Journal of Health & Medical Informatics

Mobile health is one of the most important electronic health services which use portable, smart devices, such as the mobile phone. With a very high rate of accessibility and a relatively low cost, this type of electronic health service can be used to offer health services to people anywhere, at any time. The main objective of the current study is to introduce the mobile health as a new service for promotion of self-care in the society. The study will continue to focus on numerous medical applications of mobile phone, particularly as an efficient and cost-effective modern device for self-care.

Background: The recanalization success rate of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be increased by the retrograde approach. However, the long-term outcome of patients undergoing retrograde procedures is unknown.
Aim: We aimed to evaluate the long-term MACCE (major adverse cardiac and cerebrovascular event) rate (death, myocardial infarction, coronary artery bypass surgery and stroke) in patients after retrograde versus antegrade CTO-PCI.
Methods and results: In a prospective single center study from January 2008 to June 2012, 396 consecutive patients with CTO´s (≥ 3 months old) were enrolled. Mean age was 63.4 ± 10.3 years, 86.4% were male. The recanalization success rate of the total patient cohort was 88.6%. The retrograde PCI, only attempted after a failed antegrade intervention, was performed in 18% (n = 71) of patients. Long-term MACCE rate (mean follow up 2.3 ± 1.6 years) was significantly higher in the unsuccessful compared to the successful CTO-PCI group (23.1% versus 9.4%, p = 0.01) and this was also the case in the subgroup of antegrade CTO-PCI. In the retrograde subgroup, however, procedural success had no impact on outcome. As a possible explanation for this surprising finding, patients with unsuccessful retrograde CTO-PCI had a significantly better collateral connection compared to patients with an unsuccessful antegrade approach.
Conclusions: Long-term MACCE rate after unsuccessful recanalization was significantly higher which was driven by a higher MACCE rate after unsuccessful versus successful antegrade approach. In contrast, procedural success in the retrograde group had no impact on outcome.

Background: Low-dose aspirin (LDA, range from 60-150 mg/d) therapy has been used to prevent preeclampsia (PE) for many years. However, whether LDA could positively affect pregnancy outcome remains unknown. Purpose: We performed this meta-analysis to assess the effectiveness of LDA therapy in women at high risk for PE.
Methods: We searched studies published from January 1985 to February 2015. All the studies were search from the databases of PubMed, EMBASE, Cochrane, ScienceDirect, and Biosis Preview. The association between PE and pregnancy outcome with aspirin therapy was assessed by odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Thirteen articles involving 6735 participants were included in the final meta-analysis. When all studies were pooled into the meta-analysis, a statistically significant effect was found among pregnant women who underwent LDA therapy during their second trimester (14 to 28 weeks of gestation) to reduce PE (OR=0.72, 95% CI=0.54–0.95). Meanwhile, no difference was noted in the pregnancy outcomes including low birth weight (birth weight of 2,500 g or less in a live born infant) (OR=1.06, 95% CI=0.88–1.29), postpartum haemorrhage (blood loss more than 500 ml within 24 h after delivery) (OR=1.09, 95% CI=0.85–1.40), intrauterine growth restriction (IUGR, the fetal weight was below the 10th percentile for gestational and the neonatal birth weight fell below the 10th percentile) (OR=0.66, 95% CI=0.42–1.06), and pre-term delivery (diagnosed <37 + 0 weeks of gestation) (OR=0.78, 95% CI=0.57–1.05).
Conclusions: The present meta-analysis suggests that the incidence of PE was statistically significant between LDA therapy groups and placebo groups. Furthermore, LDA therapy was not associated with pregnancy outcome including fetal birth weight, postpartum haemorrhage, IUGR, and preterm delivery. Harm from aspirin therapy was not observed in our study.

Methylenetetrahydrofolate reductase (MTHFR) is a vital enzyme involved in folate metabolism; a single nucleotide polymorphism (SNP) C677T has been reported to be linked with altered incidences of several diseases. The association between ovary cancer and the MTHFR gene C677T polymorphism has been investigated in several case-control studies. These studies rendered contradictory results, to shed light on these inconclusive findings, a meta-analysis of all available studies relating the C677T polymorphism to the risk of ovary cancer was conducted. The following electronic databases were searched without language restrictions: Pubmed, Google Scholars, Elsevier and Springer Link up to December, 2014. Odds ratios (ORs) with their 95% confidence intervals (95% CIs) were calculated. Meta-analysis was performed using Mix version 1.7. Eleven studies were finally included in present meta-analysis, which contained 5922 individuals with ovary cancer and 5235 healthy controls. There was not significant relationship between MTHFR C677T polymorphism and ovary cancer under allele contrast (OR: 1.05, 95% CI: 0.99-1.11), dominant (OR: 1.02, 95% CI: 0.91-1.13), recessive (OR: 0.99, 95% CI: 0.90-1.08), homozygous (OR: 0.99, 95% CI: 0.86-1.14) and co-dominant/heterozygous (OR: 1.02, 95% CI: 0.91-1.14) genetic models. Subgroup analysis also reached similar results. Sensitivity analysis indicated that the overall result were dependable. In conclusion, results of present meta-analysis showed that MTHFR gene C677T polymorphism is not a risk factor for Ovary cancer.

Poor dietary adherence has been implicated as a primary contributor to the (stubbornly) low success rates of long-term weight loss maintenance. In this paper, I argue that smarter diet composition (through computer-supported optimization) could help increase the chances of long-term success (and a healthy outcome) by allowing dieters customize meal plans that conform to personal preferences and needs (e.g., for things like taste, affordability, fat content).

Because of the large variety of food choices available and multiple/conflicting nutritional tradeoffs, tailoring meal composition is both combinatorially and computationally complex (where doing the obvious thing does not necessarily produce the obvious, desired outcome). Luckily, that’s precisely where computer tools can help allowing us to combine the strengths of the dieter with the strengths of the computer. The dieter specifies alternatives, preferences and requirements and the computer then sifts through the messy maze of possibilities/tradeoffs to pick the optimal choice.

Mi Volumetrics a decision-support tool to help lay dieters optimize meal planning—combines three resources: a layfriendly user interface, an extensive database of food options to select from and an optimization engine for customizing meal selection. By optimizing is meant designing meals that are: (1) Satiating to the individual dieter; (2) Include only food items that she/he likes (or can afford); and (3) Meet any other personal health requirements (e.g., a ceiling on the amount of calories from fat). To make the Mi Volumetrics tool widely accessible it is built in Microsoft Excel --- a software package that most people have access to and experience using.

Objective: Information visualization is the study of interactive depictions of abstract and data to strengthen the human cognition. Designing an appropriate information visualization system may be very useful technique for scholars, who intent to get scientific information in digital libraries. The objective of current study was to map and visualize the key-information of dissertations in academic libraries. To achieve the aim an information retrieval system was designed to present the interactive graphic view of dissertations’ subjects in academic.
Methods: We designed an information retrieval system by information visualization toolkits that presented the related subjects of dissertations in academic libraries. In addition, the satisfaction-levels of library-users was analyzed by administrating a standard questionnaire (QUIS Questionnaire). Results: The study indicated that the designed IR system helped to provide a user-friendly environment through displaying subjective relations of dissertations, overwhelming variety of colors in displaying information. Fast and easy access to the cover-to-cover information of dissertations and user-interaction facilities were the advantages of designed IR. Analysis of data furthermore indicated, the user satisfaction from the system was from medium to high grade.
Conclusion: Designing the IR-system revealed an excessive influence on users’ satisfaction; therefore, proposing such systems for employing in academic libraries is very suitable and its implementation is necessary

Viral replication occurs using the host cell synthesis mechanisms and they are able to exploit the mechanisms of nucleic acid replication and protein translation machinery. Viral proteins require a target to fit subcellular compartments of the host cell and localized in different cellular compartments including the nucleus. Human Cytomegalovirus downregulates expression of traditional class-I MHC [Major Histocompatibility Complex] molecules at the infected cell surface and allows the infected cells to avoid acknowledgment by cytotoxic T-cells. In the present study, we have focused on generally accessible online and offline computational tools to examine practical and fundamental characteristics of the most conserved domain [CD] of UL18 gene along with the viral class-I MHC molecule. Six open reading frames [ORF] were reanalyzed by selecting start codon. Site-specific homology was determined to the MHC class-I molecule [19 to 197 residual position; ID: pfam00129, E-value: 3.26e-14]. The predicted protein architecture contained about 28.90% helices [107 residues] and 10.32% strands [38 residues]. The tertiary structure represented that 276 residues [75% of sequence] were modeled by the single highest scoring template with 100% confidence and the structure represents a peptide-binding viral MHC mimic, apprenticed to a host inhibitory receptor [pdb code-3d2u]. Thus, our analysis suggests that the homologous sequence corresponding to MHC class-I gene is situated between 19 and 200th residues of UL18 ORF and the recognition domain was identified with significant E-value. Our study also demonstrated that the ORF18 is homologous to the Ig-superfamily in 229-289th position. Therefore, these domains were found to date homologous in HCMV proteins suggesting a particular functional role during infection. In light of the above, further experimental steps are needed to elucidate the exact role of the UL18 during infections.

Great strides have been made in health care over the past six years after the implementation of the policy known as meaningful use by the Center of Medicare and Medicaid Services in USA. Health care subsidies and monetary incentive programs were created for eligible professionals and critical area hospitals to encourage the use of certified electronic health records in an effort to improve quality care of all acute and chronically ill patients, as well as provide routine examinations for healthy individuals. Patients diagnosed with type II diabetes mellitus were studied using a certified electronic health record system for compliance in physician ordered lab testing and follow-up visits with their primary care physician so as to confirm a positive effect on in the quality of patient health care. Diabetes mellitus is a disease which requires constant monitoring, thus creating an ideal patient study group. Research has confirmed that patient compliance significantly improves quality of health care outcomes; now it is time to determine that if the implementation of a certified electronic health record in the family practice setting improves patient compliance, thus improving quality of health care.

Introduction: The cutting edge Technology of the 21st generation has proven to relinquish major positive enhancements and has left a huge impact in modern day medicine and health care. The Smartphone is one of the most commonly used devices in communication. It’s rightly known as a “Handy-portal computer” which has made infinite contribution by its multitasked usages besides the specifically designed applications programmed to reach a quick and sound clinical decisions, these devices are also helping in health record maintenance, patient Management, education and training of healthcare professionals. This Journey of enhanced technology coverage with existing wisdom of the field can prove to be a major boon for mankind.
Objective: To highlight the enhanced contribution of the Smartphone in today`s modern medicine by demonstrating the potential of technology and its future applications, be it for patient, implementation in healthcare and continuing medical education, for cross consultations, patient satisfaction, and removing communication barriers. Care has been taken to define and evaluate utility of evidence based technological advancements in the healthcare sector.
Methodology: In this study, a systematic review of literature was done via Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for systematic review. Google scholar and MEDLINE were used to identify articles that discussed the utility design, development, evaluation, and utility of smartphone-based software for healthcare workers, professionals, medical or nursing students, or patients. A total of 59 articles discussing 88 applications were selected for this study from 2,934 articles initially obtained from the PubMed, scholar, and Medline searches.
Conclusions: The role of this technology in medicine and healthcare is seen to be promising and technologically exciting to use. We have tried to analyze and discussed many smartphone/App-based healthcare applications that are available in the literature. We also had found that most of these applications are grouped as per the target users namely the clinicians, administrators, medical and nursing students. Further as these applications were originally not intended to replace old desktop based applications, but to add to existing pool of technologies for better healthcare. The functional uses of these Apps are growing every day. The enhanced mobile connectivity and communication between health care professionals have contributed to ease and validity of medical care besides monitoring, access to evidence based medicine which includes better diagnosis guides, drug references, literature search, and continuing medical education materials at the point of care. Further as easy access is provided to all authorized personal of records, this has resulted in remote consultation and telemedicine. Further, Apps like Netra performing visual acuity test is also viable using a smartphone. The easy and widespread adoption of these mobile health technologies by the general masses further emphasize the opportunity of better mHealth and mobile telemedicine services through patient oriented applications.

Heat shock protein participates in several broad ranges of protein folding processes and control activity of regulatory proteins. Nearly all cells react in a similar manner against the external environmental abrupt changes like heat, chemicals such as analogues of amino acid, ethanol, arsenite, several heavy metals, mitochondrial functional inhibitors, cold, UV light. These all causes several severe, rapid changes in at the level of gene expression. The major significant activity of HSP protein to stabilize newly synthesized protein by securing its right folding, which generally undergone any damaged under cell stress condition. Through overexpression, this protein provides protection to cells against apoptotic cell death. The hsp70 chaperonis targeted as novel anticancer therapeutic candidate for a broad spectrum of tumor types due to its diverse functional role. Homology modeling methodology allowsmodeling the 3Dstructure of the protein using the experimentally determined three dimensional structure of related homologues protein as template. In the current investigation, we have taken the Hsp70 protein and conducted the 3-imensional structure prediction through Swiss- Model by using the crystal structure as the template. Template search of the desired protein were conducted with Blast and HHBlits against the SMTL and keyed out the highest sequence identity, comparatively, above the other obtained template sequences. The homology modelling was performed and the model protein was evaluated by using the PSVS.

Introduction: Cerebral palsy is characterized by a group of posture and movement disorder which can be aggravated. Children with cerebral palsy are lacking plantar cutaneous afferent which provides information to control upright posture. A new approach to induce postural response by plantar vibratory stimulation was suggested for children with cerebral palsy.
Methods: Seven children with cerebral palsy, five boys and two girls, aged 11.41 (1.97) years with diagnoses of spastic diplegia, participated in this study. The participants stood barefooted, with their vision and auditory perception blocked, on the standing frame placed on the force plate. Twelve vibration conditions under three frequencies (20, 60 and 100 Hz) and four locations (left forefoot, right forefoot, left rear foot and right rear foot) were tested for every participant. Center of pressure coordinates were collected at a sampling rate of 200 Hz for a period of 44s.
Results: The height of standing frame had negligible effect on the center of pressure. The postural adjustments were significantly direction-specific when the vibration was applied on different plantar surfaces. Vibration on the rear foot resulted in a forward body tilt while the vibration on the forefoot resulted in a backward body tilt. The postural response was oriented to the right when the left foot was vibrated and to the left when the right foot was vibrated. There were significant differences across frequencies of stimulation on every location (P<0.001).
Conclusion: Plantar vibratory stimulation can produce direction-specific body tilts in children with cerebral palsy. Applying appropriate vibration stimulation on plantar surface is suggested to be a new rehabilitation training method for cerebral palsy rehabilitation to promote balance and posture control.

Background: The new technological platform developed by the Electronic Health Records for Clinical Research (EHR4CR) European research project (2011-2016) has been specially designed to enable the trustworthy reuse of health data contained in hospital-based electronic health records (EHR) for enhancing and speeding up clinical research scenarios. In particular, protocol feasibility assessments, patient identification for recruitment, and clinical data exchange for study conduct, in accordance with data privacy, ethical and legal requirements. The objective of our study was to assess the financial impact of adopting these advanced solutions compared to current practices, from the perspective of the primary sponsors of clinical trials in Europe.
Methods: Considering a scalable implementation of EHR4CR solutions in up to 5-10% of Phase II, III and IV clinical trials to be commercially sponsored in Europe over 5 years, two potential market sizes were defined. The first has a European initial scope (i.e., for European clinical trials only), and the second has a European subsequent broader scope (also including European arms of global studies). Based on expert opinions, the EHR4CR initial scope target market was estimated to be 30% of the broader scope. Direct costs to clinical research sponsors were estimated under current practices, and with the EHR4CR platform. Uncertainty was managed using 100,000 Monte Carlo simulations.
Results: Compared to current practices, the potential average 5-year savings with EHR4CR solutions for Phase II, III and IV commercially sponsored clinical trials in Europe were estimated at €175.5 m for the European initial scope market, and at €585.3 m for the European broader scope market. These results were confirmed by robust probabilistic sensitivity analyses.
Conclusions: Compared to current practices, EHR4CR solutions appear cost-saving for primary sponsors of clinical trials. These results suggest that the potential for savings would increase with a broader adoption of EHR4CR solutions in Europe, and beyond.

Introduction: Cisplatin-related arrhythmias are not routinely described in the literature and their cardiac complications can lead to relevant hemodynamic events that could compromise the administration of chemotherapy and, above all, they could cause life threatening consequences.
Methods: A 37-year-old man with stage II B testicular seminoma was admitted to our department. The patient had a negative cardiologic history, blood count and chemistry were within normal limits except for hypomagnesaemia, and hence PEB chemotherapy was started. During cisplatin infusion, the patient experienced pulse arrhythmia with EKG diagnosis of atrial fibrillation.
Results: Despite the finding of atrial fibrillation, thanks to digoxin infusion and magnesium supplementation, chemotherapy was completed and on the next morning the heartbeat was rhythmical again.
Conclusion: One of the most important causes of arrhythmia is electrolytic imbalance and, for this reason, sodium, potassium, calcium, chlorine and magnesium plasmatic levels should be accurately checked before, during and after chemotherapy. In particular, magnesium seems to have a dominant role in the generation of arrhythmias during cisplatin-based chemotherapy because this antineoplastic compound increases ionic renal waste due to tubular damage. This case gives strength to the role of oral and intravenous electrolytes supplementation during platinumbased chemotherapy.

The purpose of this review is to briefly examine published articles regarding patients’ access to health information in China. The searching was performed on the PubMed using MeSH words such as “consumer health information, health literacy, health education and drug information service”. After preliminary screen, the contents were categorized as present situation, obstacles and future perspectives. In conclusion, patients now rely more on alternative access to health information to complement doctor consultation. Traditional alternative sources suffer low timeliness, credibility and efficiency. Though the current boom of online health information is promising, low quality of information, unequal access and poor design features have become obstacles for further development. In the future, Chinese authority and professional institutions will support the construction of search websites able to provide authentic health information. Training programs of health literacy will be employed universally, and pharmacist counselling will be well received.