Medical systems

Automated medical diagnosis systems based on knowledge-oriented descriptions have gained momentum with the emergence of semantic descriptions. The objective of this paper is to propose a normalized design that solves some of the problems which have been detected by authors in previous tools. The authors bring together two different technologies to develop a new clinical decision support system: description logics aimed at developing inference systems to improve decision support for the prevention, treatment and management of illness and semantic technologies. Because of its new design, the system is capable of obtaining improved diagnostics compared with previous efforts. However, this evaluation is more focused in the computational performance, giving as result that description logics is a good solution with small data sets. In this paper, we provide a well-structured ontology for automated diagnosis in the medical field and a threefold formalization based on Description Logics with the use of Semantic Web technologies.

The means of designing an effective user interface software package varies from one application to another. Almost the entire ICT infrastructure was damaged following the impact of the tsunami tidal wave. Under such circumstances, transporting critically ill patients is a must and becomes the first priority. Many considerations are needed when designing a specific user interface for emergency situations in developing countries. In this study we proposed how to design the user interface in order to support emergency medical care in the early stages of disasters. The user interface was classified into two tabs, firstly to indicate critically ill patients and secondly to notify details of the medicine having been administered to the patients. Classifying the user interface of emergency medical care information systems by using VHF radio connections will be beneficial, especially for the early stages of disaster-stricken developing countries, in order to preserve the lives of more victims.

Subarachnoid hemorrhage (SAH) is a medical emergency which can lead to death or severe disability. Misinterpretation of computed tomography (CT) in patients with SAH is a common problem. How to improve the accuracy of diagnosis is a great challenge to both the clinical physicians and medical researchers. In this paper we proposed a method for the automatic detection of SAH on clinical non-contrast head CT scans. The novelty includes approximation of the subarachnoid space in head CT using an atlas based registration, and exploration of support vector machine to the detection of SAH. The study included 60 patients with SAH and 69 normal controls from clinical hospitals. Thirty patients with SAH and 30 normal controls were used for training, while the rest were used for testing to achieve a testing sensitivity of 100% and specificity of 89.7%. The proposed algorithm might be a potential tool to screen the existence of SAH.

The concept of Total Quality Management (TQM) has come to be applied in healthcare over the last few years. The process management category in the Baldrige Health Care Criteria for Performance Excellence model is designed to evaluate the quality of medical services. However, a systematic approach for implementation support is necessary to achieve excellence in the healthcare business process. The

Ontology engineering covers issues related to ontology development and use. In Case Based Reasoning (CBR) system, ontology plays two main roles; the first as case base and the second as domain ontology. However, the ontology engineering literature does not provide adequate guidance on how to build, evaluate, and maintain ontologies. This paper proposes an ontology engineering methodology to generate case bases in the medical domain. It mainly focuses on the research of case representation in the form of ontology to support the case semantic retrieval and enhance all knowledge intensive CBR processes. A case study on diabetes diagnosis case base will be provided to evaluate the proposed methodology.

Securing electronic health records, in scenarios in which the provision of care services is share among multiple actors, could become a complex and costly activity. Correct identification of patients and physician, protection of privacy and confidentiality, assignment of access permissions for healthcare providers and resolutions of conflicts rise as main points of concern in the development of interconnected health information networks. Biometric technologies have been proposed as a possible technological solution for these issues due to its ability to provide a mechanism for unique verification of an individual identity. This paper presents an analysis of the benefit as well as disadvantages offered by biometric technology. A comparison between this technology and more traditional identification methods is used to determine the key benefits and flaws of the use biometric in health information systems. The comparison as been made considering the viability of the technologies for medical environments, global security needs, the contemplation of a share care environment and the costs involved in the implementation and maintenance of such technologies. This paper also discusses alternative uses for biometrics technologies in health care environments. The outcome of this analysis lays in the fact that even when biometric technologies offer several advantages over traditional method of identification, they are still in the early stages of providing a suitable solution for a health care environment.

Diabetes is a chronic end organ disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly. Over time, diabetes affects the circulatory system, including that of the retina. Diabetic retinopathy is a medical condition where the retina is damaged because fluid leaks from blood vessels into the retina. Ophthalmologists recognize diabetic retinopathy based on features, such as blood vessel area, exudes, hemorrhages, microaneurysms and maculopathy. With this paper we review algorithms which automate the extraction of these features from digital eye fundus images. Furthermore, we discuss systems that use these features to classify individual fundus images. The classifications range from simple disease no-disease problems to sophisticated disease severity detection systems. Most of the reported systems are highly optimized with respect to the analyzed fundus images, therefore a generalization of individual results is difficult. However, this review shows that the classification results improved over the last years, they are getting closer to the classification capabilities of human ophthalmologists.

This paper approaches an intellectual diagnosis system using hybrid approach of Adaptive Neuro-Fuzzy Inference System (ANFIS) model for classification of Electrocardiogram (ECG) signals. This method is based on using Symlet Wavelet Transform for analyzing the ECG signals and extracting the parameters related to dangerous cardiac arrhythmias. In these particular parameters were used as input of ANFIS classifier, five most important types of ECG signals they are Normal Sinus Rhythm (NSR), Atrial Fibrillation (AF), Pre-Ventricular Contraction (PVC), Ventricular Fibrillation (VF), and Ventricular Flutter (VFLU) Myocardial Ischemia. The inclusion of ANFIS in the complex investigating algorithms yields very interesting recognition and classification capabilities across a broad spectrum of biomedical engineering. The performance of the ANFIS model was evaluated in terms of training performance and classification accuracies. The results give importance to that the proposed ANFIS model illustrates potential advantage in classifying the ECG signals. The classification accuracy of 98.24 % is achieved. Keywords ECG . Symlet wavelet transform . Five cardiac arrhythmias . Myocardial ischemia . ANFIS This article is part of the Topical Collection on Patient Facing Systems.

Concerns about inefficiency and excessive expenditures has stimulated interest in the measurement of the output of the hospital, an organization that produces a wide variety of products. Diagnosis Related Groups and a number of severity measures including Disease Staging, the Severity of Illness Index, and Patient Management Categories are described and evaluated. Using criteria such as reliability, clinical validity, homogeneity, number of categories, and data acquisition costs, the analysis suggests that while none of the hospital patient classification systems is perfect, great strides have been made in reflecting the multiproduct nature of the hospital.

The electromyography (EMG) signals give information about different features of muscle function. Realtime measurements of EMG have been used to observe the dissociation between the electrical and mechanical measures that occurs with fatigue. The purpose of this study was to detect fatigue of biceps brachia muscle using timefrequency methods and independent component analysis (ICA). In order to realize this aim, EMG activity obtained from activated muscle during a phasic voluntary movement was recorded for 14 healthy young persons and EMG signals were observed in time-frequency domain for determination of fatigue. Time-frequency methods are used for the processing of signals that are non-stationary and time varying. The EMG contains transient signals related to muscle activity. The proposed method for the detection of muscle fatigue is automated by using artificial neural networks (ANN). The results show that ANN with ICA separates EMG signals from fresh and fatigued muscles, hence providing a visualization of the onset of fatigue over time. The system is adaptable to different subjects and conditions since the techniques used are not subject or workload regime specific.

In pattern classification problems, feature extraction is an important step. Quality of features in discriminating different classes plays an important role in pattern classification problems. In real life, pattern classification may require high dimensional feature space and it is impossible to visualize the feature space if the dimension of feature space is greater than four. In this paper, we have proposed a Similarity-Dissimilarity plot which can project high dimensional space to a two dimensional space while retaining important characteristics required to assess the discrimination quality of the features. Similarity-dissimilarity plot can reveal information about the amount of overlap of features of different classes. Separable data points of different classes will also be visible on the plot which can be classified correctly using appropriate classifier. Hence, approximate classification accuracy can be predicted. Moreover, it is possible to know about whom class the misclassified data points will be confused by the classifier. Outlier data points can also be located on the similarity-dissimilarity plot. Various examples of synthetic data are used to highlight important characteristics of the proposed plot. Some real life examples from biomedical data are also used for the analysis. The proposed plot is independent of number of dimensions of the feature space.

The integration of computer systems into clinical practice is a consequence of the growing sophistication of medical machinery. The fact that patient management in large institutions is handled by complex information systems brings about the need for integration between applications on both sides. The paper describes a prototype for automatic data collection from intensive care devices developed at Pedro Hispano Hospital in Portugal. The system acts as an application gateway between the network of patient monitoring devices and the general-purpose hospital network. The conformance to medical standards is one of the main concerns. The international standard Health Level 7 (HL7) has been adopted to import vital signs, as well as to prepare data for visualization in departmental applications and to organize archives. The design has followed the administrative and clinical processes in the hospital closely, leading to a successful interaction with the health professionals. Automatic acquisition eliminates transcription errors, improves the quality of records and allows the assembly of large electronic archives of vital sign data. The concern with data archiving in standard formats opens many possibilities for further analysis of the collected data sets. The possibility of communicating via the HL7 standard makes the whole system easily interoperable with applications in related domains.

A new algorithm for medical image retrieval is presented in the paper. An 8-bit grayscale image is divided into eight binary bit-planes, and then binary wavelet transform (BWT) which is similar to the lifting scheme in real wavelet transform (RWT) is performed on each bitplane to extract the multi-resolution binary images. The local binary pattern (LBP) features are extracted from the resultant BWT sub-bands. Three experiments have been carried out for proving the effectiveness of the proposed algorithm. Out of which two are meant for medical image retrieval and one for face retrieval. It is further mentioned that the database considered for three experiments are OASIS magnetic resonance imaging (MRI) database, NEMA computer tomography (CT) database and PolyU-NIRFD face database. The results after investigation shows a significant improvement in terms of their evaluation measures as compared to LBP and LBP with Gabor transform.

Telecare Medical Information System (TMIS) makes an efficient and convenient connection between patient(s)/user(s) at home and doctor(s) at a clinical center. To ensure secure connection between the two entities (patient(s)/user(s), doctor(s)), user authentication is enormously important for the medical server. In this regard, many authentication protocols have been proposed in the literature only for accessing single medical server. In order to fix the drawbacks of the single medical server, we have primarily developed a novel architecture for accessing several medical services of the multi-medical server, where a user can directly communicate with the doctor of the medical server securely. Thereafter, we have developed a smart card based user authentication and key agreement security protocol usable for TMIS system using cryptographic one-way hash function. We have analyzed the security of our proposed authentication scheme through both formal and informal security analysis. Furth...

Hospitals often invest significant resources in the development of large and complex information systems that must be modified and extended to respond to changing requirements and to exploit the capabilities offered by modern technologies. A disciplined approach of managing the evolution of hospital information systems is then required so that to meet the increasing demands for effective and efficient use of scarce resources. This paper takes a process oriented view of the hospital and presents an approach based on hospital process modeling which aims at assessing the current status of computer support within a hospital and at identifying new opportunities for automation. The approach is illustrated by an example taken from a major Greek hospital.

Chilean primary healthcare practice is analyzed using a Data Envelopment Analysis (DEA) multiple stage approach. We estimate the efficiency level of 259 municipalities nationwide. Since the efficiency score by itself is of limited value for decision making, we use a multivariate tool to help explain the effect of relevant factors. First, we use a cluster analysis to homogenize the units under study. Second, we use DEA to estimate the efficiency levels, which varies from 61% to 71% for urban municipalities, and from 51% to 56% in rural ones. Third, we use bootstrap to estimate confidence intervals for the efficiency scores, and a Biplot method to identify adequate variables to include in the Tobit Model, which is our last stage. We identify six factors associated with rural municipalities' operational efficiency, and two with urban ones. Knowing the efficiency level of municipalities can help determine ways to improve their efficiency.

As health care providers seek ways to reduce the cost of health care services, hospital operating rooms (ORs) have been identified as potential areas for cost reduction efforts. Cost containment efforts which have shifted significant portions of the inpatient population to ambulatory areas have resulted in an inpatient population which is sicker and more procedure-intensive. Efficient management of operating rooms has assumed even greater importance in this environment. Inefficient or inaccurate scheduling of OR time often results in delays of surgery or cancellations of procedures, which are costly to the patient and the hospital. Approaches to efficient use of ORs include computerized scheduling, utilization monitoring, and refinement of scheduling policies and procedures. In the absence of commercially available software to meet operating room management information needs, Johns Hopkins developed its own system in 1983. This software provides detailed information for daily OR management and long-term planning. The computerized operating room scheduling and monitoring system is described in this article and an operational measure of scheduling accuracy is proposed. Suggestions are made for incorporating this measure into planning and allocation decisions.

The EEG (Electroencephalogram) signal indicates the electrical activity of the brain. They are highly random in nature and may contain useful information about the brain state. However, it is very difficult to get useful information from these signals directly in the time domain just by observing them. They are basically non-linear and nonstationary in nature. Hence, important features can be

The appraisal and relative performance evaluation of nurses are very important and beneficial for both nurses and employers in an era of clinical governance, increased accountability and high standards of health care services. They enhance and consolidate the knowledge and practical skills of nurses by identification of training and career development plans as well as improvement in health care quality services, increase in job satisfaction and use of cost-effective resources. In this paper, a data envelopment analysis (DEA) model is proposed for the appraisal and relative performance evaluation of nurses. The model is validated on thirty-two nurses working at an Intensive Care Unit (ICU) at one of the most recognized hospitals in Lebanon. The DEA was able to classify nurses into efficient and inefficient ones. The set of efficient nurses was used to establish an internal best practice benchmark to project career development plans for improving the performance of other inefficient nurses. The DEA result confirmed the ranking of some nurses and highlighted injustice in other cases that were produced by the currently practiced appraisal system. Further, the DEA model is shown to be an effective talent management and motivational tool as it can provide clear managerial plans related to promoting, training and development activities from the perspective of nurses, hence increasing their satisfaction, motivation and acceptance of appraisal results. Due to such features, the model is currently being considered for implementation at ICU. Finally, the ratio of the number DEA units to the number of input/output measures is revisited with new suggested values on its upper and lower limits depending on the type of DEA models and the desired number of efficient units from a managerial perspective.

The novel coronavirus disease-19 (COVID-19) infection has altered the society, economy, and entire healthcare system. Whilst this pandemic has presented the healthcare system with unprecedented challenges, it has rapidly promoted the adoption of telemedicine to deliver healthcare at a distance. Telemedicine is the use of Information and Communication Technology (ICT) for collecting, organizing, storing, retrieving, and exchanging medical information. But it is faced with the limitations of conventional IP-based protocols which makes it challenging to provide Quality of Service (QoS) for telemedicine due to issues arising from network congestion. Likewise, medical professionals adopting telemedicine are affected with low QoS during health consultations with outpatients due to increased internet usage. Therefore, this study proposes a Software-Defined Networking (SDN) based telemedicine architecture to provide QoS during telemedicine health consultations. This study utilizes secondary data from existing research works in the literature to provide a roadmap for the application of SDN to improve QoS in telemedicine during and after the COVID-19 pandemic. Findings from this study present a practical approach for applying SDN in telemedicine to provide appropriate bandwidth and facilitate real time transmission of medical data.

Disasters are fortunately rare occurrences. However, accurate and timely information and communication are vital to adequately prepare individual health organizations for such events. The current article investigates the health related communication and information systems for emergency management in Iran. A mixed qualitative and quantitative methodology was used in this study. A sample of 230 health service managers was surveyed using a questionnaire and 65 semi-structured interviews were also conducted with public health and therapeutic affairs managers who were responsible for emergency management. A range of problems were identified including fragmentation of information, lack of local databases, lack of clear information strategy and lack of a formal system for logging disaster related information at regional or local level. Recommendations were made for improving the national emergency management information and communication system. The findings have implications for health organizations in developing and developed countries especially in the Middle East. Creating disaster related information databases, creating protocols and standards, setting an information strategy, training staff and hosting a center for information system in the Ministry of Health to centrally manage and share the data could improve the current information system.

Using a sample of Virginia hospitals, performance measures of quality were examined as they related to technical efficiency. Efficiency scores for the study hospitals were computed using Data Envelopment Analysis (DEA). The study found that the technically efficient hospitals were performing well as far as quality measures were concerned. Some of the technically inefficient hospitals were also performing well with respect to quality. DEA can be used to benchmark both dimensions of hospital performance: technical efficiency and quality. The results have policy implications in view of growing concern that hospitals may be improving their efficiency at the expense of quality.

High demand but limited staffs within some services of a hospital require a proper scheduling of staff and patients. In this study, a hierarchical mathematical model is proposed to generate weekly staff scheduling. Due to computational difficulty of this scheduling problem, the entire model is broken down into manageable three hierarchical stages: (1) selection of patients, (2) assignment of patients to the staff, (3) scheduling of patients throughout a day. The developed models were tested on the data collected in College of Medicine Research Hospital at Cukurova University using GAMS and MPL optimization packages. From the results of the case study, the presented hierarchical model provided a schedule that ensures to maximize the number of selected patients, to balance the workload of physiotherapist, and to minimize waiting time of patients in their treatment day.

A novel design of low noise amplifier for medical ultrasound transducers is described in this paper. Unlike conventional low noise preamplifiers, this design proposes a new circuit configuration which has electronically adjustable matching resistance that allows the preamplifier to be compatible with a variety of medical ultrasound transducers. The design employs current feedback operational amplifier to enhance the gain-bandwidth independence

Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way health care is currently delivered. Although smart health monitoring systems automate patient monitoring tasks and, thereby improve the patient workflow management, their efficiency in clinical settings is still debatable. This paper presents a review of smart health monitoring systems and an overview of their design and modeling. Furthermore, a critical analysis of the efficiency, clinical acceptability, strategies and recommendations on improving current health monitoring systems will be presented. The main aim is to review current state of the art monitoring systems and to perform extensive and an in-depth analysis of the findings in the area of smart health monitoring systems. In order to achieve this, over fifty different monitoring systems have been selected, categorized, classified and compared. Finally, major advances in the system design level have been discussed, current issues facing health care providers, as well as the potential challenges to health monitoring field will be identified and compared to other similar systems.

This paper reports the design and development of Digital Signal Controller (DSPIC)-based ECG simulator intended to use in testing, calibration and maintenance of electrocardiographic equipment, and to support biomedical engineering students' education. It generates all 12 healthy ECG derivation signals having a profile that varies with heart rate, amplitude, and different noise contamination in a manner which reflects true in vivo conditions. The heart rate can be set at the range of 30 to 120 beats/minute in four steps. The noise and power line interference effects can be set at the range of 0 to 20 dB in three steps. Since standard commercially available electronic components were used to construct the prototype simulator, the proposed design was also relatively inexpensive to produce.

Most of the available studies into information technology (IT) have been limited to investigating specific issues, such as how IT can support decision makers distributing the information throughout health care organization, or how technology impacts organizational performance. In this study, for use in the planning of information system development projects, a theoretical model for the classification of health care organizations

OASIS is a non-for-profit consortium that drives the development convergence and adoption of open standards for the global information society. It involves more than 600 organizations and individuals as well as IT leaders Sun, Microsoft, IBM and Oracle. One of its standards is XACML which appeared a few years ago and now there are about 150,000 hits on Google. XACML (eXtensible Access Control Markup Language) is not technology related. Sun published in 2004 open source Sun XACML which is in compliance with XACML 1.0. specification and now works to make it comply with XACML 2.0. The heart of XACML are attributes values of defined type and name that is to be attached to a subject, a resource, an action and an environment in which a subject request action on resource. In that way XACML is to replace Role Based Access Control which dominated for years. The paper examines performances in CEN 13 606 and ISO 22 600 based healthcare system which uses XACML for access control. Keywords Security and privacy. Access control. Electronic Health Record Related work on using XACML At the RSA 2008 Conference, members of the OASIS open standards consortium, in cooperation with the Health Information Technologies Standards Panel (HITSP), demonstrated interoperability of the Extensible Access Control Markup Language (XACML) version 2.0. Simulating a real world scenario provided by the US Department of Veterans Affairs, the demo showed how XACML ensures successful authorization decision requests and the exchange of authorization policies. The XACML Interop at the RSA 2008 conference utilizes requirements from Health Level Seven (HL7), ASTM International, and the American National Standards Institute (ANSI) [1]. For security reasons, enterprises are frequently unwilling to publicize the security mechanisms they use internally, and many deployments of XACML fall into this category. However, a large and growing number of businesses, institutions and university/research groups are now using XACML in their security systems. An example is children's hospital in Boston. The world's first personally controlled health record system, called Personal Internetworked Notary and Guardian (PING), enables a patient to own a complete, secure copy of his/ her record, integrating health information across sites of care and over time. PING utilizes the XACML Library to implement the necessary authorization functionality [2]. Another example is Australian's project NEHTA (National E-Health Transition Authority) which recommends XACML as a standard method of defining access policies for e-health services. [3] Related work on access control standards Commite European de Normalisation (CEN) standard ENV 13606 [4] In 2008 ISO gave ISO 13 606 on Electronic Healthcare Record Architecture. This standard is a revised Commite

Although information technology (IT)-based applications in healthcare have existed for more than three decades, methods to evaluate outputs and outcomes of the use of IT-based systems in medical informatics is still a challenge for decision makers, as well as to those who want to measure the effects of ICT in healthcare settings. The aim of this paper is to review published articles in the area evaluations of IT-based systems in order to gain knowledge about methodologies used and findings obtained from the evaluation of IT-based systems applied in healthcare settings. The literature review includes studies of IT-based systems between 2003 and 2005. The findings show that economic and organizational aspects dominate evaluation studies in this area. However, the results focus mostly on positive outputs such as user satisfaction, financial benefits and improved organizational work. This review shows that there is no standard framework for evaluation effects and outputs of implementation and use of IT in the healthcare setting and that until today no studies explore the impact of IT on the healthcare system' productivity and effectiveness.

The increasing use of wireless networks and the constant miniaturization of electrical devices has empowered the development of Wireless Body Area Networks (WBANs). In these networks various sensors are attached on clothing or on the body or even implanted under the skin. The wireless nature of the network and the wide variety of sensors offer numerous new, practical and innovative applications to improve health care and the Quality of Life. The sensors of a WBAN measure for example the heartbeat, the body temperature or record a prolonged electrocardiogram. Using a WBAN, the patient experiences a greater physical mobility and is no longer compelled to stay in the hospital. This paper offers a survey of the concept of Wireless Body Area Networks. First, we focus on some applications with special interest in patient monitoring. Then the communication in a WBAN and its positioning between the different technologies is discussed. An overview of the current research on the physical layer, existing MAC and network protocols is given. Further, cross layer and quality of service is discussed. As WBANs are placed on the human body and often transport private data, security is also considered. An overview of current and past projects is given. Finally, the open research issues and challenges are pointed out.

This study compares the organization and structure of information flow in a Dutch and in a Hungarian hospital. The study was carried out as a field orientation part of a Health Care Management project of the Hogeschool van Amsterdam. The host of the field orientation was the BAZIS Foundation, the Central Development and Support Group Hospital Information System, Leiden. The visited hospitals were equipped with the BAZIS Hospital Information System. The method of study consisted of series of formalized interviews with all-level actors of a hospital; the interpretation of data was enhanced by a two axes (patient and management) model of information flow defined by the authors. In summary, Dutch hospitals show a more elaborate information flow system, with more information flow channels sideways among equal levels, less bureaucracy in organization of information flow, and significantly more benefits of automation, compared to the Hungarian situation.

The use of machine learning tools has become widespread in medical diagnosis. The main reason for this is the effective results obtained from classification and diagnosis systems developed to help medical professionals in the diagnosis phase of diseases. The primary objective of this study is to improve the accuracy of classification in medical diagnosis problems. To this end, studies were carried out on 3 different datasets. These datasets are heart disease, Parkinson's disease (PD) and BUPA liver disorders. Key feature of these datasets is that they have a linearly non-separable distribution. A new method entitled k-medoids clustering-based attribute weighting (kmAW) has been proposed as a data preprocessing method. The support vector machine (SVM) was preferred in the classification phase. In the performance evaluation stage, classification accuracy, specificity, sensitivity analysis, f-measure, kappa statistics value and ROC analysis were used. Experimental results showed that the developed hybrid system entitled kmAW + SVM gave better results compared to other methods described in the literature. Consequently, this hybrid intelligent system can be used as a useful medical decision support tool.

The widespread deployment and utility of Wireless Body Area Networks (WBAN's) in healthcare systems required new technologies like Internet of Things (IoT) and cloud computing, that are able to deal with the storage and processing limitations of WBAN's. This amalgamation of WBAN-based healthcare systems to cloud-based healthcare systems gave rise to serious privacy concerns to the sensitive healthcare data. Hence, there is a need for the proactive identification and effective mitigation mechanisms for these patient's data privacy concerns that pose continuous threats to the integrity and stability of the healthcare environment. For this purpose, a systematic literature review has been conducted that presents a clear picture of the privacy concerns of patient's data in cloud-assisted healthcare systems and analyzed the mechanisms that are recently proposed by the research community. The methodology used for conducting the review was based on Kitchenham guidelines. Res...

Certain Saudi healthcare organizations transfer outpatients to medical imaging departments for radiological examinations in a manual process that relies on the use of paper-based forms. With the increased implementation of electronic medical records in Saudi Hospitals, little is known about the completeness and legibility of information captured in  electronic-based medical imaging forms. The purpose of this study is to audit the completeness and legibility of medical imaging paper-based forms in comparison with electronic-based medical imaging forms. As a secondary objective, we also examined the number of errors found on the forms.An observational retrospective cross-sectional study was utilized to audit the completeness and legibility of both paper and electronic forms collected between March 1 and May 15, 2015. The study measured the association among categorical variables using Chi-Square analysis. The results of this investigation show a significant association between form co...

…todas aquellas prácticas medicas que existen incorporadas en la conciencia sanitaria de la multitud y que representan supervivencia admirable de doctrinas, de conceptos y de prácticas empíricas que formaron parte de la conciencia sanitaria de nuestros remotos antepasados."(Valdizán y Maldonado, 1922).

Objective: To determine the factors affecting general satisfaction level of patients with the food services in a military hospital in Turkey. Study design: The study was carried out in a military hospital providing tertiary health care services with the capacity of 1000 hospital bed. A questionnaire was used as data collection tool on measuring satisfaction of the patients with the food services. Results: The results showed that of 374 patients 51.3% evaluated food service quality adequate, 32.4% said that the food quality was inadequate, and 16.3% stated that they were uncertain. A logistic regression model was estimated in determining the most important and statistically significant factors affecting patient satisfaction with hospital foods and food services. The results showed that patient-specific demographic characteristics were insignificant in explaining satisfaction level with food services, but the variables of taste (OR = 9.853, p = 0.000) and appearance (OR = 2.687, p = 0.014) of the food were statistically significant and important determinants of patient satisfaction with the foods served at the hospital. Conclusions: The results of this study would be helpful in making decision on increasing the level of satisfaction of patients with the food services for hospital managers and the food (nutrition) departments. On the other hand, the results can also be used in benchmarking the hospital's B. Sahin ( ) · Y. Celik food services quality with other hospitals, and in monitoring improvements in food services quality in the future.

Literature related to chief information officer (CIO) in the developed countries during the past 20 years has been reviewed to identify the future trends of the position. The literature shows that CIO is a growing position in the healthcare industry that has achieved much popularity because today's healthcare has a great focus on information management and technology and that CIO can be future powerful strategist for healthcare organizations. Therefore, a model for an ideal healthcare CIO based on lesson learned from literature was suggested. It seems that in the developed countries, CIOs will achieve many opportunities to come in the highest executive teams of healthcare organizations and may undertake CEO roles.

Communication via mobile phones has become an essential tool for health professionals. The latest generation of smartphones is comparable to computers, allowing the development of new applications in health field. This paper aims to describe the use of smartphones by health professionals and patients in the field of health promotion. We conducted a bibliographic search through Pubmed. Then, research results were analyzed critically in order to select the best experiences available. All searches were carried out on November 2012 and were not limited by date. Each item from the initial search was reviewed independently by members of the project team. Initial search returned 472 items with PubMed. After the removal of duplicates, 406 items were reviewed by all the members of the project team and 21 articles were identified as specifically centered on health promotion. In the nutrition field there are applications that allow to count calories and keep a food diary or more specific platforms for people with food allergies, while about physical activity many applications suggest exercises with measurement of sports statistics. Some applications deal with lifestyles suggestions and tips. Finally, some positive experiences are reported in the prevention of falls in elderly and of sexually-transmitted diseases. Smartphones are transforming the ways of communication but the lack of monitoring of contents, the digital divide, the confidentiality of data, the exclusion of the health professional from the management of patient, are the main risks related to their use.

Recent advances in microelectronics and integrated circuits, system-on-chip design, wireless communication and intelligent low-power sensors have allowed the realization of a Wireless Body Area Network (WBAN). A WBAN is a collection of low-power, miniaturized, invasive/non-invasive lightweight wireless sensor nodes that monitor the human body functions and the surrounding environment. In addition, it supports a number of innovative and interesting applications such as ubiquitous healthcare, entertainment, interactive gaming, and military applications. In this paper, the fundamental mechanisms of WBAN including architecture and topology, wireless implant communication, low-power Medium Access Control (MAC) and routing protocols are reviewed. A comprehensive study of the proposed technologies for WBAN at Physical (PHY), MAC, and Network layers is presented and many useful solutions are discussed for each layer. Finally, numerous WBAN applications are highlighted.

Compliance in medicine dispensation has proven critical for dosage control, diagnosis, and treatment. We have designed, manufactured, and characterized a novel dynamically programmable e-pill dispensing system. Our system is initially programmed remotely through a cell phone. After programming, the system may be reconfigured in order to adapt pill dispensation to new conditions. In this paper we describe the mechanics, electronics, control, and communication protocols implemented. Our dyn-e-pill devices can be actuated for over 350 h with two pill retrievals per hour. We challenged the charging circuit and demonstrated that the system has a lifetime longer than 6 h with a 30 min charging cycle, while it lasts for 14 h of uninterrupted use with a full charge.

Use of computer based decision tools to aid clinical decision making, has been a primary goal of research in biomedical informatics. Research in the last five decades has led to the development of Medical Decision Support (MDS) applications using a variety of modeling techniques, for a diverse range of medical decision problems. This paper surveys literature on modeling techniques for diagnostic decision support, with a focus on decision accuracy. Trends and shortcomings of research in this area are discussed and future directions are provided.

There is a gap between the demand and supply of efficiency analyses within primary care (PC), despite the threatening financial sustainability of health care systems. This paper provides a systematic literature review on PC efficiency analysis using Data Envelopment Analysis (DEA). We reviewed 39 DEA applications in PC, to understand how methodological frameworks impact results and influence the information provided to decision makers. Studies were combined using qualitative narrative synthesis. This paper reports data for each efficiency analysis on the: 1) evaluation context; 2) model specifications; 3) application of methods to test the robustness of findings; 4) presentation of results. Even though a consistent number of analyses aim to support policymakers and practice managers in improving the efficiency of their PC organizations, the results indicate that DEA -at least when applied to PC-is a methodology still in progress; it needs to be further advanced to meet the complexity that characterizes the production of PC outcomes. Future studies are needed to fill some gaps in this particular domain of research, such as on the standardization of methodologies and the improvement of outcome research in PC. Most importantly, further studies should include extensive uncertainty analyses and be based on good evidence-based rationales. We suggest a number of considerations to academics and researchers to foster the utility of efficiency measurement for the decision making purposes in PC.

This study was conducted to evaluate the usability of widely used laboratory and radiology information systems. Three usability experts independently evaluated the user interfaces of Laboratory and Radiology Information Systems using heuristic evaluation method. They applied Nielsen's heuristics to identify and classify usability problems and Nielsen's severity rating to judge their severity. Overall, 116 unique heuristic violations were identified as usability problems. In terms of severity, 67 % of problems were rated as major and catastrophic. Among 10 heuristics, "consistency and standards" was violated most frequently. Moreover, mean severity of problems concerning "error prevention" and "help and documentation" heuristics was higher than of the others. Despite widespread use of specific healthcare information systems, they suffer from usability problems. Improving the usability of systems by following existing design standards and principles from the early phased of system development life cycle is recommended. Especially, it is recommended that the designers design systems that inhibit the initiation of erroneous actions and provide sufficient guidance to users.

The effective maintenance management of medical technology influences the quality of care delivered and the profitability of healthcare facilities. Medical equipment maintenance in Jordan lacks an objective prioritization system; consequently, the system is not sensitive to the impact of equipment downtime on patient morbidity and mortality. The current work presents a novel software system (EQUIMEDCOMP) that is designed to achieve valuable improvements in the maintenance management of medical technology. This work-order prioritization model sorts medical maintenance requests by calculating a priority index for each request. Model performance was assessed by utilizing maintenance requests from several Jordanian hospitals. The system proved highly efficient in minimizing equipment downtime based on healthcare delivery capacity, and, consequently, patient outcome. Additionally, a preventive maintenance optimization module and an equipment quality control system are incorporated. The system is, therefore, expected to improve the reliability of medical equipment and significantly improve safety and cost-efficiency.