Aim There is both favorable and controversial evidence on the application of telemedicine in the emergency department (ED), which has created uncertainty regarding the effectiveness of these systems. We performed a systematic review of the literature on systematic reviews to provide an overview of the benefits and challenges to the application of telemedicine systems for the ED. Subject and methods PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases were explored for systematic reviews of telemedicine applications for the ED. Each review was critically appraised by two authors for data items to be extracted and evaluated. The most highly recommended technology, feasibility, benefits, and challenges to the application of telemedicine systems were studied and reported. Results We identified 18 studies of varying methodological quality and summarized their key findings. Form these 18 studies, 12 papers yielded a high risk of bias in their investigation. Nine papers concluded that real-time video conferencing was the best method of delivery, eight papers found cost reduction as an outcome of implementing these systems, and six studies found technical and infrastructure issues as a challenge when implementing telemedicine for EDs. Conclusion There is strong evidence suggesting that the use of telemedicine positively impacts patient care. However, there are many challenges in implementing telemedicine that may impede the process or even impact patient safety. In conclusion, despite the high potential of telemedicine systems, there is still a need for better quality of evidence in order to confirm their feasibility in the ED.

Background Approximately 110 million Farsi speakers worldwide have access to a growing mobile app market. Despite restrictions and international sanctions, Iran’s internal mobile health app market is growing, especially for Android-based apps. However, there is a need for guidelines for developing health apps that meet international quality standards. There are also no tools in Farsi that assess health app quality. Developers and researchers who operate in Farsi could benefit from such quality assessment tools to improve their outputs. Objective This study aims to translate and culturally adapt the Mobile Application Rating Scale in Farsi (MARS-Fa). This study also evaluates the validity and reliability of the newly developed MARS-Fa tool. Methods We used a well-established method to translate and back translate the MARS-Fa tool with a group of Iranian and international experts in Health Information Technology and Psychology. The final translated version of the tool was tested on a sample of 92 apps addressing smartphone addiction. Two trained reviewers completed an independent assessment of each app in Farsi and English. We reported reliability and construct validity estimates for the objective scales (engagement, functionality, aesthetics, and information quality). Reliability was based on the evaluation of intraclass correlation coefficients, Cronbach α and Spearman-Brown split-half reliability indicators (for internal consistency), as well as Pearson correlations for test-retest reliability. Construct validity included convergent and discriminant validity (through item-total correlations within the objective scales) and concurrent validity using Pearson correlations between the objective and subjective scores. Results After completing the translation and cultural adaptation, the MARS-Fa tool was used to assess the selected apps for smartphone addiction. The MARS-Fa total scale showed good interrater reliability (intraclass correlation coefficient=0.83, 95% CI 0.74-0.89) and good internal consistency (Cronbach α=.84); Spearman-Brown split-half reliability for both raters was 0.79 to 0.93. The instrument showed excellent test-retest reliability (r=0.94). The correlations among the MARS-Fa subdomains and the total score were all significant and above r=0.40, suggesting good convergent and discriminant validity. The MARS-Fa was positively and significantly correlated with subjective quality (r=0.90, P<.001), and so were the objective subdomains of engagement (r=0.85, P<.001), information quality (r=0.80, P<.001), aesthetics (r=0.79, P<.001), and functionality (r=0.57, P<.001), indicating concurrent validity. Conclusions The MARS-Fa is a reliable and valid instrument to assess mobile health apps. This instrument could be adopted by Farsi-speaking researchers and developers who want to evaluate the quality of mobile apps. While we tested the tool with a sample of apps addressing smartphone addiction, the MARS-Fa could assess other domains or issues since the Mobile App Rating Scale has been used to rate apps in different contexts and languages.

BACKGROUND There are 110 million Farsi speakers worldwide who have access to a growing mobile app market. Despite restrictions and international sanctions, the internal mHealth app market in Iran is growing, especially for Android-based apps. However, there are no guidelines for developing health apps that meet international quality standards. There are also no tools in Farsi that assess health app quality. Developers and researchers who operate in Farsi could benefit from such quality assessment tools to improve their outputs. OBJECTIVE This study aimed to translate and culturally adapt the Mobile App Rating Scale in Farsi (MARS-Fa). This study also evaluated the validity and reliability of the newly developed MARS-Fa tool. METHODS We used a well-established method to translate and back-translate the MARS-Fa tool with a group of Iranian and international experts in Health Information Technology and Psychology. We validated the MARS-Fa with a sample of 92 apps addressing smartphone addiction using two trained reviewers. We reported inter-rater reliability, internal consistency, and convergent and discriminant validity of the validation exercise. RESULTS Cronbach’s alpha coefficient was .84 for the total MARS-Fa and subjective quality, indicating excellent internal consistency. Spearman-Brown split-half reliability indicators were very good and excellent (.79 to .93). The MARS-Fa showed excellent inter-rater reliability (ICC=.91) and test-retest reliability (r=.94). The inter-item correlation coefficients among 18 items were greater than 0.20, suggesting good construct and discriminant validity. CONCLUSIONS The MARS-Fa tool can be reliably used to evaluate health apps by trained reviewers who speak Farsi. Further research should be done to validate the tool with health apps targeting other health problems.

Aim: This study aims to conduct a review of information technologies and telemedicine services during Covid-19 pandemic in order to identify the main challenges on the way, and provide recommendations. Method: A systematic review of medical informatics and telemedicine application in the 2019n-CoV period was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) method. The original papers or proceedings in English language containing the keywords were considered eligible for this study. 323 studies from the seven databases searched (PubMed, Web of Science, Science Direct, Scopus, Google Scholar, IEEE Xplore Library, and Springer Link) were imported to a project in Covidence.com and checked for duplications. After the reviewers screened their titles and abstracts, each potentially relevant study (n=107) was assessed in full text by one reviewer. As a result, 37 papers entered the study. The selected papers were then thoroughly checked by the reviewers for the desired data. Results: The included studies were reviewed to extract the following information: types of technologies used in each paper, challenges and limitations faced around the world (both developed and developing countries). It also provided recommendations made by reviewed studies as solutions to the mentioned challenges. Conclusion: This review unveils that there are few suitable policies and strategies simplifying technology use in managing crisis like pandemics even in countries that do not lack infrastructures or equipment. This study can present a starting point as it identifies the most utilized technologies and existing limitations on the way and offers practical recommendations to conquer them.