors Related to Quality of Life in Heart Transplant Recipients / 임상간호연구

PURPOSE@#This study was a systematic review and meta-analysis to explore the factors related to quality of life in heart transplant recipients.@*METHODS@#To identify studies that suggested the factors related to the quality of life in heart transplant recipients, we searched the articles published from 1974 to November 2018 using Six databases, PubMed, CINAHL, EMBASE, Cochrane, KMBASE and RISS. A total of 22 studies were selected out of 5,234 for the systematic review and meta-analysis on the basis of the PRISMA flow. The quality of study was assessed by assessment tool form the NIH and meta-analysis was performed using the ‘R 3.5.2’ version to analyze the correlated effect sizes.@*RESULTS@#Factors related to quality of life in heart transplant recipients were categorized into six domains based on the health-related quality of life model introduced by Ferrans: individual, environmental, biological function, symptoms, functional status, and general health perception. In the meta-analysis, 34 factors were used and 17 factors having significant effect sizes were as follows: self-efficacy, demoralization, perceived control, current occupational status, age, marital status, health promotion life style in the individual characteristics; stress in environmental characteristics; physical function status, creatinine level, left ventricular ejection fraction (LVEF) in biological function; anxiety, depression, symptom frequency and distress in symptoms domain; coping, self-care compliance in functional status.@*CONCLUSION@#The findings indicate that the multi-dimensional factors influencing the quality of life in heart transplant recipients and provide the evidence for developing effective interventions for improving the quality of life of recipients.

Association of Job Stress and Health Promotion Behaviors with Quality of Life among Female Riot Police Officers / 산업간호학회지

PURPOSE: The purpose of this study was to investigate the association of job stress and health promotion behaviors with the quality of life in female riot police officers.METHODS: A cross-sectional design was adopted, and a convenience sample of 182 female riot police officers from 5 Metropolitan Police Agencies in South Korea. All participants completed a self-administered survey questionnaire that assessed job stress, health promotion behavior, and quality of life in May 2018. The collected data were analyzed using t-test, analysis of variance, and correlation and multiple linear regression analyses, all of which were executed using SPSS/WIN 23.0 and STATA 13.0.RESULTS: The level of job stress among participants was moderate, and the mean was 45.25 out of a maximum possible score of 100. The mean scores that emerged for health promotion behaviors and the quality of life were 2.62 (maximum=4) and 56.59 (maximum=100), respectively. Job stress (r=−.380, p < .001) and health promotion behaviors (r=.559, p < .001) were correlated with the quality of life. The statistically significant predictors of the quality of life were job stress (β=−.212, p=.001) and health promotion behaviors (β=.417, p < .001).CONCLUSION: The variables that were associated with the quality of life of female riot police officers were job stress and health promotion behaviors. Therefore, interventions that can enhance job stress management and health promotion behaviors are needed to improve the quality of life of female riot police officers.

Factors Associated with Daily Completion Rates in a Smartphone-Based Ecological Momentary Assessment Study / 대한의료정보학회지

OBJECTIVES: Ecological momentary assessment (EMA) methods are known to have validity for capturing momentary changes in variables over time. However, data quality relies on the completion rates, which are influenced by both participants' characteristics and study designs. This study applied an EMA method using a mobile application to assess momentary moods and stress levels in patients with Moyamoya disease to examine variables associated with EMA completion rates. METHODS: Adults with Moyamoya disease were recruited from a tertiary hospital in Seoul. Patients with cognitive impairment were excluded. The EMA survey was loaded as a mobile application onto the participants' personal smartphones. Notifications were sent at semi-random intervals four times a day for seven consecutive days. Daily completion rates were calculated as the percentage of completed responses per day; overall completion rates were calculated as the proportion of completed responses per total of the 28 scheduled measures in the study and assessed through a descriptive analysis, t-test, ANOVA, and regression analysis, with mixed modeling to identify the point at which the daily completion rate significantly decreased. RESULTS: A total of 98 participants responded (mean age, 41.00 ± 10.30 years; 69.4% female; 75.5% married). The overall completion rate was 70.66%, with no gender or age differences found. The daily completion rate decreased significantly after day 5 (p = 0.029). CONCLUSIONS: Obtaining a good completion rate is essential for quality data in EMA methods. Strategic approaches to a study design should be established to encourage participants throughout a study to improve completion rates.

Association of Job Stress and Health Promotion Behaviors with Quality of Life among Female Riot Police Officers / 한국직업건강간호학회지

PURPOSE@#The purpose of this study was to investigate the association of job stress and health promotion behaviors with the quality of life in female riot police officers.@*METHODS@#A cross-sectional design was adopted, and a convenience sample of 182 female riot police officers from 5 Metropolitan Police Agencies in South Korea. All participants completed a self-administered survey questionnaire that assessed job stress, health promotion behavior, and quality of life in May 2018. The collected data were analyzed using t-test, analysis of variance, and correlation and multiple linear regression analyses, all of which were executed using SPSS/WIN 23.0 and STATA 13.0.@*RESULTS@#The level of job stress among participants was moderate, and the mean was 45.25 out of a maximum possible score of 100. The mean scores that emerged for health promotion behaviors and the quality of life were 2.62 (maximum=4) and 56.59 (maximum=100), respectively. Job stress (r=−.380, p < .001) and health promotion behaviors (r=.559, p < .001) were correlated with the quality of life. The statistically significant predictors of the quality of life were job stress (β=−.212, p=.001) and health promotion behaviors (β=.417, p < .001).@*CONCLUSION@#The variables that were associated with the quality of life of female riot police officers were job stress and health promotion behaviors. Therefore, interventions that can enhance job stress management and health promotion behaviors are needed to improve the quality of life of female riot police officers.

Ecological Momentary Assessment Using Smartphone-Based Mobile Application for Affect and Stress Assessment / 대한의료정보학회지

OBJECTIVES: This study aimed to describe the process of utilizing a mobile application for ecological momentary assessment (EMA) to collect data on stress and mood in daily life setting. METHODS: A mobile application for the Android operating system was developed and installed with a set of questions regarding momentary mood and stress into a smartphone of a participant. The application sets alarms at semi-random intervals in 60-minute blocks, four times a day for 7 days. After obtaining all momentary affect and stress, the questions to assess the usability of the mobile EMA application were also administered. RESULTS: The data were collected from 97 police officers working in Gyeonggi Province of South Korea. The mean completion rate was 60.0% ranging from 3.5% to 100%. The means of positive and negative affect were 18.34 of 28 and 19.09 of 63. The mean stress was 17.92 of 40. Participants responded that the mobile application correctly measured their affect (4.34 ± 0.83) and stress (4.48 ± 0.62) of 5-point Likert scale. CONCLUSIONS: Our study investigated the process of utilizing a mobile application to assess momentary affect and stress at repeated times. We found challenges regarding adherence to the research protocol, such as completion and delay of answering after alarm notification. Despite this inherent issue of adherence to the research protocol, the EMA still has advantages of reducing recall bias and assessing the actual moment of interest at multiple time points that improves ecological validity.

Healthcare Informatics Research's Journey of Paving the Road to Excellence in Global Healthcare Informatics / 대한의료정보학회지

No abstract available.

Citation Analysis for Biomedical and Health Sciences Journals Published in Korea / 대한의료정보학회지

OBJECTIVES: A citation analysis of biomedical and health sciences journals was conducted based on their enlistment in journal databases to identify the factors contributing to the citation metrics. METHODS: Among the 1,219 academic journals managed by the National Center for Medical Information and Knowledge at the Korea Centers for Disease Control and Prevention, 556 journals were included for analysis as of July 2016. The characteristics of the journals include history years, publication media, language, open-access policy as well as the status enlisted in international and domestic databases, such as Science Citation Index (SCI), Scopus, Medline, PubMed Central, Embase, and Korea Citation Index (KCI). Six bibliometric measures were collected from SCI, Scopus, and KCI as of 2015, the most recent disclosure year. Analyses of group differences and influential factors were conducted using t-tests, Mann-Whitney tests, and multiple regression. RESULTS: Journal characteristics, such as history years, publication media, and open-access policy, were not significant factors influencing global or domestical citation of the journals. However, global citations were higher for SCI and Medline enlisted journals than for their counterparts. Among KCI journals, the KCI impact factors of journals published in English only were lower. CONCLUSIONS: Efforts by journals to be enlisted in international databases, especially in SCI and Medline, are critical to enhance their global circulation. However, articles published in English only hinder the use of domestic researchers. Different strategies are required for enhancing international and domestic readerships.

Semantic Network Analysis of Online News and Social Media Text Related to Comprehensive Nursing Care Service

PURPOSE: As comprehensive nursing care service has gradually expanded, it has become necessary to explore the various opinions about it. The purpose of this study is to explore the large amount of text data regarding comprehensive nursing care service extracted from online news and social media by applying a semantic network analysis. METHODS: The web pages of the Korean Nurses Association (KNA) News, major daily newspapers, and Twitter were crawled by searching the keyword ‘comprehensive nursing care service’ using Python. A morphological analysis was performed using KoNLPy. Nodes on a ‘comprehensive nursing care service’ cluster were selected, and frequency, edge weight, and degree centrality were calculated and visualized with Gephi for the semantic network. RESULTS: A total of 536 news pages and 464 tweets were analyzed. In the KNA News and major daily newspapers, ‘nursing workforce’ and ‘nursing service’ were highly rated in frequency, edge weight, and degree centrality. On Twitter, the most frequent nodes were ‘National Health Insurance Service’ and ‘comprehensive nursing care service hospital.’ The nodes with the highest edge weight were ‘national health insurance,’‘wards without caregiver presence,’ and ‘caregiving costs.’‘National Health Insurance Service’ was highest in degree centrality. CONCLUSION: This study provides an example of how to use atypical big data for a nursing issue through semantic network analysis to explore diverse perspectives surrounding the nursing community through various media sources. Applying semantic network analysis to online big data to gather information regarding various nursing issues would help to explore opinions for formulating and implementing nursing policies.

Factors Associated with the Timeliness of Electronic Nursing Documentation / 대한의료정보학회지

OBJECTIVES: To investigate the factors associated with the timeliness of electronic nursing documentation using the entry time on the Electronic Medical Record (EMR) system. METHODS: As a retrospective study, data were extracted from January 1 to February 28, 2014 from a hospital EMR system and a nurses’ personnel information system. The timeliness of instances of nursing documentation was categorized into ‘timely’ or ‘untimely’ according to whether the entry time was time-stamped within the working hours during each day, evening, or night shift. Factors associated with the timeliness of the electronic nursing documentation were included in the logistic regression models as nurse- and patient-associated factors. RESULTS: Among 1,700,247 instances of electronic nursing documentation, 79.3% (n = 1,347,711) were completed within the working hours. Years of nursing experience, nursing shift, days of the week, patients’ age, and medical department had a statistically significant associated with the timeliness of nursing records. Nurses with experience of more than 1 year entered nursing records over 2 times more during their working hours than did less experienced nurses. During the evening and night shifts, nurses were 1.49 times and 9.19 times more likely to enter nursing documents in a timely manner, respectively, as compared to those in the day shift. CONCLUSIONS: Nursing documentation was typically completed outside of working hours when a nurse had little experience, worked during the day shift or weekdays, and when tasks were unpredictable. This shows that new nurses need support to familiarize them with various tasks and the overall workflow.

Big Data and Healthcare: Building an Augmented World / 대한의료정보학회지

No abstract available.

Factors Related to N-Terminal Pro-B-Type Natriuretic Peptide as a Biomarker for Heart Failure

PURPOSE: This study aimed to examine the relationships between the N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels with the sociodemographic and clinical factors, self-care behaviors, and the physical symptom experiences in patients with heart failure. METHODS: This cross-sectional study utilized a convenience sample of adult outpatients and inpatients who attended a cardiology department in a tertiary hospital in Seoul, Korea. The data from 154 patients with heart failure were collected using a questionnaire, and their clinical data were extracted from their electronic medical records. RESULTS: Compared with the patients with high NT-proBNP levels, those with low NT-proBNP levels had significantly lower physical symptom experiences scores. Patients with low- and mid-NT-proBNP levels were more likely to be employed compared with those with high NT-proBNP levels. Patients with low NT-proBNP levels had higher left ventricular ejection fractions, and were less likely to have arrhythmias and comorbidities. CONCLUSION: The results from this study showed that patients with more severe heart failure had higher physical symptom experiences scores; hence, individualizing treatment approaches based on heart failure severity is necessary.

Social Media in Clinical Practice / 대한의료정보학회지

No abstract available.

Usability of Academic Electronic Medical Record Application for Nursing Students' Clinical Practicum / 대한의료정보학회지

OBJECTIVES: Nursing curricula for undergraduate nursing students need to reflect the information technology used in current nursing practice. A smart-device Academic Electronic Medical Record (AEMR) application can help nursing students access and document records for the clinical practicum. We conducted a pilot study to evaluate the usability of an AEMR application before applying it to the clinical nursing practicum. METHODS: A previously developed EMR application was modified as an AEMR to access patient information at bedside and to practice documentation. We added several features to the current EMR application to create an AEMR environment. We created a series of document forms and several useful scales on an external application, which included nursing admission notes, vital signs, and intake/output. The case scenarios and tasks were created by a research team to evaluate aspects of AEMRs, including their usability and functionality. Five nursing students completed 15 tasks using a think-aloud method with a tablet device. RESULTS: Minor usability issues were identified and rectified. All participants indicated that they became familiar with the application with little effort. They said that the application icons were intuitive, which helped them find patient information more quickly and accurately. CONCLUSIONS: The application will improve timely access to patient data and documentation for nursing students. We are confident that this AEMR application will enhance nursing students' experience with their clinical practicum, and help them to better understand patient conditions and document them with ideal accessibility.