The retention duration of digital images in picture archiving and communication systems.

Introduction: Every year, a large number of medical images such as MRIs, CT scans, and radiographs are prepared in hospitals, and a lot of money is spent on their preparation. Picture archiving and communication system (PACS) is an integrated image management system for maintaining and storing digital images. The objective of this study was to determine the storage duration of digital images in PACS. Methods: This was a scoping review study in which we searched the PubMed and Embase databases using a combination of terms related to radiography, storage, and duration. The reference lists of included articles were checked to identify other relevant articles. Moreover, we searched Google to retrieve relevant gray literature and other information sources including guidelines. The selection process was carried out in three stages and was reported based on the PRISMA flowchart and the data were extracted using the data collection form. Results: Based on the database search 2867 articles were identified, of which 13 articles were eligible for inclusion. Searching for gray literature identified 7 relevant sources. The results showed that based on the institutions' plans and regulations, different countries have different storage policies. In general, to store images between 6 and 240 months for short-term storage and between 0 and 240 months for long-term storage were considered. Conclusion: Due to financial constraints and storage space requirements, healthcare organizations can provide a solution by drafting guidelines on the appropriate storage duration for medical images. The findings of this study can assist healthcare authorities and healthcare centers in employing PACS systems to manage and minimize storage space for medical images, thereby reducing storage costs.

Statistical evaluation of tongue capability with visual feedback.

BACKGROUND: Analysis of tongue movement would benefit from a reference showcasing healthy tongue capability. We aimed to develop a reference of tongue capability and evaluated the role of visual feedback on the expression of movement. METHODS: Using a wireless tracking intraoral wearable device, we composed probability distributions of the tongue tip as subjects were asked to explore the entire sensing surface area. Half of the 32 subjects received live visual feedback of the location of the center of the tongue tip contact. RESULTS: We observed that the visual feedback group was 51.0% more consistent with each other in the position domain, explored 21.5% more sensing surface area, and was 50.7% more uniformly distributed. We found less consistent results when we evaluated velocity and acceleration. CONCLUSION: Visual feedback best established a healthy capability reference which can be used for designing new interfaces, quantifying tongue ability, developing new diagnostic and rehabilitation techniques, and studying underlying mechanisms of tongue motor control.

The viewpoints of parents of children with mental disorders regarding the confidentiality and security of their children's information in the Iranian national electronic health record system.

INTRODUCTION: Electronic health records help collect and communicate patient information among healthcare providers. The confidentiality of information, especially for patients with mental disorders, is paramount due to its profound impacts on individuals' lives' social and personal aspects. This study aimed to investigate the viewpoints and concerns of parents of children with mental disorders regarding the confidentiality and security of their children's information in the Iranian National Electronic Health Record System (IEHRS). METHODS: This is a survey study on parents or guardians of children with mental disorders who visited Kerman's specialised child psychiatry treatment centres. The data collection tool was a researcher-made questionnaire with 28 questions organised in seven sections, including demographic information of parents, children's medical history, Internet use, knowledge about IEHRS, the necessity of data collection, IEHRS security concerns, and privacy concerns. The data were analysed in SPSS 24 software using descriptive statistics and logistic and ordinal regressions to assess the relationship between parents' demographic characteristics and their viewpoints regarding information security and confidentiality concerns. RESULTS: The results showed that more than 85 % of the parents believed that the security of their children's information in IEHRS was moderate to high. More than two-thirds (71 %) of the parents also believed that IEHRS should tighten its privacy policies. Most participants (87 %) were concerned about their children's information security in IEHRS. In this study, the parents' concerns about the privacy and security of information in IEHRS were not significantly associated with their age, gender, or knowledge about IEHRS. CONCLUSIONS: Most parents of children with mental disorders were concerned about the security and confidentiality of their children's information in IEHRS. Thus, health policymakers should maintain a high level of security and establish appropriate privacy and confidentiality rules in IEHRS. In addition, they should be transparent about the system's security mechanisms and confidentiality regulations to win public trust.

The Impact of Health Technologies on Ostomy Care: A Systematic Review of Health Technologies Impact on Ostomy Care.

PURPOSE: The purpose of this systematic review was to evaluate studies in which health information technology was used to improve ostomy care and management. METHODS: Systematic literature review. SEARCH STRATEGIES: The review was performed according to PRISMA Guidelines. Three scientific databases, Scopus, PubMed, and Web of Science, were searched with no time limitation using key words related to information technology and ostomy. The selection of articles and data collection were carried out by 2 reviewers and disagreements were resolved via discussion with a third, independent reviewer. FINDINGS: The initial search of electronic databases retrieved 1679 elements; following removal of duplicate records, title and abstract review, and articles read in full for inclusion/exclusion criteria, 10 articles were included in the review. Analysis of findings from studies included in our review addresses technologies used to care for persons living with an ostomy. Elements were divided into 2 categories: (1) sensor-based wearable technologies, which were mostly used to assess the fecal output and fullness of ostomy pouching system, and (2) computer-based, tablet based, and smartphones platforms, which were used for teaching and learning. The most significant outcomes were increasing patients' knowledge and awareness of ostomy, enhancing patient's participation in self-care processes, and improving self-efficacy levels. IMPLICATIONS FOR PRACTICE: We found limited research regarding the effectiveness of technology-based interventions on the management of ostomy patients. Findings of this systematic review suggest that the application of technologies has created a positive effect on the management of an ostomy, provided opportunities for enhancing self-efficacy, self-care, and self-management. The results of this study can be a basis for designing efficient technology-based systems for the management of ostomy.

Identifying the data elements and functionalities of clinical decision support systems to administer medication for neonates and pediatrics: a systematic literature review.

BACKGROUND: Patient safety is a central healthcare policy worldwide. Adverse drug events (ADE) are among the main threats to patient safety. Children are at a higher risk of ADE in each stage of medication management process. ADE rate is high in the administration stage, as the final stage of preventing medication errors in pediatrics and neonates. The most effective way to reduce ADE rate is using medication administration clinical decision support systems (MACDSSs). The present study reviewed the literature on MACDSS for neonates and pediatrics. It identified and classified the data elements that mapped onto the Fast Healthcare Interoperability Resources (FHIR) standard and the functionalities of these systems to guide future research. METHODS: PubMed/ MEDLINE, Embase, CINAHL, and ProQuest databases were searched from 1995 to June 31, 2021. Studies that addressed developing or applying medication administration software for neonates and pediatrics were included. Two authors reviewed the titles, abstracts, and full texts. The quality of eligible studies was assessed based on the level of evidence. The extracted data elements were mapped onto the FHIR standard. RESULTS: In the initial search, 4,856 papers were identified. After removing duplicates, 3,761 titles, and abstracts were screened. Finally, 56 full-text papers remained for evaluation. The full-text review of papers led to the retention of 10 papers which met the eligibility criteria. In addition, two papers from the reference lists were included. A total number of 12 papers were included for analysis. Six papers were categorized as high-level evidence. Only three papers evaluated their systems in a real environment. A variety of data elements and functionalities could be observed. Overall, 84 unique data elements were extracted from the included papers. The analysis of reported functionalities showed that 18 functionalities were implemented in these systems. CONCLUSION: Identifying the data elements and functionalities as a roadmap by developers can significantly improve MACDSS performance. Though many CDSSs have been developed for different medication processes in neonates and pediatrics, few have actually evaluated MACDSSs in reality. Therefore, further research is needed on the application and evaluation of MACDSSs in the real environment. PROTOCOL REGISTRATION: (dx.doi.org/10.17504/protocols.io.bwbwpape).

Exploring Common Symptoms in Patients with Respiratory Allergies Using K-Means Algorithm in the North-East of Iran in 2012-2015.

Background: As a common disease among people of almost any age, allergic rhinitis has many adverse effects such as lowering the quality of life and efficiency at work or school. Considering these conditions and the collection of large amounts of data, the present research was conducted on allergic rhinitis and asthma patients' data to extract the common symptoms of these diseases using cluster analysis and the k-means algorithm. Materials and Methods: The present cross-sectional research was conducted in Mashhad city. The inclusion criteria were affliction with one or two respiratory allergy diseases diagnosed by an allergy specialist through clinical history taking and physical examination. A researcher-made checklist was used in the present study for data collection. Then, the K-means algorithm's cluster analysis model was conducted to extract clusters (WEKA software (3, 6, 9)). Results: Overall, 1,231 patients met the inclusion criteria. The result of the Cluster analysis consisted of Cluster 1 in allergic rhinitis consisted of 702 patients, and cluster 2 consisted of 382 patients.46 asthma patients were assigned to cluster 1 and 23 to cluster 2.Also, 60 asthma and allergic rhinitis patients were assigned to cluster 1 and 19 to cluster 2. The most common symptoms in all patients were rhinorrhea, sneezing, nasal congestion, and itchy nose. Conclusion: Overall, Salsola kali was the most common allergen in allergic rhinitis and asthma patients. Also, the most common symptoms in patients are rhinorrhea, sneezing, itchy nose, and nasal congestion. This study can help physicians diagnose allergic rhinitis and asthma in geographical areas with a high prevalence of Salsola kali.

Extracting cancer concepts from clinical notes using natural language processing: a systematic review.

BACKGROUND: Extracting information from free texts using natural language processing (NLP) can save time and reduce the hassle of manually extracting large quantities of data from incredibly complex clinical notes of cancer patients. This study aimed to systematically review studies that used NLP methods to identify cancer concepts from clinical notes automatically. METHODS: PubMed, Scopus, Web of Science, and Embase were searched for English language papers using a combination of the terms concerning "Cancer", "NLP", "Coding", and "Registries" until June 29, 2021. Two reviewers independently assessed the eligibility of papers for inclusion in the review. RESULTS: Most of the software programs used for concept extraction reported were developed by the researchers (n = 7). Rule-based algorithms were the most frequently used algorithms for developing these programs. In most articles, the criteria of accuracy (n = 14) and sensitivity (n = 12) were used to evaluate the algorithms. In addition, Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) and Unified Medical Language System (UMLS) were the most commonly used terminologies to identify concepts. Most studies focused on breast cancer (n = 4, 19%) and lung cancer (n = 4, 19%). CONCLUSION: The use of NLP for extracting the concepts and symptoms of cancer has increased in recent years. The rule-based algorithms are well-liked algorithms by developers. Due to these algorithms' high accuracy and sensitivity in identifying and extracting cancer concepts, we suggested that future studies use these algorithms to extract the concepts of other diseases as well.

The preferred IT sources and tools of Iranian people for accessing health information.

INTRODUCTION: People need health information to maintain their health. Despite the variety of sources and tools for providing health information, there is little evidence about Iranian people's preferences in using these sources and tools. The objective of this study was to identify the preferred health information sources, tools, and methods for presenting health information in these tools. METHODS: This national survey was conducted among a sample of 4000 Iranian people between April and September 2021. The data was collected using a valid and reliable questionnaire (α = 0.86) consisting of four sections: participants' demographic information, current sources of obtaining health information, preferred information technology (IT) tools for accessing health information, and the method of presenting this information. Linear regression was used to investigate the relationship between demographic factors and other questions. RESULTS: The participants received health information mostly from the "Internet" (3.62), "family or friends" (3.43), "social networks" (3.41), "specific websites" (3.41), and "mobile apps" (3.27). "Social networks" (3.67), Internet "websites" (3.56), and "mobile apps" (3.50) were the most suitable tools for receiving health information. The participants preferred the presentation of health information in the form of "Images" (3.85), "educational videos" (3.69), and "texts" (3.53). Age, education, and marital status had a significant relationship with most of the preferred information sources, tools, and information presentation methods (p < 0.05). CONCLUSION: The results of this study showed that Iranian people are more active information seekers than passive ones compared to a decade ago. The preferred sources and tools identified in this research can be used by healthcare planners and policy-makers in Iran and other developing countries to design and develop IT interventions that meet people's needs. Improving access to the Internet, social networks, and mobile apps and providing health information via images, educational videos, and texts on these platforms enhance access to the information people need.

The relationship between e-health literacy and information technology acceptance, and the willingness to share personal and health information among pregnant women.

BACKGROUND: Many factors may affect pregnant women's willingness to accept information (IT) technology and share their personal and health information. One of these factors is their e-health literacy level. OBJECTIVE: To investigate the relationship between e-health literacy and IT acceptance, as well as the willingness of pregnant women to share their information. METHODS: This survey was conducted among pregnant women visiting hospitals and private physicians' offices in Zahedan, Iran in 2019. Data were collected using a 4-part questionnaire with 66 questions. The data were analyzed using descriptive (frequency, percentage, mean and standard deviation) and inferential (Pearson correlation coefficient and linear regression) statistics. RESULTS: The mean scores of electronic health literacy, information technology acceptance, and willingness of pregnant women to share personal and health information were 27.43 ± 5.82, 145.49 ± 25.72, and 19.16 ± 5.47, respectively. There was a significant relationship between IT acceptance and information sharing, which means that with increasing IT acceptance, people were more willing to share their information. Also, the results showed that with the decrease in economic well-being, the willingness to share personal and health information decreases. CONCLUSION: This study showed that with the increase in e-health literacy of pregnant women, their IT acceptance grows. Increasing IT acceptance improves their willingness to share their information. Setting and updating information-sharing rules and security mechanisms with the participation of people can help reduce concerns and increase public trust. Healthcare policymakers can encourage the use of health IT in the prevention and treatment of diseases by providing relevant education and informing people.

A systematic review of data elements of computerized physician order entry (CPOE): mapping the data to FHIR.

OBJECTIVE: Medication errors are the third leading cause of death. There are several methods to prevent prescription errors, one of which is to use a Computerized Physician Order Entry system (CPOE). In a CPOE system, necessary data needs to be collected so that making decisions about prescribing medications and treatment plans could be made. Although many CPOE systems have been developed worldwide, studies have yet to identify the necessary data and data elements of CPOE systems. This study aims to identify data elements of CPOE and standardize these data with Fast Healthcare Interoperability Resources (FHIR) to facilitate data sharing and integration with the electronic health record (EHR) system and reduce data diversity. METHODS: PubMed, Web of Science, Embase, and Scopus databases for studies up to October 2019 were searched. Two reviewers independently assessed original articles to determine eligibility for inclusion in this review. All articles describing data elements of a COPE system were included. Data elements were obtained from the included articles' text, tables, and figures.Classification of the extracted data elements and mapping them to FHIR was done to facilitate data sharing and integration with the electronic health record (EHR) system and reduce data diversity. The final data elements of CPOE were categorized into five main categories of FHIR (foundation, base, clinical, financial, and specialized) and 146 resources, where possible. One of the researchers did mapping and checked and verified by the second researcher. If a data element could not be mapped to any FHIR resources, this data element was considered an extension to the most relevant resource. RESULTS: We retrieved 5162 articles through database searches. After the full-text assessment, 21 articles were included. In total, 270 data elements were identified and mapped to the FHIR standard. These elements have been reported in 26 FHIR resources of 146 ones (18%). In total, 71 data elements were considered an extension. CONCLUSIONS: The results of this study showed that the same data elements were not used in the CPOE systems, and the degree of homogeneity of these systems is limited. The mapping of extracted data with data elements used in the FHIR standard shows the extent to which these systems comply with existing standards. Considering the standards in these systems' design helps developers design more coherent systems that can share data with other systems.

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

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

Designing a minimum data set of laboratory data for the electronic summary sheet of pediatric ward in Iran: A cross-sectional study.

Background and Aim: Iranian hospitals are provided with hospital information systems (HISs) from different vendors, which make it hardly possible to summarize laboratory data in an consistent manner. Therefore, there is a need to design a minimum data set of laboratory data that will define standard criteria and reduce potential medical errors. The purpose of this study was to design a minimum data set (MDS) of laboratory data for an electronic summary sheet to be used in the pediatric ward of Iranian hospitals. Methods: This study consists of three phases. In the first phase, out of 3997 medical records from the pediatric ward, 604 summary sheets were chosen as sample. The laboratory data of these sheets were examined and the recorded tests were categorized. In the second phase, based on the types of diagnosis we developed a list of tests. Then we asked the physicians of the ward to select which ones should be documented for each patient's diagnosis. In the third phase, the tests that were reported in 21%-80% of the records, and were verified by the same percentage of physicians, were evaluated by the experts' panel. Results: In the first phase, 10,224 laboratory data were extracted. Of these, 144 data elements reported in more than 80% of the records, and more than 80% of experts approved them to be included in the MDS for patients' summary sheet. After data elements were investigated in the experts' panel, 292 items were chosen for the final list of the data set. Conclusions: This MDS was designed such that, if implemented in hospital information systems, it could automatically enable registering data in the summary sheet when patient's diagnosis is registered.

The role of mobile health in prevention, diagnosis, treatment and self-care of COVID-19 from the healthcare professionals' perspectives.

Background: To facilitate disease management, understanding the attitude of healthcare professionals regarding the use of this tool can help mobile health (mHealth) program developers develop appropriate interventions. Aims: To assess the perspective of healthcare professionals regarding the contribution of mobile-based interventions in the prevention, diagnosis, self-care, and treatment (PDST) of COVID-19. Methods: This is a survey study conducted in 2020 in Iran with 81 questions. In this study mHealth functionalities were categorized into four dimensions including innovative, monitoring and screening, remote services, and education and decision-making. The data were analyzed using descriptive statistics, ANOVA, and the Kruskal-Wallis test to compare the attitudes of the different job groups. Results: In total, 123 providers participated, and 87.4% of them reported that mHealth technology is moderate to most helpful for the management of COVID-19. Healthcare professionals believed that mHealth technology could be most helpful in self-care and least helpful in the diagnosis of COVID-19. Regarding the functionalities of the mobile application, the results showed that the use of patient decision aids can be most helpful in self-care and the use of computer games can be least helpful in treatment. The participants believed that mHealth is more effective in monitoring and screening dimensions and less effective in providing remote services. Conclusions: This study showed that healthcare professionals believed that mHealth technology could have a better contribution to self-care for patients with COVID-19. Therefore, it is better to plan and invest more in the field of self-care to help patients to combat COVID-19. The results of this study revealed which mhealth functionalities work better in four domains of prevention, treatment, self-care, and diagnosis of COVID-19. This can help healthcare authorities to implement appropriate IT-based interventions to combat COVID-19.

Developing a minimum data set for cardiovascular Computerized Physician Order Entry (CPOE) and mapping the data set to FHIR: A multi-method approach.

Many medical errors occur in the process of treating cardiovascular patients, and most of these errors are related to prescription errors. There are several, one of the methods to prevent prescription errors is the use of a computerized physician order entry (CPOE) system. One of the obstacles of implementing this system is improper design and non-compliance with user needs. one of the issues that should be considered in designing information systems is having a standard minimum data set (MDS). Although many computerized physicians order entry (CPOE) systems have been developed in the world, no study has identified the necessary data and minimum data set (MDS) of CPOE system, and published the process of creating this MDS. This study aimed to develop an MDS for cardiovascular CPOE and standardize it with Fast Healthcare Interoperability Resources (FHIR). A multi-method approach including systematic review for identifying data elements of CPOE, reviewing the content of medical records, validation of the data elements using the expert panel and, determination of the necessary data elements using a survey was conducted. Classification of the data elements and mapping them to FHIR were done to facilitate data sharing and integration with the electronic health record (EHR) system as well as to reduce data diversity. The final data elements of MDS were categorized into 5 main categories of FHIR (foundation, base, clinical, financial, and specialized) and 146 resources, where possible. Mapping was done by one of the researchers and checked and verified by the second researcher. Non-mapped data elements were added to relevant resources as extensions of existing FHIR resources. In total, 270 data elements were identified from the systematic review. After reviewing the content of 20 patients' medical records, 28 data elements were identified. After combination of data elements of two previous phases and removing duplication, 282 data elements remained. Data elements that were considered necessary to be included in CPOE by conducting a survey among cardiovascular physicians were 109 elements. From 146 resources of FHIR, the data elements of this MDS are covered by 5 resources. This study introduced an MDS for cardiovascular CPOE by combining suggested data elements of previous research, and the practical and local requirements identified in patients' medical records. To facilitate data sharing and integration with EHR, reduce data diversity, and also to categorize data, this MDS was standardized with FHIR. The steps we used to develop this MDS could be a model for creating MDS in other CPOEs and health information systems. This is the first time that the process of developing an MDS for cardiovascular CPOE has been presented in the literature.

Attitudes of Covid-19 patients toward sharing their health data: A survey-based study to understand security and privacy concerns.

Background and Aims: Many people around the world, especially at the time of the Covid-19 outbreak, are concerned about their e-health data. The aim of this study was to investigate the attitudes of patients with Covid-19 toward sharing their health data for research and their concerns about security and privacy. Methods: This survey is a cross-sectional study conducted through an electronic researcher-made questionnaire from February to May 2021. Convenience sampling was applied to select the participants and all 475 patients were referred to two to Afzalipour and Shahid Bahonar hospitals were invited to the study. According to the inclusion and exclusion criteria, 204 patients were included in the study and completed the questionnaire. Descriptive statistics (frequency, mean, and standard deviation) were used to analyze the questionnaire data. SPSS 23.0 was used for data analysis. Results: Participants tended to share information about "comments provided by individuals on websites" (68.6%), "fitness tracker data" (64.19%), and "online shopping history" (63.21%) before death. Participants also tended to share information about "electronic medical records data" (36.75%), "genetic data" (24.99%), and "Instagram data" (24.99%) after death. "Fraud or misuse of personal information" (4.48 [±1.27]) was the most common concern of participants regarding the virtual world. "Unauthorized access to the account" (4.38 [±0.73]), "violation of the privacy of personal information" (4.26 [±0.85]), and "violation of the patient privacy and personal information confidentially" (4.26 [±0.85]) were the most of the unauthorized security incidents that occurred online for participants. Conclusion: Patients with Covid-19 were concerned about releasing information they shared on websites and social networks. Therefore, people should be made aware of the reliability of websites and social media so that their security and privacy are not affected.

A Rule Based Intelligent Software to Predict Length of Stay and the Mortality Rate in Trauma Patients in the Intensive Care Unit.

Background: Intensive Care Unit (ICU) has the highest mortality rate in the world. ICU has special equipment that leads to the hospital's most costly parts. The length of stay in the ICU is a special issue, and reducing this time is a practical approach. We aimed to use artificial intelligence to help early and timely diagnosis of the disease to help with health. Methods: We designed a rule-based intelligent system to predict the length of stay and the mortality rate of trauma patients in ICU. A neuro-Fuzzy and eight machine learning models were used to predict the mortality rate in trauma patients in ICU. The performances of these techniques were evaluated with accuracy, sensitivity, specificity, and area under the ROC curve. Decision-Table was used to predict the length of stay in trauma patients in ICU. For comparison, eight machine learning models were used. The method is compared based on Mean absolute error and relative absolute error (%). Results: Neuro-Fuzzy expert system and Decision-Table showed better results than other techniques. Accuracy, sensitivity, specificity, and ROC Area of Nero-Fuzzy are 83.6735, 0.9744, 0.3000, 0.8379, and 1, respectively. The mean absolute error and Relative absolute error (%) of the Decision-Table model are 4.5426 and 65.4391, respectively. Conclusion: Neuro-Fuzzy expert system with the highest level of accuracy and a Decision-Table with the lowest Mean absolute error, which are rule-based models, are the best models. Therefore, these models are recommended as a valuable tool for prediction parameters of ICU as well as medical decision-making.

A pragmatically before-after trial of tele-visits vs face-to-face visits for chronic patients during the COVID-19 pandemic: patient-reported adherence.

BACKGROUND: During the COVID-19 pandemic, chronic patients are at a higher risk of contamination with the virus. Specific strategies are required to restrict these patients' exposure to contaminated areas and improve medication adherence. One suggested strategy is tele-visiting, which is effective for the continuity of care and medication adherence during the pandemic. OBJECTIVE: The present study aimed to explore the effect of tele-visiting services via telephone on chronic patients' medication adherence before and after implementing a tele-visit program during the COVID-19 pandemic. METHODS: All patients received the tele-visit twice on the phone during the study. To compare patients' medication adherence in face-to-face visits and tele-visit, an adapted version of the Morisky Medication Adherence Scale-8 was used. Paired-samples T-test was run to measure participants' medication adherence before and after the tele-visit program. RESULTS: The tele-visit was run for 314 patients. The participants' adherence score before the intervention was 60.02, and after the intervention was 59.9. As the paired-sample T-test results showed, the difference between these two was not statistically significant. Moreover, medication adherence was not significantly associated with any of these variables: BMI, occupation, comorbidities, duration of disease, age, gender, marital status, and education level. CONCLUSIONS: The present findings showed that chronic patients' medication adherence did not differ significantly in face-to-face visits and tele-visiting. During the Covid-19 pandemic, due to the effectiveness of tele-visiting services, they can be used effectively to lower the transmission rate of the disease and reduce healthcare providers' burden.

Role of MexAB-OprM efflux pump in the emergence of multidrug-resistant clinical isolates of Pseudomonas aeruginosa in Mazandaran province of Iran.

BACKGROUND: Multidrug-resistant clinical isolates can cause many therapeutic problems. The MexAB-OprM efflux pump plays a significant role in expelling toxins and drugs from the bacterial cells resulting in multidrug-resistant Pseudomonas aeruginosa isolates. PURPOSE: This study aimed to investigate the effect of the MexAB-OprM efflux pump in the emergence of multidrug-resistant clinical isolates of P. aeruginosa. METHODS AND RESULTS: For the present study, 100 clinical isolates of P. aeruginosa were collected from different wards of teaching hospitals (2018-2019). After confirmation and detection of bacteria by standard methods, the antibiotic resistance pattern of the isolates was determined by the disk agar diffusion method. Also, the minimum inhibitory concentration (MIC) of ciprofloxacin was measured in the presence and absence of phenylalanine arginine beta-naphthylamide by the broth microdilution method. Then, the real-time PCR was used to investigate the expression level of the mexB gene compared to the standard PAO1 strain. Forty-one/100 isolates exhibited multidrug-resistant phenotype (MDR), while piperacillin-tazobactam and levofloxacin were the most and least effective antibiotics tested, respectively. Also, 54/100 isolates showed no increased expression of mexB gene compared to the standard PAO1 strain. However, among the 41 MDR isolates, 12 (29.26%) showed a more than three-fold increase in the expression level of the mexB gene. In this study, a significant relationship was observed between the resistance to tested antibiotics in MDR strains and the increased expression of the mexB gene. CONCLUSION: We found that increasing the expression of the mexB gene can cause the emergence of multidrug-resistant strains by increasing the minimum inhibitory concentration of the antibiotics. Then, we need to evaluate the resistance mechanisms separately in different area of a country to improve the antibiotic stewardship.

Determining the readiness of patients with renal failure to use health information technology.

INTRODUCTION: Using information technology (IT) for purposes such as patient education and disease prevention and management is effective when patients are ready to use it. The objective of this study was to determine the readiness of patients with renal failure to use health IT. METHODS: This study was performed on all dialysis patients in South Khorasan province (n = 263) using a 28-item questionnaire. The questionnaire consisted of (1) demographic information of participants and (2) questions concerning eight main factors including the need for information, desire to receive information, ability to use computers and the Internet, computers and the Internet anxiety, communication with physicians, using mobile phones and concerns about security and confidentiality of information. Descriptive statistics and Mann-Whitney and Kruskal-Wallis statistical tests were used to analyze the data. RESULTS: About 15% of the participants stated that they do not want to receive information from the Internet. Anxiety and concern about Internet security and confidentiality were higher in women, married people, people over 60, villagers, and illiterate people (p < 0.05). Married people and people over 60 years had a higher desire to get information (p < 0.05). The rate of computer anxiety and Internet privacy concern was higher than average (p < 0.001). Most patients (34.2%) could only send text messages using mobile phones. CONCLUSION: Despite the need of most patients to online health information, they do not use this information due to a lack of skills and experience to use IT. Therefore, the ability of users should be considered when developing IT-based interventions. Due to patients' concerns about Internet privacy, it is required to teach patients how to protect their privacy while using the Internet.