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Abstract Background and Aims Hypospadias, a congenital anomaly, can have long‐term effects on sexual, urinary, and reproductive functions, making proper postoperative care essential for desirable outcomes, which could be facilitated through a mobile application for diseases with long‐term complications. The aim of this study was to investigate the data and functional requirements or minimum data set of a postoperative education mobile application for caregivers of children with hypospadias. Methods A literature review of papers published until April 2023 using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement was conducted to determine the data and functional requirements of a mobile application that provides postoperative education to caregivers of children with congenital hypospadias. Based on the results, a questionnaire was prepared, and its content validity and reliability were evaluated by CVI and CVR. Additionally, data was examined by 30 residents, specialists, and subspecialists in pediatric surgery using the Delphi approach. Results The study identified 28 data elements in three main categories: demographic data, clinical data, and application function. Functional requirements of the mobile application were suggested for use in designing the application. Also, the most critical data elements included the definition of disease, the importance of treatment, surgical preparation, bandage, hygiene, symptoms and infection, bleeding, and emergency condition. Conclusion The study will pave the way for developing postoperative educational applications for caregivers of children with congenital hypospadias. M‐Health app developers and clinician specialists can utilize these findings to design practical applications that assist caregivers in managing the care of hypospadias patients.

Background and Aim: According to the report of the World Health Organization, overweight and chronic and psychological diseases caused by it have reached an alarming level in the world. Today, cognitive behavioral therapy as a specific method for controlling overweight teaches the audience how to identify and change inappropriate behavior patterns and destructive thoughts with distress that negatively affect their behavior and emotions. The purpose of this research was to provide a mobile-based application for overweight control with a cognitive-behavioral therapy approach. Materials and Methods: This research was of applied-developmental type. In the first stage, by examining the available applications based on mobile and related to weight control and also Beck cognitive therapy protocol for weight loss, the capabilities of the application were identified and then based on a survey of experts, these capabilities were determined. Afterwards, the user interface of the application was designed and the necessary coding was done to use it. The database was then created using MySQL software and the application program was created using Flutter software and Dart programming language and was named CBTdiet. Finally, the usability of the application was evaluated by users using a standard QUIS questionnaire. Results: Based on the entry and exit criteria, among the 247 identified applications, the capabilities of 17 applications were examined. Finally, according to the opinion of the experts, 21 capabilities, including the ability to send motivational messages to the audience and the ability to reward to achieve weight loss of one kilogram per week, were considered for the design of the application program. The application designed in this research was at a good level from the users’ point of view with an average of 7.99±1.1 and was able to obtain an acceptable level of satisfaction in the evaluation stage. The software’s overall capabilities section got the highest average score (8.12) and the screen section got the lowest average score (7.89) among all sections. Conclusion: Based on the determined capabilities, a mobile-based application for controlling overweight was designed and created with a cognitive behavioral therapy approach, and it can be effective in overweight control by modifying lifestyle and changing destructive thoughts.

Background and Aim: Identifying risk factors is recommended as the first step for depression management in children and adolescents. This study aims to determine the data elements required for developing a clinical decision support system for screening major depression in young people. Materials and Methods: This research was a descriptive-analytical study. The research population included a variety of mental health specialists that were both psychologists and students in psychiatry and guidance & counseling majors as well as electronic databases including Scopus, Pubmed, Embase, PsychInfo, WOS and Clinical key. The data collection tool was a questionnaire designed in three main sections which was answered by a convenient sample of 8 people who were specialists in the field. To analyze the extracted data Content Validity Ratio (CVR) and Mean measures were calculated for each item in questionnaire. Content Validity Index (CVI) and Cronbach’s Alpha (using SPSS software) were calculated which were equal to 0.74 and 0.824 respectively which confirmed validity and reliability of the research tool. Results: According to Lawshe’s table, data elements with CVR between 0 and 0.75 and Mean less than 1.5, like “Ethnicity and race” (CVR=-0.25, Mean=1.125), were rejected. Items such as “Gender” (CVR=0.5) with a CVR equal to or less than 0.75, as well as items with a CVR between 0 and 0.75 and a Mean equal to or more than 1.5, like “Marital status” (CVR=0.5, Mean=1.625) were retained and considered to be included as the minimum data set for screening major depression in ages 10 to 25 years. Data elements were categorized in three categories: Demographic, Clinical and Psychosocial Conclusion: Clinical decision support systems can facilitate providing healthcare at different levels such as screening major depression. These systems can be used for screening major depression risk factors to improve accessibility to mental health practitioners, assure the implementation of guidelines and provide a common language between different levels of healthcare. Determining the minimum data set for screening major depression in ages 10 to 25 years, is the first step toward developing a clinical decision support system for screening individuals for major depression.

Abstract Background and Aims Overweight and obesity lead to the development of physical diseases. Cognitive factors play a vital role in controlling one's weight. Currently, cognitive‐behavioral therapy (CBT) interventions are recognized as a subcategory of lifestyle modification programs that can be implemented to control weight and modify eating patterns as well as physical activity. Nowadays, smartphone‐based applications are utilized to implement behavioral interventions. The main purpose of this study is to evaluate the quality of CBT‐based smartphone applications available on Google Play and the App Store in the field of overweight control. Methods Smartphone‐based utility applications available on Google Play and App Store were identified in March 2021. Weight control smartphone applications were obtained based on inclusion and exclusion criteria. The app name, platform, version, number of downloads, password protection, affiliations, and features of retrieved apps were tabulated. The Mobile Application Rating Scale was utilized to evaluate the quality of the identified apps. Results Seventeen CBT‐based weight control smartphone apps were retrieved. The average engagement, functionality, aesthetics, and information quality scores were 3.65, 3.92, 3.80, and 3.91, respectively. Also, the average score in an aspect containing the usefulness of the app, frequency of using the application, cost, and user satisfaction was 3.5. Conclusion Future applications related to this field can be improved by providing a personalization program according to the needs of users and the possibility of online chatting with the therapist. Further improvements can be achieved by improving the areas of engagement, aesthetics, and subjective quality as well as having appropriate privacy policies.

BackgroundPatients with colorectal cancer who undergo surgery face many postoperative problems. These problems include the risk of relapse, side effects, and long-term complications. ObjectiveThis study sought to design and develop a remote monitoring system as a technological solution for the postdischarge care of these patients. MethodsThis research was conducted in 3 main steps: system feature extraction, system design, and evaluation. After feature extraction from a systematic review, the necessary features were defined by 18 clinical experts in Iran. In the next step, the architecture of the system was designed based on the requirements; the software and hardware parts of the system were embedded in the architecture, then the software system components were drawn using the unified modeling language diagrams, and the details of software system implementation were identified. Regarding the hardware design, different accessible hardware modules were evaluated, and suitable ones were selected. Finally, the usability of the system was evaluated by demonstrating it over a Skype virtual meeting session and using Nilsen’s usability principles. ResultsA total of 21 mandatory features in 5 main categories, including patient information registration, periodic monitoring of health parameters, education, reminders, and assessments, were defined and validated for the system. The software was developed using an ASP.Net core backend, a Microsoft SQL Server database, and an Ionic frontend alongside the Angular framework, to build an Android app. The user roles of the system included 3 roles: physicians, patients, and the system administrator. The hardware was designed to contain an Esp8266 as the Internet of Things module, an MLX90614 infrared temperature sensor, and the Maxim Integrated MAX30101 sensor for sensing the heartbeat. The hardware was designed in the shape of a wristband device using SolidWorks 2020 and printed using a 3D printer. The firmware of the hardware was developed in Arduino with the capability of firmware over the air. In evaluating the software system from the perspective of usability, the system received an average score of 3.8 out of 5 from 4 evaluators. ConclusionsSensor-based telemonitoring systems for patients with colorectal cancer after surgery are possible solutions that can make the process automatic for patients and caregivers. The apps for remote colorectal patient monitoring could be designed to be useful; however, more research regarding the developed system’s implementation in clinic settings and hospitals is required to understand the probable barriers and limitations.

Background: Oral health is one of the most important components of health that can affect the quality of life of children. Oral problems affect over 600 million children, globally. Evidence showed that mobile-based applications have the potential to facilitate self-care processes for oral health in children. Despite the importance of children's oral health and the role of mobile health in facilitating parental education, few systematic reviews were conducted regarding child oral health and mobile-based applications. Objective: This study aimed to investigate the characteristics and capabilities of m-health applications in children's oral health. Methods: A systematic search was completed using keywords alongside thesaurus and MeSH terms on Web of Science, Scopus, and PubMed databases from 2015 to 2020. The present study was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist based on inclusion and exclusion criteria. A synthesis was done to report study findings and patterns identified across studies. All results were analyzed and summarized into general and specific categories. Results: Out of 23 articles included, only nine studies were RCTs (Randomized controlled trials), two studies were cross-sectional studies, one study was evidence-based, and one study was a cluster-randomized trial. According to the findings, most studies were conducted in Brazil, the United Kingdom, and the United States. In terms of the field of dentistry and the application of studies related to dental science, studies fall into three domains, including oral health (61%), orthodontics (4%), and periodontology (26%). Our analysis showed that the developed mobile health applications are equipped with some features to help patients improve their oral health. The most popular features include educational multimedia, game-based stories, reminders, and sending SMS. Conclusion: This study could be the first step towards enhancing our understanding and knowledge regarding applications of mobile health applications in children's oral health. These applications should be developed by involving the end users in the design phase and should be evaluated in terms of usability and effects on the oral health of children.

Introduction. Telemedicine has been able to bring healthcare services to all people in far locations such as the sea. Our main objective was to overview the main features, challenges, and requirements of applying telemedicine at sea. Methods. The electronic search includes all types of papers published in English. It was performed in four databases with keywords to Feb 2023. Next, main categories were defined to extract major concepts. By mapping extracted themes, maritime telemedicine concepts were represented in two conceptual models. Results. After screening the papers based on title and abstract, 18 articles remained. They can be divided into 13 categories based on their clinical domains. Out of 18 reviewed articles, six articles were published in 2020. The greatest number of studies with five articles was conducted in France. Evidence showed that maritime telemedicine service can be provided to all kinds of ships. Regarding clinical domains, the greatest demand belonged to primary care problems (5 papers) and general health assessment (4 papers). Challenges were divided into four main categories. Moreover, the required services and equipment in four categories were described too. Finally, a conceptual model is represented for providing telemedicine services at sea using satellite Internet. Conclusion. Despite the existing challenges in providing the required equipment and resources for the implementation of maritime medicine, it has an important role in providing better care for seafarers without time limitations.

Introduction: Meaningful use program indicates that health care organizations make meaningful use of an accredited electronic health record system. The objective of this study was to investigate the process of “meaningful use” program and the related challenges for the development of electronic health record. Method: This review study was conducted in 2020. The PubMed, Scopus, Science Direct, and Google scholar databases were searched from 2010 to October 2019 using “Meaningful Use Program” and “Electronic Health Record” as keywords. After applying the inclusion criteria, 20 articles were reviewed. Results: Based on the studies, the measures related to “Meaningful Use” program included 15 main measures, 5 selected sub-measures, and 6 qualitative clinical measures. The program includes three steps: data recording and sharing, advanced clinical processes, and improving health outcomes. The primary criteria for receiving the incentive amount of “Meaningful Use” program included computerized physician order entry, investigation of drug interactions, creation of electronic prescriptions, and registration of demographic characteristics. The challenges of this program included the time-consuming nature of the program, the lack of control over infrastructure development, unusable technologies of electronic health records, and the all-or-nothing approach to certification. Conclusion: The use of new programs and solutions like “Meaningful Use” program can lead to the development of electronic health record and enables more secure exchange of information.

Background and Aim: Social networks that provide users with health data not only educate them but also play an active role in the health decision-making process. Health social networks, in addition to being a good tool for better patient communication with health care providers, can play an effective role in connecting similar patients with each other to receive social support. Social networking is one of the biggest achievements of Web 2, which facilitates communication between people. Despite the spread of social networks, their use in the field of health is still at its early levels. To implement an information system, it is first necessary to identify, design and model the related processes. The main purpose of this study was to provide technical documentation for the development of social networks in the field of health in order to facilitate future developments. Materials and Methods: This study was an applied research. Due to the review of texts in the first phase, this research was descriptive. It is also a developmental research due to its technological dimensions in modeling and pattern model presentation. First, extracted features were confirmed based on experts’ opinions. Then, according to the identified features, social network modeling was performed at three levels of data, functional and process. Based on the modeling, a prototype model was designed and evaluated. Results: In this research, technical documents were prepared for the development of social networks in the field of health in the three axes of data modeling, functional modeling and process modeling. In the usability assessment by Nielsen model, the created prototype based on modeling was evaluated. Finally, the number of problems in each case of the Nielsen model was determined. The case of "Visibility of system status" with 26.31 and "Consistency and standards" with 5.27 were associated with the highest and lowest problems, respectively. Conclusion: The growing need and expansion of the use of social networks has created a good platform for using this tool in the field of health and exploiting its benefits. The present study focuses on providing technical documentation for the development of health social networks and to facilitate the development of social networks in the field of health.

Background and Aim: Sepsis is the most important disease in the first 28 days of life and one of the main causes of infant mortality in the intensive care unit. Its definitive diagnosis is possible by performing blood culture. Neonatal sepsis can be a clinical sign of nosocomial infections that are often resistant to antibiotics. Therefore, the purpose of this study was to create and evaluate a hospital sepsis prediction model and present its results to health care providers. Materials and Methods: In this descriptive-applied study, the research population includes neonates admitted to the intensive care unit of Valiasr Hospital in Tehran and the research sample is the data of 4196 neonates admitted to this ward from 2016 to August, 2020. The initial features for creating a predictive model of sepsis were prepared by examining the relevant information sources and under the supervision of professors and officials of Valiasr Hospitalchr('39')s mother and fetus research center and its validity was confirmed by 5 neonatal professors of this hospital. In this research, machine learning algorithms have been used to create a sepsis prediction model. Results: Accuracy and AUROC(area under the ROC curve) parameters were used to evaluate the generated models. The highest values of Accuracy and AUROC are related to Adaptive Boosting and random forest algorithms, respectively. Conclusion: Learning curves show that using different training examples and more complex selection of combination features improves the performance of the models. Further research is needed to evaluate the clinical effectiveness of machine learning models in a trial.

Background and Purpose: Diagnosis of multiple sclerosis (MS) is complicated because of the lack of definite factor. Decision support systems are expert systems which help physicians in decision-making process. First step in designing the system is identification of a minimum dataset (MDS). This study aimed to determine minimum dataset required to design diagnosis decision support system. Materials and Methods: This research was a descriptive cross-sectional study. Data were gathered from medical guideline approved by Ministry of Health, Treatment and Medical Training, Multiple Sclerosis diagnosis, international guideline of Royal college of England, and McDonald Diagnostic criteria. Data collection tool was a designed checklist consisting of 100 items provided to 25 neurologists and MS fellowships of medical universities and private clinics in Iran. Results: Out of 100 designed information’s items, 10 items were omitted due to CVR less than 0.49. Employment status items, history of MS in 3rd grade relatives, history of viral diseases, orbital MRI, optical coherence tomography, brain CT-scan, ESR, CRP, visually evoked potentials, delay duration of P100 for each eyes are all examples of information elements that have been omitted. Conclusion: Determining the minimum dataset related to MS is an important step in designing diagnosis decision support system and medication follow-up. Therefore, MDSs can help those responsible for gathering standard information of patients with Multiple Sclerosis (MS), and causes improvement in management of information for this disease.

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

Background and Aim: Pelvic floor disorders are a common disease which, with varying degrees of severity, disrupts daily life and also decreases the quality of life of the individual. This disease can be cured by lifestyle modifications and self-care education; on the other hand, smartphones have become a good platform for health services and therapeutic interventions. The aim of this study was to identify information and educational components for the self-care application of women with pelvic floor disorders. Materials and Methods: This descriptive study was performed in Yas Hospital affiliated to Tehran University of Medical Sciences. According to Morgan table, 30 gynecologists who were randomly selected were included in the study. The data gathering tool was a researcher-made questionnaire which its validity and reliability were confirmed (α=0.85) and its content was provided by reviewing the scientific sources. Results: The results of the analyzes showed that from the experts’ point of view the interventional section including reminders, daily activities diaries and targeting with an average score of 4.14 has been of great importance. Since then, the applied and self-care section with an average score of 4.364is ranked second in priority. Conclusion: According to a survey by experts who play a major role in the management of the disease. The essential components of this application were identified in three main sections consist of: electronic records, the interventional section and the practical and self-care and their subsections.

Introduction: Nowadays, smart systems and advanced tools such as wearable systems have grown significantly in order to monitor patients and keep their condition under control. The aim of this study was to determine the requirements for designing a wearable smart blanket system (WSBS) to monitor patients in ambulance instantaneously. Method: After reviewing the characteristics of wearable systems by conducting a comparative study, the requirements for designing the proposed system were determined using appropriate data collection methods. In the first step, studies were conducted to identify the requirements for the development of wearable systems, and in the second step, a questionnaire obtained from the studies was distributed among specialists, and based on the results obtained from the questionnaire, the requirements for designing the system were determined. Results: Wearable Smart Blanket System (WSBS) has special functional features such as monitoring of vital signs, ability to communicate with the environment, instantaneous processing of vital signs, the ability to alert when vital signs exceed the threshold, and the ability to record all the patients' vital signs. The main non-functional features of WSBS include easy installation and operation, interoperability, error tolerance, low power consumption, accuracy of signs recording, data evaluation and analysis. Conclusion: The WSBS records all the vital signs needed for the control of patients seamlessly and provides interpreted data for the ambulatory treatment team. All patients' medical, diagnostic, and monitored health information are stored in the physician assistants' system, and therefore, allows them to provide early diagnosis.

Background: Epilepsy is a neurological disorder characterized by seizures and recurrent attacks. Self-management leads to seizure control and maximizes the quality of life in epileptic patients. The purpose of this study was to evaluate the quality of applications available in the epileptic google play store based on the rating features of MARS (Mobile Applications Rating Scale). Methods: The search was conducted systematically using the keywords "epilepsy", "seizure", "mobile health" at the Android google play store. Data were extracted and analyzed from Feb 2018 to Apr 2019. Results: Accordingly, 45 apps were identified potentially relevant of which 20 met inclusion criteria. Twenty-five apps were excluded because they were unrelated to epilepsy self-management, or not Development for people with epilepsy, not in English language or were not free and available. The total mean MARS score was 3.21 out of 5, and more than half of apps (17, 85%) had a minimum acceptability score of 3.0. The mean of apps’ items were 3.27 in Engagement, 3.96 in function, 3.30 in Aesthetics, 2.96 in Information and 2.73 in subjective quality items. Conclusion: Few apps meet prespecified criteria for quality, content, and functionality for epilepsy self-management. Despite the rapid evolution of self-management apps, lack of validation studies is a significant concern that limits the clinical value of these apps. Moreover, having a guideline and benchmarking in the field of mobile application development, in epilepsy management, can help analyze the content of established applications.

Despite the benefits of using virtual reality (VR) in medical education and treatment, some challenges and limitations result in the uselessness or misuse of this technology. Therefore, recognizing potential challenges related to VR might be helpful in the strategic decision-making process to implement and develop this technology in the healthcare field. Accordingly, our review aimed to determine the challenges associated with the application of VR in the field of medical education and treatment. We searched Science Direct, Google Scholar, and PubMed databases for relevant papers using a defined search query. We restricted the search to articles in English or Persian language published by the end of 2018. The main challenges of developing and using VR with educational and therapeutic objectives are categorized as general and specific. General challenges include reduced face-to-face communications, education, cost challenges, users’ attitudes, and specific challenges such as designing, safety considerations, VR side effects, evaluation, and validation of VR applications. Challenges related to VR will have different effects, thus identifying each of them helps to determine the solutions for each challenge. Also, it is suggested to develop and update laws, standards, and protocols, which play an important role in increasing the effective application of VR at the national level.

Background: Success of infection treatment depends on the availability of accurate, reliable, and comprehensive data, information, and knowledge at the point of therapeutic decision-making. The identification of a national minimum data set will support the development and implementation of an effective surveillance system. The goal of this study was to develop a national antimicrobial resistance surveillance minimum data set. Methods: In this cross-sectional and descriptive study, data were collected from selected pioneering countries and organizations which have national or international antimicrobial resistance surveillance systems. A minimum data set checklist was extracted and validated. The ultimate data elements of the minimum data set were determined by applying the Delphi technique. Results: Through the Delphi technique, we obtained 80 data elements in 8 axes. The resistance data categories comprised basic, clinical, electronic reporting, infection control, microbiology, pharmacy, World Health Organization-derived, and expert-recommended data. Relevance coding was extracted based on the Iranian electronic health record coding system. Conclusion: This study provides a set of data elements and a schematic framework for the implementation of an antimicrobial resistance surveillance system. A uniform minimum data set was created based on key informants’ opinions to cover essential needs in the early implementation of a global antimicrobial resistance surveillance system in Iran.

Background: In recent years, mobile-based applications have become important technologies to the delivery of healthcare around the world. Mobile-based self-management systems with standard features for providing, evaluating, and improving HIV care are significantly required in developing countries. Objective: To determine the common elements of a mobile-based self-management system for people living with HIV (PLWH). Methods: This cross-sectional study was done in two main phases in 2017. In the first phase, a review was conducted in relevant databases such as; PubMed, Scopus, Up To Date, and Web of Science. The keywords used to search for resources were as follows; Self-care, Self-management, Data elements, Minimum data set, Mobile application, Mobile health, and HIV/AIDS. In the second phase, the infectious diseases specialists and health information managers affiliated with Tehran University of Medical Sciences were consulted to score identified elements by a questionnaire. Frequency and mean of collected data were calculated using SPSS software (version 19). Results: By full-text reviewing of 9 related articles, the identified elements were justified in 3 main categories and 37 subcategories including: clinical data elements (17), technical capabilities (12) and demographic data elements (8). According to the findings, among the clinical category, 11 data elements were selected by the statistical population. Among the identified technical capabilities, 11 features were selected. Moreover, 6 data elements were selected as the demographic category. Conclusion: We obtained data elements and technical capabilities of a mobile-based self-management system for people living with HIV. Using these elements and features, designing of self-management system architecture will be possible. Self-management skills of PLWH and their communication with healthcare providers will improve by using this system

Introduction: Due to the widespread use of mobile-based systems, and the low cost of this technology, application of mobile-based self-management system can lead to adherence to the treatment and promotion of the health for the people living with human immunodeficiency virus (HIV). The purpose of this study was to identify requirements for the mobile-based self-management system for these people. Methods: This study was a descriptive one, carried out in two main phases in year 2017. In the first stage, in order to identify the requirements for the mobile-based self-management system, similar articles were searched and reviewed, and in the second phase, identified requirements were validated using a researcher-made questionnaire. The statistical population was infectious diseases specialists affiliated with Tehran University of Medical Sciences, Iran. The collected data were analyzed using descriptive statistics methods. Results: The requirements for the self-management system were identified in four categories: demographic data requirements, clinical data requirements, technical capabilities, and self-management strategies. Furthermore, according to the research community' attitude, six data elements for demographic category, 10 data elements for clinical category, 11 features for technical capabilities, and 10 items for self-management strategies were selected. Conclusion: Use of proposed requirements strategies can improve the self-management skills and medication adherence of the people living with human immunodeficiency virus, and facilitate their communication with health care providers.

Background: In recent years, the use of new tools and technologies has decreased the neonatal mortality rate. Despite the positive effect of using these technologies, the decisions are complex and uncertain in critical conditions when the neonate is preterm or has a low birth weight or malformations. There is a need to automate the high-risk neonate management process by creating real-time and more precise decision support tools. Objective: To create a collaborative and real-time environment to manage neonates with critical conditions at the NICU (Neonatal Intensive Care Unit) and to overcome high-risk neonate management weaknesses by applying a multi agent based analysis and design methodology as a new solution for NICU management. Methods: This study was a basic research for medical informatics method development that was carried out in 2017. The requirement analysis was done by reviewing articles on NICU Decision Support Systems. PubMed, Science Direct, and IEEE databases were searched. Only English articles published after 1990 were included; also, a needs assessment was done by reviewing the extracted features and current processes at the NICU environment where the research was conducted. We analyzed the requirements and identified the main system roles (agents) and interactions by a comparative study of existing NICU decision support systems. The Universal Multi Agent Platform (UMAP) was applied to implement a prototype of our multi agent based high-risk neonate management architecture. Results: Local environment agents interacted inside a container and each container interacted with external resources, including other NICU systems and consultation centers. In the NICU container, the main identified agents were reception, monitoring, NICU registry, and outcome prediction, which interacted with human agents including nurses and physicians. Conclusion: Managing patients at the NICU units requires online data collection, real-time collaboration, and management of many components. Multi agent systems are applied as a well-known solution for management, coordination, modeling, and control of NICU processes. We are currently working on an outcome prediction http://www.ephysician.ir Page 6194 module using artificial intelligence techniques for neonatal mortality risk prediction. The full implementation of the proposed architecture and evaluation is considered the future work.

BACKGROUND AND AIM: Oral squamous cell carcinoma (OSCC) is a rapidly progressive disease and despite the progress in the treatment of cancer, remains a life-threatening illness with a poor prognosis. Diagnostic techniques of the oral cavity are not painful, non-invasive, simple and inexpensive methods. Clinical decision support systems (CDSSs) are the most important diagnostic technologies used to help health professionals to analyze patients’ data and make decisions. This paper, by studying CDSS applications in the process of providing care for the cancer patients, has looked into the CDSS potentials in OSCC diagnosis. METHODS: We retrieved relevant articles indexed in MEDLINE/PubMed database using high-quality keywords. First the title and then the abstract of the related articles were reviewed in the step of screening. Only research articles which had designed clinical decision support system in different stages of providing care for the cancer patient were retained in this study according to the input criteria. RESULTS: Various studies have been conducted about the important roles of CDSS in health processes related to different types of cancer. According to the aim of studies, we categorized them into several groups including treatment, diagnosis, risk assessment, screening, and survival estimation. CONCLUSION: Successful experiences in the field of CDSS applications in different types of cancer have indicated that machine learning methods have a high potential to manage the data and diagnostic improvement in OSCC intelligently and accurately.

Background and Aim: Agents can provide suitable infrastructure for follow-up data analysis and Chronic Heart Failure (CHF) management due to their many advantages such as autonomy and pro-activeness. The aim of this article is to explain the key points which should appropriately be considered in designing a CHF management system. Materials and Methods: In this literature review, articles with the following keywords were searched in ScienceDirect, Google Scholar and PubMed databases without regard to their publication year: multi-agent system, chronic heart failure, and chronic disease management. Results: In designing CHF management through a multi-agent system approach, there are key points in general and specific aspects that must be considered; for example, confidentiality and privacy, architecture, appropriate information and communication technology infrastructure, and legal and ethical issues. Conclusion: Clearly, identifying and resolving technical and non-technical challenges are vital to the successful implementation of this technology. Thus, in the design and implementation of agent-based systems, many issues should be considered; for instance, reduced face-to-face communication between patients and doctors that can lead to increased stress in some CHF patients, appropriate architecture and application of communication standards and protocols, the mode of communication between agents, users’ attitudes, supporting stakeholders to use agent technology, sufficient budget, coverage of healthcare costs based on agent technology, financial capability, and identification of opportunities and barriers.

Objective: To demonstrate an architecture to automate the prehospital emergency process to categorize the specialized care according to the situation at the right time for reducing the patient mortality and morbidity.Methods: Prehospital emergency process were analyzed using existing prehospital management systems, frameworks and the extracted process were modeled using sequence diagram in Rational Rose software. System main agents were identified and modeled via component diagram, considering the main system actors and by logically dividing business functionalities, finally the conceptual architecture for prehospital emergency management was proposed. The proposed architecture was simulated using Anylogic simulation software. Anylogic Agent Model, State Chart and Process Model were used to model the system. Results: Multi agent systems (MAS) had a great success in distributed, complex and dynamic problem solving environments, and utilizing autonomous agents provides intelligent decision making capabilities. The proposed architecture presents prehospital management operations. The main identified agents are: EMS Center, Ambulance, Traffic Station, Healthcare Provider, Patient, Consultation Center, National Medical Record System and quality of service monitoring agent.Conclusion: In a critical condition like prehospital emergency we are coping with sophisticated processes like ambulance navigation health care provider and service assignment, consultation, recalling patients past medical history through a centralized EHR system and monitoring healthcare quality in a real-time manner. The main advantage of our work has been the multi agent system utilization. Our Future work will include proposed architecture implementation and evaluation of its impact on patient quality care improvement.

Introduction: Today, increasing development of technology in communication sciences has facilitated access to basic information in the area of individual health. One of the most important decisions in the field of health is measuring the health level of students; thus, designing electronic records is a step toward addressing the requirements of healthcare providers in the assessment of various health indexes in children. Methods: First, a comparative study was carried out on the content and structure of paper-based and electronic systems for children's health in leading countries in this field (Australia, England, and USA). Then, the required information was collected using health measuring database and elementary school students' health measurement sheets. Subsequently, a checklist with three axes of demographic and social information, screening tests, and physician's assessment was compiled and distributed among professionals Results: Among 62 surveyed elements were approved as main elements and 2 as suggested elements. Based on the results of the survey, data elements were approved by the study population and the software was designed in SQL server database management system by C# language. Conclusion: This application provides the registration and reporting of students' health indexes. Therefore, it helps healthcare providers recognize troubled children and make decisions and targeted plans.

Background Advancements in information technology have been instrumental in successful recent developments in telemonitoring systems. In this regard, there is a lack of development of valid and reliable tools to determine the requirements and applications of telemonitoring systems used to provide health care for frail elderly people living at home, specifically in a national setting. Method A cross-sectional study was carried out in 2018. The statistical population was 15 geriatric and gerontology professionals and 15 health information management experts. Then, content validity ratio (CVR), Cronbach's alpha, and correlation coefficient were calculated for measuring content validity, internal consistency and external reliability (through the test–retest method) respectively. SPSS software was used to analyze the collected data. Results Based on the identified items, a draft questionnaire was developed. Using the validity analysis in two stages, 37 items were removed, and 60 items were approved as the essential system requirements. The final questionnaire was organized into five sections with content validity index 99% and internal reliability (Cronbach's alpha coefficient 0.9). Furthermore, the external reliability results of the questionnaire showed that this instrument has a desirable correlation coefficient ( r = 0.85, p -value

Introduction: Results of previous studies have showed that there is no comprehensive and standard model for the development of Electronic Health Record (EHR). Therefore, in this study, with the aim of proposing a set of applicable standards for EHR development in Iran, different standards were compared in terms of structure and content, architecture and function aspects. Method: This comparative study was done in 2017 to compare standards of ASTM, HL7 and ISO organization based on their content. Then, a set of required standards for the development of a national electronic health record was suggested. Results: ASTME1384 not only included structure and content standard of EHR and CCR user friendly architecture, but also it considered data exchange. Executive function of HER in DSTU-functional model was significant achievement of Hl7. ISO18308 contained requirements for structure and content of EHR and ISO18306 presented interoperability of data comprehensively. Conclusion: In spite of different activities of standardization organizations in various fields of EHR development, each of them is more comprehensive in some specific aspects. According to the obtained results, for successful development of HER, E1384 is suggested for structure and content, CDA for architecture and DSTU conformance criteria for evaluation.

Introduction: Biochemistry laboratories provide important information about the health status of people for clinical interventions and decisions. The purpose of this study was to evaluate the data elements of biochemistry laboratory information systems, measure their values, and determine the local minimum dataset (MDS) for designing these systems. Methods: A descriptive-analytical survey was used in this study. The statistical population of this research was hospital and non-hospital biochemistry laboratories in Isfahan city, Iran, and sampling was carried out using the convenient sampling method. The research tools were a checklist and a questionnaire with confirmed validity. Data were analyzed using descriptive statistics and one-sample t, independent t, Friedman and Leven tests via SPSS21 software. Results: The average utilization of the standard data elements in non-hospital and hospital biochemistry laboratory information systems were 61.7% and 61.2%, respectively. The minimum utilization of the standard elements was in the identity information section, physicians and referring centers information sections; and the maximum utilization of the standards was in the accounting section. Some data elements had high value, but had not been considered in the laboratory information systems and some of the current data elements used in the laboratory information systems had low values. Conclusion: Despite the widespread use of the biochemistry laboratory information systems in Iran, the required minimum dataset and international standards have not been considered in their design. Because of the different applications of these systems, using a local minimum dataset for designing these systems is very important.

ObjectivesMonitoring heart failure patients through continues assessment of sign and symptoms by information technology tools lead to large reduction in re-hospitalization. Agent technology is one of the strongest artificial intelligence areas; therefore, it can be expected to facilitate, accelerate, and improve health services especially in home care and telemedicine. The aim of this article is to provide an agent-based model for chronic heart failure (CHF) follow-up management.MethodsThis research was performed in 2013-2014 to determine appropriate scenarios and the data required to monitor and follow-up CHF patients, and then an agent-based model was designed.ResultsAgents in the proposed model perform the following tasks: medical data access, communication with other agents of the framework and intelligent data analysis, including medical data processing, reasoning, negotiation for decision-making, and learning capabilities.ConclusionsThe proposed multi-agent system has ability to learn and thus improve itself. Implementation of this model with more and various interval times at a broader level could achieve better results. The proposed multi-agent system is no substitute for cardiologists, but it could assist them in decision-making.

BACKGROUND: Oral soft tissue diseases include a broad spectrum, and the wide array of patient data elements need to be processed in their diagnosis. One of the biggest and most basic challenges is the analysis of this huge amount of complex patient data in an increasing number of complicated clinical decisions. This study seeks to identify the necessary steps for collecting and management of these data elements through establishing a consensus-based framework. METHODS: This research was conducted as a descriptive, cross-sectional study from April 2016 to January 2017, which has been performed in several steps: literature review, developing the initial draft (v. 0), submitting the draft to experts, validating by an expert panel, applying expert opinions and creating version v.i, performing Delphi rounds, and creating the final framework. RESULTS: The administrative data category with 17 and the historical data category with 23 data elements were utilized in recording data elements in the diagnosis of all of the different oral diseases. In the paraclinical indicator and clinical indicator categories, the necessary data elements were considered with respect to the 6 main axes of oral soft tissue diseases, according to Burket's Oral Medicine: ulcerative, vesicular, and bullous lesions; red and white lesions of the oral mucosa; pigmented lesions of the oral mucosa; benign lesions of the oral cavity and the jaws; oral and oropharyngeal cancer; and salivary gland diseases. CONCLUSIONS: The study achieved a consensus-based framework for the essential data element in the differential diagnosis of oral medicine using a comprehensive search with rich keywords in databases and reference texts, providing an environment for discussion and exchange of ideas among experts and the careful use of the Delphi decision technique.

Background and Aim: If the evaluation is done from the perspective of users, Successful development of measures and features related to use and implementation of hospital information system and identify areas that need further consideration is to be provided. The main purpose of this study was assessment the views of physicians and nurses of hospital information system; identify the effective criteria for the use of it and their satisfaction. Materials and Methods: Present research is a descriptive cross-sectional study and was applied in public- education hospitals of Tehran University of Medical Sciences in 2012- 2013. The main tool was a questionnaire prepared by reviewing relevant literature in databases Iranmedex, Magiran, SID, PubMed, Science direct, Google scholar, and surveys by experts. In order to determine the validity, a questionnaire was distributed among 5 experts in the area of ​​information technology. After completion of the questionnaires, results were analyzed using software SPSS17. Results: Information systems in half of the hospitals surveyed from the perspective of research community have an average of 30 - 60 percent capabilities in order management. Also users in all surveyed hospitals with more than 43 % agree the ease of using hospital systems. Conclusion : User satisfaction is a guarantee for the implementation of information system. To improve the situation and move towards the ideal condition we suggest users needs in hospital information systems should be considered. Also design and system should be Compatible with the skills and knowledge of users as possible.

ObjectivesGiven the importance of the follow-up of chronic heart failure (CHF) patients to reduce common causes of re-admission and deterioration of their status that lead to imposing spiritual and physical costs on patients and society, modern technology tools should be used to the best advantage. The aim of this article is to explain key points which should be considered in designing an appropriate multi-agent system to improve CHF management.MethodsIn this literature review articles were searched with keywords like multi-agent system, heart failure, chronic disease management in Science Direct, Google Scholar and PubMed databases without regard to the year of publications.ResultsAgents are an innovation in the field of artificial intelligence. Because agents are capable of solving complex and dynamic health problems, to take full advantage of e-Health, the healthcare system must take steps to make use of this technology. Key factors in CHF management through a multi-agent system approach must be considered such as organization, confidentiality in general aspects and design and architecture points in specific aspects.ConclusionsNote that use of agent systems only with a technical view is associated with many problems. Hence, in delivering healthcare to CHF patients, considering social and human aspects is essential. It is obvious that identifying and resolving technical and non-technical challenges is vital in the successful implementation of this technology.

Introduction: Evaluation of university faculty members which is aimed to improve teaching quality is performed through several methods. One of the most common and conflicting methods is faculty evaluation by students. This method is commonly used in most universities in spite of controversy over its validity. This paper presents a glance at the current research literature on the viewpoints of faculty members toward their evaluation by students. Methods: This study is a literature review performed using library studies and electronic databases. First, 64 articles in the area of faculty member evaluation were studied. Out of these articles, 42 ones were selected which met the inclusion criteria. The inclusion criteria encompassed articles related to teacher evaluation, faculty members, and students’ viewpoints toward teaching approaches of faculties, teachers’ characteristics, classroom management, teachers’ communication skills and their relationship with students. Using the keywords of evaluation, student, faculty member, and university, we searched in journals such as Iranian Journal of Medical Education, Journal of Research and Planning in Higher Education, Knowledge and Research in Education, and other specialized journals in medical education area. Using scientific search engines such as Iran Medex, Magiran, SID, PubMed, Google Scholar, ISC, Medline, and Scopus the articles published or indexed between 1991 and 2010 were retrieved. Other papers which evaluated teachers and faculty members from other aspects or via other viewpoints were excluded. Results: The results were presented in three parts as “proponent to faculty evaluation by students”, “opponent”, and “teaching conditions affecting teacher evaluation by students”. The results showed that evaluation of teaching process must consider six aspects of content, students’ learning, classroom behavior, curriculum and materials, knowledge of faculty member, student characteristics (including material, students with high or low background, and postgraduate students), self-evaluation by the faculty member, evaluation by colleagues, educational administrators, and educational consultants and it must be compatible to organizational goals. Conclusion: The viewpoints of most faculty members of national universities and other countries states that they basically consider evaluation by their students as a valuable and reliable source of information for feedback to teachers in order to improve the quality of education. But, they believe that interventional factors should be identified and considered in this method. They also believed that teacher evaluation by students should be a part of comprehensive evaluation system of faculty members. But if the evaluation results are going to be utilized in commendation and promotion of faculty members, it would be better to employ other evaluation methods comprehensively.