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em
o
n
s
tr
ated
ef
f
ec
tiv
e
n
ess
in
im
p
r
o
v
in
g
p
atien
t o
u
tc
o
m
es.
T
h
ese
s
er
v
ices a
r
e
esp
ec
ially
v
alu
ab
le
f
o
r
ass
ess
in
g
p
atien
ts
'
liv
in
g
co
n
d
itio
n
s
an
d
h
a
v
e
d
em
o
n
s
tr
ated
ef
f
ec
t
iv
en
ess
in
r
ed
u
ci
n
g
h
o
s
p
italizatio
n
s
an
d
im
p
r
o
v
in
g
o
v
er
all
q
u
ality
o
f
life
a
m
o
n
g
o
ld
er
ad
u
lts
[
9
]
.
T
elem
ed
icin
e
h
as
em
e
r
g
ed
as
a
p
r
o
m
is
in
g
s
o
lu
tio
n
to
ad
d
r
ess
th
e
d
is
p
ar
ity
in
h
ea
lth
ca
r
e
ac
ce
s
s
f
o
r
h
o
m
eb
o
u
n
d
o
r
im
m
o
b
ile
p
atien
ts
[
1
0
]
.
T
eleh
o
m
ec
ar
e
is
a
b
r
an
ch
o
f
teleh
ea
lth
.
I
t
en
tail
s
p
r
o
v
id
in
g
p
atien
ts
with
h
ea
lth
ca
r
e
s
er
v
ices
at
h
o
m
e
v
ia
telec
o
m
m
u
n
icatio
n
s
tech
n
o
lo
g
ies
t
h
at
allo
w
v
o
i
ce
,
v
id
e
o
,
an
d
h
ea
lth
-
r
elate
d
d
ata
to
in
ter
ac
t
[
1
1
]
.
T
eleh
ea
lth
b
r
o
ad
l
y
en
co
m
p
ass
es
h
ea
lth
o
r
s
o
cial
s
er
v
ices
d
eli
v
er
ed
r
em
o
tely
v
ia
s
y
n
ch
r
o
n
o
u
s
o
r
asy
n
c
h
r
o
n
o
u
s
v
id
eo
co
n
f
e
r
en
cin
g
,
d
ig
ital
ap
p
lic
atio
n
s
,
o
r
telep
h
o
n
e
to
en
h
an
ce
h
ea
lth
o
u
tco
m
es
[
1
2
]
.
T
elem
e
d
icin
e
u
s
es
tech
n
o
l
o
g
y
to
d
eliv
er
h
ea
lth
ca
r
e
s
er
v
ices
d
ir
ec
tly
t
o
p
atien
ts
in
th
eir
h
o
m
es,
m
ak
in
g
it
ea
s
ier
f
o
r
th
em
to
m
an
a
g
e
th
eir
o
wn
h
ea
lt
h
[
1
3
]
.
I
n
th
is
s
tu
d
y
,
teleh
o
m
e
ca
r
e
is
th
e
p
r
im
ar
y
ter
m
,
wh
ile
telem
ed
icin
e
an
d
t
eleh
ea
lth
ar
e
u
s
ed
o
n
ly
in
b
r
o
a
d
er
co
n
te
x
ts
.
I
n
h
o
m
ec
ar
e
s
ettin
g
s
,
teleh
o
m
ec
ar
e
is
in
cr
ea
s
in
g
ly
a
d
o
p
te
d
t
o
en
h
a
n
ce
tim
e
ef
f
icien
cy
in
h
ea
lth
ca
r
e
d
eliv
er
y
,
e
x
p
an
d
ac
ce
s
s
to
m
ed
ical
s
er
v
ices,
an
d
s
u
p
p
o
r
t
p
r
ev
en
tiv
e
s
tr
ateg
ies
to
av
er
t
co
s
tly
em
er
g
en
cies
[
1
4
]
.
R
esear
ch
s
h
o
ws
th
at
teleh
o
m
ec
ar
e
h
elp
s
p
a
tien
ts
tak
e
ca
r
e
o
f
th
em
s
elv
es
a
n
d
m
an
ag
e
th
eir
o
wn
h
ea
lth
,
wh
ich
co
u
ld
lea
d
to
lo
wer
c
o
s
ts
,
b
etter
ac
ce
s
s
,
an
d
b
etter
h
ea
lth
o
u
tco
m
es
(
1
5
)
.
Alth
o
u
g
h
its
ef
f
ec
t
o
n
t
h
e
f
r
eq
u
e
n
cy
o
f
f
o
llo
w
-
u
p
v
is
its
m
ay
b
e
lim
ited
,
teleh
o
m
ec
ar
e
h
as b
ee
n
ass
o
ciate
d
with
r
ed
u
ce
d
m
o
r
tality
,
f
ewe
r
em
er
g
en
cy
v
is
its
,
an
d
im
p
r
o
v
ed
q
u
ality
o
f
life
[
1
5
]
.
R
esear
ch
o
n
g
estatio
n
al
d
ia
b
etes
s
h
o
wed
th
at
teleh
o
m
ec
ar
e
r
ed
u
ce
d
in
-
p
er
s
o
n
v
is
its
b
y
5
6
%
an
d
lo
wer
e
d
co
s
ts
b
y
1
6
%
[
1
6
]
.
T
eleh
o
m
ec
ar
e
tech
n
o
lo
g
ies
f
o
r
in
-
h
o
m
e
ca
r
e
d
eliv
er
m
o
r
e
ac
ce
s
s
ib
le
an
d
ef
f
icien
t
h
ea
lth
ca
r
e
s
er
v
ices
[
1
3
]
.
As
a
r
esu
lt,
p
atien
ts
ca
n
r
ec
eiv
e
co
n
s
u
ltatio
n
s
an
d
h
ea
l
th
m
o
n
ito
r
in
g
with
o
u
t
f
ac
ilit
y
v
is
its
,
ex
p
an
d
in
g
ac
ce
s
s
to
s
u
p
p
o
r
tin
g
au
to
n
o
m
y
in
s
elf
-
ca
r
e
an
d
d
is
ea
s
e
m
an
ag
em
en
t
[
1
7
]
,
[
1
8
]
.
Desp
ite
th
ese
ad
v
an
tag
es,
th
e
s
u
cc
ess
o
f
teleh
o
m
ec
a
r
e
i
m
p
lem
en
tatio
n
i
n
h
o
m
ec
ar
e
s
ettin
g
s
is
s
tr
o
n
g
ly
i
n
f
lu
en
ce
d
b
y
c
o
n
tex
t
u
al
an
d
h
u
m
an
f
ac
to
r
s
.
Pre
v
io
u
s
s
tu
d
ies
h
av
e
h
ig
h
lig
h
ted
th
at
p
er
ce
iv
ed
n
ee
d
s
,
ea
s
e
o
f
ac
ce
s
s
,
an
d
th
e
f
le
x
ib
ilit
y
o
f
tech
n
o
l
o
g
y
ar
e
im
p
o
r
tan
t
f
o
r
teleh
o
m
ec
ar
e
a
d
o
p
tio
n
[
1
9
]
.
Hea
lth
ca
r
e
p
r
o
v
id
e
r
s
’
attitu
d
es
to
war
d
te
ch
n
o
lo
g
y
,
t
h
eir
p
e
r
ce
iv
ed
u
s
ef
u
ln
ess
o
f
teleh
ea
lth
-
en
ab
led
s
er
v
ices,
an
d
th
eir
p
r
o
f
ess
io
n
al
co
m
p
eten
ce
in
u
s
in
g
d
ig
ital sy
s
tem
s
s
ig
n
if
ican
tly
af
f
ec
t im
p
lem
e
n
tatio
n
o
u
tco
m
es
[
2
0
]
,
[
2
1
]
.
I
n
I
n
d
o
n
esia,
telem
ed
icin
e
is
r
eg
u
lated
u
n
d
e
r
th
e
Min
is
tr
y
o
f
Hea
lth
R
eg
u
latio
n
No
.
2
0
o
f
2
0
1
9
[
2
2
]
,
an
d
n
atio
n
al
d
ig
ital
h
ea
lth
d
e
v
elo
p
m
en
t
is
g
u
id
e
d
b
y
th
e
B
lu
ep
r
in
t
f
o
r
Dig
ital
Hea
lth
T
r
an
s
f
o
r
m
atio
n
2
0
2
4
[
2
3
]
.
H
o
wev
er
,
th
ese
f
r
am
ewo
r
k
s
p
r
im
ar
ily
a
d
d
r
ess
tech
n
ical
s
tan
d
ar
d
s
an
d
in
t
er
-
f
ac
ilit
y
clin
ical
co
n
s
u
ltatio
n
s
.
Giv
en
th
at
th
e
s
u
cc
ess
o
f
teleh
o
m
ec
ar
e
im
p
lem
en
tatio
n
d
ep
e
n
d
s
o
n
u
n
d
er
s
tan
d
in
g
th
e
p
er
s
p
ec
tiv
es
an
d
n
ee
d
s
o
f
m
u
ltip
le
s
tak
eh
o
ld
er
s
[
2
4
]
,
th
er
e
r
em
ain
s
a
n
ee
d
f
o
r
in
-
d
ep
th
q
u
alitativ
e
in
q
u
ir
y
in
to
h
o
w
teleh
o
m
ec
a
r
e
is
ex
p
er
ien
ce
d
a
n
d
n
eg
o
tiated
in
r
e
al
-
wo
r
ld
h
o
m
ec
ar
e
s
ettin
g
s
.
T
h
er
ef
o
r
e
,
th
is
s
tu
d
y
aim
s
to
id
en
tify
u
s
er
-
ce
n
te
r
e
d
s
y
s
tem
r
eq
u
ir
em
en
ts
em
er
g
in
g
f
r
o
m
th
e
ad
o
p
tio
n
an
d
u
s
e
o
f
teleh
o
m
ec
ar
e
with
in
h
o
s
p
ital
-
b
ased
h
o
m
ec
ar
e
s
er
v
ices in
I
n
d
o
n
esia.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
em
p
lo
y
ed
a
q
u
al
itativ
e
d
escr
ip
tiv
e
d
esig
n
,
wh
ich
is
a
p
p
r
o
p
r
iate
f
o
r
s
y
s
tem
atica
lly
d
escr
ib
in
g
e
x
p
er
ie
n
ce
s
,
p
r
ac
ti
ce
s
,
an
d
u
s
er
n
ee
d
s
in
ap
p
lied
h
ea
lth
s
er
v
ice
co
n
t
ex
ts
with
o
u
t
im
p
o
s
in
g
h
ea
v
y
th
eo
r
etica
l
in
ter
p
r
etatio
n
[
2
5
]
,
[
2
6
]
.
T
h
e
s
tu
d
y
was
co
n
d
u
ct
ed
at
Ho
m
e
C
ar
e
J
atay
u
,
th
e
Aca
d
em
ic
Ho
s
p
ital
(
R
SA)
o
f
Un
iv
er
s
itas
Gad
jah
Ma
d
a,
Yo
g
y
ak
a
r
ta,
I
n
d
o
n
esia.
T
h
i
s
s
ett
in
g
was
s
elec
ted
b
ec
au
s
e
J
atay
u
Ho
m
e
C
ar
e
o
p
er
ates
as
a
h
o
s
p
ital
-
b
a
s
ed
h
o
m
ec
ar
e
u
n
it
d
eliv
er
i
n
g
d
aily
h
o
m
e
-
v
is
it
s
er
v
ices
ac
r
o
s
s
d
iv
er
s
e
clin
ical
co
n
d
itio
n
s
,
f
u
n
ctio
n
in
g
as
a
“
h
o
s
p
ital
with
o
u
t
walls”.
T
h
e
S
p
ec
ial
R
eg
io
n
o
f
Yo
g
y
ak
a
r
ta
was
ch
o
s
en
b
ec
a
u
s
e
it h
as th
e
h
ig
h
est p
r
o
p
o
r
tio
n
o
f
o
ld
er
a
d
u
lts
in
I
n
d
o
n
esia,
ac
c
o
u
n
tin
g
f
o
r
1
7
.
7
8
% o
f
t
h
e
p
o
p
u
latio
n
[
1
]
.
T
o
s
u
p
p
o
r
t
co
n
tex
tu
al
ex
p
l
o
r
atio
n
o
f
teleh
o
m
ec
a
r
e
p
r
ac
t
ices,
th
e
C
o
v
W
atch
h
o
m
ec
ar
e
d
e
v
ice,
d
ev
elo
p
e
d
b
y
PT
C
o
v
W
atch
Kar
y
a
Nu
s
an
tar
a,
was
d
ep
l
o
y
ed
am
o
n
g
1
5
h
o
m
ec
ar
e
p
atien
ts
.
T
h
e
d
ev
ice
en
ab
les
r
em
o
te
m
o
n
ito
r
in
g
o
f
v
ital
s
ig
n
s
v
ia
a
n
I
o
T
-
b
ased
d
ash
b
o
a
r
d
a
n
d
was
u
s
ed
s
o
l
ely
as
a
co
n
tex
tu
al
p
r
o
b
e
to
f
ac
ilit
ate
p
ar
ticip
an
t
r
ef
lectio
n
an
d
d
is
cu
s
s
io
n
d
u
r
i
n
g
d
ata
co
llectio
n
,
r
ath
er
th
a
n
as
an
in
ter
v
en
tio
n
o
r
tech
n
o
l
o
g
y
ef
f
ec
tiv
en
ess
ev
alu
atio
n
.
Alth
o
u
g
h
th
e
u
s
e
o
f
C
o
v
W
atch
m
ay
h
av
e
s
h
ap
ed
p
a
r
ticip
an
ts
’
r
esp
o
n
s
es to
war
d
d
ev
ice
-
r
elate
d
f
ea
tu
r
es,
th
e
in
ter
v
iew
g
u
id
es e
m
p
h
asized
b
r
o
a
d
er
teleh
o
m
ec
ar
e
e
x
p
er
ie
n
ce
s
,
n
ee
d
s
,
wo
r
k
f
lo
ws,
a
n
d
c
o
n
ce
r
n
s
b
ey
o
n
d
th
e
d
ev
ice'
s
s
p
ec
if
ic
f
u
n
ctio
n
alities
.
Par
ticip
an
ts
wer
e
also
en
co
u
r
a
g
ed
to
a
r
ticu
late
th
e
d
e
s
ir
ed
f
ea
tu
r
es a
n
d
c
h
allen
g
es t
h
at
th
e
s
y
s
tem
d
o
es n
o
t c
u
r
r
e
n
tly
ad
d
r
ess
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
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tr
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tech
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teleh
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e
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I
ma
n
P
e
r
ma
n
a
)
503
A
to
tal
o
f
1
2
p
ar
ticip
an
ts
wer
e
in
clu
d
e
d
(
T
ab
le
1
)
,
co
m
p
r
is
i
n
g
o
n
e
p
h
y
s
ician
,
o
n
e
h
ea
d
o
f
h
o
m
ec
ar
e
s
er
v
ices,
o
n
e
h
ea
d
o
f
h
o
s
p
ital
in
f
o
r
m
atio
n
s
y
s
tem
s
an
d
I
T
,
f
iv
e
h
o
m
ec
ar
e
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
(
n
u
r
s
es/p
h
y
s
io
th
er
a
p
is
ts
)
,
an
d
f
o
u
r
h
o
m
ec
ar
e
p
atien
ts
.
Sam
p
le
s
ize
ad
eq
u
ac
y
was
d
eter
m
in
ed
u
s
in
g
t
h
e
co
n
ce
p
t
o
f
i
n
f
o
r
m
atio
n
p
o
wer
,
wh
ich
r
eq
u
ir
es
f
ewe
r
p
ar
ti
cip
an
ts
wh
en
th
e
s
tu
d
y
aim
i
s
a
n
ar
r
o
w,
h
ig
h
ly
s
p
ec
if
ic
s
am
p
le
with
r
ich
d
at
a
[
2
7
]
.
I
n
f
o
r
m
atio
n
p
o
wer
w
as
s
u
p
p
o
r
ted
b
y
a
f
o
cu
s
ed
s
tu
d
y
o
f
u
s
er
-
ce
n
tr
ed
teleh
o
m
ec
ar
e
r
eq
u
ir
e
m
en
ts
,
h
ig
h
s
am
p
le
s
p
ec
if
icity
in
v
o
lv
in
g
k
e
y
cli
n
ical,
m
a
n
ag
er
ial,
tech
n
o
lo
g
ical,
an
d
p
atien
t
s
tak
eh
o
ld
er
s
,
an
d
s
tr
o
n
g
d
ialo
g
u
e
q
u
ality
in
f
o
r
m
ed
b
y
p
ar
ticip
a
n
ts
’
d
ir
ec
t
ex
p
e
r
ie
n
ce
with
h
o
m
ec
a
r
e
s
er
v
ices.
Data
co
llectio
n
was c
o
n
clu
d
e
d
wh
en
s
u
f
f
icien
t th
e
m
atic
d
ep
th
an
d
r
ed
u
n
d
a
n
cy
w
er
e
ac
h
iev
ed
ac
r
o
s
s
p
ar
ticip
an
t
g
r
o
u
p
s
.
Par
ticip
an
ts
wer
e
r
ec
r
u
ited
u
s
in
g
p
u
r
p
o
s
iv
e
s
am
p
lin
g
with
in
clu
s
io
n
cr
iter
ia:
i
)
in
v
o
lv
e
m
en
t
in
h
o
m
ec
ar
e
s
er
v
ices
f
o
r
at
least
s
ix
m
o
n
th
s
(
f
o
r
s
taf
f
)
o
r
c
u
r
r
en
t
en
r
o
ll
m
en
t
as
a
h
o
m
ec
ar
e
p
atien
t
with
p
r
io
r
ex
p
o
s
u
r
e
to
teleh
o
m
ec
ar
e
d
e
v
ices;
ii
)
ag
e
≥
1
8
y
ea
r
s
;
an
d
iii
)
ab
ilit
y
t
o
p
r
o
v
id
e
in
f
o
r
m
atio
n
r
eq
u
ir
ed
,
esp
ec
ially
f
o
r
th
e
h
o
m
ec
ar
e
p
atien
ts
.
T
ab
le
1
.
T
h
e
ch
ar
ac
ter
is
tics
o
f
r
esp
o
n
d
e
n
ts
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
D
e
scri
p
t
i
o
n
F
r
e
q
u
e
n
c
y
%
A
g
e
<
3
0
y
e
a
r
s
30
–
5
0
y
e
a
r
s
>
5
0
y
e
a
r
s
M
e
a
n
±
S
D
R
a
n
g
e
4
5
3
4
5
.
7
±
1
4
.
7
28
–
75
3
3
.
3
4
1
.
7
2
5
.
0
G
e
n
d
e
r
F
e
mal
e
M
a
l
e
5
7
4
1
.
7
5
8
.
3
R
o
l
e
/
P
o
s
i
t
i
o
n
P
h
y
s
i
c
i
a
n
H
e
a
d
o
f
H
o
s
p
i
t
a
l
I
n
f
o
r
ma
t
i
o
n
H
e
a
d
o
f
H
o
m
e
c
a
r
e
H
o
mec
a
r
e
H
e
a
l
t
h
P
r
o
f
e
ssi
o
n
a
l
H
o
mec
a
r
e
P
a
t
i
e
n
t
1
1
1
5
4
8
.
3
8
.
3
8
.
3
4
1
.
7
3
3
.
3
Ed
u
c
a
t
i
o
n
l
e
v
e
l
H
i
g
h
S
c
h
o
o
l
B
a
c
h
e
l
o
r
M
a
s
t
e
r
D
o
c
t
o
r
a
l
2
6
3
1
1
6
.
7
5
0
.
0
2
5
.
0
8
.
3
Data
wer
e
co
llected
th
r
o
u
g
h
s
em
i
-
s
tr
u
ctu
r
ed
in
-
d
ep
t
h
in
ter
v
iews
an
d
o
n
e
f
o
cu
s
g
r
o
u
p
d
is
cu
s
s
io
n
(
FGD)
.
I
n
d
iv
id
u
al
in
ter
v
iews
wer
e
co
n
d
u
cted
with
p
h
y
s
ician
s
,
I
T
p
er
s
o
n
n
el,
h
o
m
ec
a
r
e
m
an
ag
er
s
,
an
d
p
atien
ts
to
ca
p
tu
r
e
p
er
s
o
n
al
e
x
p
er
ien
ce
s
,
d
ec
is
io
n
-
m
ak
in
g
p
r
o
ce
s
s
es,
an
d
in
d
i
v
id
u
al
p
e
r
s
p
ec
tiv
es
r
elate
d
to
teleh
o
m
ec
ar
e
u
s
e
an
d
n
ee
d
s
.
T
h
e
FGD,
in
v
o
lv
in
g
h
o
m
ec
a
r
e
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als,
was
d
esig
n
ed
to
elici
t
s
h
ar
ed
o
p
er
atio
n
al
p
r
ac
tices,
co
llectiv
e
ch
allen
g
es,
an
d
tea
m
-
b
ased
co
o
r
d
in
atio
n
ex
p
e
r
ien
ce
s
in
d
eliv
er
in
g
h
o
s
p
ital
-
b
ased
h
o
m
ec
ar
e
s
er
v
ices.
Data
co
llectio
n
to
o
k
p
l
ac
e
b
etwe
en
J
u
n
e
an
d
Sep
te
m
b
er
2
0
2
3
at
R
SA
UGM
an
d
p
ar
ticip
an
ts
’
h
o
m
e
s
.
I
n
ter
v
iews
an
d
t
h
e
FGD
la
s
ted
4
5
to
6
0
m
in
u
tes,
wer
e
a
u
d
io
-
r
ec
o
r
d
e
d
with
p
ar
ticip
an
ts
’
p
er
m
is
s
io
n
,
a
n
d
t
r
an
s
cr
ib
ed
v
e
r
b
atim
.
E
th
ical
cl
ea
r
an
ce
was o
b
tain
ed
b
ef
o
r
e
t
h
e
r
esear
ch
.
Data
wer
e
an
aly
ze
d
u
s
in
g
in
d
u
ctiv
e
th
em
atic
an
al
y
s
is
,
f
o
llo
win
g
th
e
p
h
ases
:
f
am
iliar
izin
g
y
o
u
r
s
elf
with
y
o
u
r
d
ata,
g
en
er
atin
g
i
n
itial
co
d
es,
s
ea
r
ch
in
g
f
o
r
th
em
es,
r
ev
iewin
g
th
em
es,
d
ef
in
in
g
an
d
n
am
in
g
th
em
es,
an
d
p
r
o
d
u
cin
g
th
e
r
ep
o
r
t
[
2
8
]
.
C
o
d
in
g
f
o
cu
s
ed
o
n
id
en
tify
in
g
p
atter
n
s
r
elate
d
to
f
u
n
ctio
n
a
l
r
eq
u
ir
em
e
n
ts
,
tech
n
ical
r
eq
u
ir
em
en
ts
,
an
d
d
ata
s
ec
u
r
ity
co
n
s
id
er
atio
n
s
.
T
h
e
an
aly
s
is
was
led
b
y
th
e
s
ec
o
n
d
au
th
o
r
(
MZ
I
)
,
wh
o
h
as
p
r
io
r
ex
p
er
ien
ce
in
q
u
alitativ
e
h
ea
l
th
an
d
tech
n
o
lo
g
y
r
esear
c
h
.
An
aly
tic
r
ig
o
r
was
en
h
an
ce
d
th
r
o
u
g
h
iter
ativ
e
team
d
is
cu
s
s
io
n
s
ac
r
o
s
s
c
lin
i
ca
l
an
d
tech
n
o
lo
g
ical
p
e
r
s
p
ec
tiv
es,
co
n
s
en
s
u
s
-
b
u
ild
in
g
o
n
th
e
m
e
in
ter
p
r
et
atio
n
,
an
d
th
e
m
ain
te
n
an
ce
o
f
an
a
u
d
it
tr
ail.
T
r
u
s
two
r
th
in
ess
was
f
u
r
th
er
s
tr
en
g
th
en
ed
t
h
r
o
u
g
h
d
ata
an
d
m
eth
o
d
tr
ia
n
g
u
latio
n
an
d
p
ee
r
d
eb
r
ief
in
g
.
3.
RE
SU
L
T
S
T
h
r
ee
o
v
er
a
r
ch
in
g
th
em
es
em
er
g
ed
f
r
o
m
th
e
an
aly
s
is
:
f
u
n
ctio
n
al
r
eq
u
ir
em
en
ts
,
tech
n
ical
r
eq
u
ir
em
e
n
ts
,
an
d
d
ata
s
ec
u
r
it
y
,
p
r
i
v
ac
y
,
a
n
d
d
ig
ital
in
clu
s
i
o
n
.
T
a
b
le
2
p
r
o
v
id
es
a
co
n
cise
s
y
n
th
esis
o
f
u
s
er
-
ce
n
ter
ed
teleh
o
m
ec
ar
e
r
e
q
u
ir
e
m
en
ts
ac
r
o
s
s
th
ese
in
ter
r
elate
d
d
o
m
ain
s
.
3
.
1
.
F
un
ct
io
na
l
r
equirem
ent
s
Par
ticip
an
ts
id
en
tifie
d
co
n
tin
u
o
u
s
r
em
o
te
m
o
n
ito
r
in
g
as
a
co
r
e
r
e
q
u
ir
em
e
n
t
to
s
u
p
p
o
r
t
ea
r
ly
d
etec
tio
n
o
f
clin
ical
ch
an
g
es.
Acc
ess
to
r
ea
l
-
tim
e
v
ital
s
ig
n
s
was
p
er
ce
iv
ed
as
en
ab
lin
g
clin
ical
r
esp
o
n
s
iv
en
ess
ev
en
in
t
h
e
ab
s
en
ce
o
f
p
h
y
s
ical
v
is
its
.
As o
n
e
n
u
r
s
e
ex
p
lai
n
ed
,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
5
0
1
-
5
1
0
504
“[
.
.
.
]
I
f
th
e
p
a
tien
t
s
u
d
d
en
ly
h
a
s
h
ig
h
b
lo
o
d
p
r
e
s
s
u
r
e,
w
e
c
a
n
mo
n
ito
r
th
e
co
n
d
itio
n
r
emo
tely,
ev
en
fr
o
m
th
e
h
o
s
p
ita
l.
”
(
P5
)
Par
ticip
an
ts
f
u
r
th
er
s
tr
ess
ed
th
e
n
ee
d
t
o
d
e
v
elo
p
d
is
ea
s
e
-
s
p
ec
if
ic
s
y
s
tem
co
n
f
ig
u
r
atio
n
s
.
R
ath
er
th
an
ap
p
l
y
in
g
u
n
if
o
r
m
m
o
n
ito
r
in
g
p
a
r
am
et
er
s
,
teleh
o
m
ec
ar
e
s
y
s
tem
s
wer
e
ex
p
ec
ted
to
a
d
ap
t
t
o
p
atien
ts
’
u
n
d
e
r
ly
in
g
co
n
d
itio
n
s
.
As o
n
e
p
ar
ticip
an
t
n
o
ted
,
“T
h
ere
n
ee
d
s
to
b
e
a
s
p
ec
ia
lis
ed
s
ystem
b
a
s
ed
o
n
ea
ch
p
a
tien
t’
s
co
n
d
itio
n
,
s
u
ch
a
s
d
ia
b
etes
o
r
n
erve
is
s
u
es
.
”
(
P1
2
)
An
ea
r
ly
war
n
in
g
s
y
s
tem
(
E
W
S)
was
s
ee
n
as
an
im
p
o
r
tan
t
to
o
l
th
at
h
elp
s
d
o
cto
r
s
m
ak
e
d
ec
is
io
n
s
b
y
au
to
m
atica
lly
aler
tin
g
th
em
wh
en
clin
ical
v
alu
es
ar
e
ab
n
o
r
m
al,
e
n
ab
lin
g
q
u
ick
er
r
esp
o
n
s
es
in
lin
e
with
s
tan
d
ar
d
o
p
er
atin
g
p
r
o
ce
d
u
r
es
.
On
e
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
al
s
tated
,
“[
.
.
.
]
I
f p
a
r
a
mete
r
s
ex
ce
ed
th
e
n
o
r
ma
l limits
a
cc
o
r
d
in
g
to
th
e
S
OP
,
th
e
med
ica
l te
a
m
c
a
n
t
a
ke
a
ctio
n
mo
r
e
q
u
ickly
.
”
(
P2
)
I
n
ad
d
itio
n
to
r
ea
l
-
tim
e
m
o
n
it
o
r
in
g
,
p
ar
ticip
an
ts
em
p
h
asized
th
e
v
alu
e
o
f
lo
n
g
itu
d
i
n
al
ac
ce
s
s
to
p
atien
t
d
ata.
His
to
r
y
-
b
ased
h
ea
lth
in
f
o
r
m
a
tio
n
w
as
co
n
s
id
er
ed
ess
en
tial
f
o
r
ev
alu
atin
g
tr
en
d
s
an
d
s
u
p
p
o
r
tin
g
lo
n
g
-
ter
m
ca
r
e
p
lan
n
in
g
.
As a
p
h
y
s
ician
ex
p
lain
ed
,
“T
h
e
s
ystem
s
h
o
u
ld
in
clu
d
e
il
ln
ess
h
is
to
r
y,
ex
a
min
a
tio
n
r
esu
lts
,
d
ia
g
n
o
s
es,
a
n
d
o
th
er
r
elev
a
n
t
d
a
t
a
fo
r
o
n
g
o
in
g
ev
a
lu
a
tio
n
.
”
(
P1
)
C
o
m
m
u
n
icatio
n
an
d
c
o
o
r
d
in
a
tio
n
wer
e
also
id
en
tifie
d
as
k
ey
f
u
n
ctio
n
al
r
e
q
u
ir
em
e
n
ts
.
No
tific
atio
n
s
y
s
tem
s
wer
e
co
n
s
id
er
ed
ess
en
tial
f
o
r
f
ac
ilit
atin
g
tim
ely
in
f
o
r
m
atio
n
ex
ch
a
n
g
e
am
o
n
g
p
at
ien
ts
,
f
am
ilies
,
an
d
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
.
As o
n
e
n
u
r
s
e
r
em
ar
k
e
d
,
“N
o
tifi
ca
tio
n
s
a
r
e
imp
o
r
ta
n
t
s
o
fa
milies
a
r
e
a
w
a
r
e
o
f
th
e
p
a
tien
t’
s
co
n
d
itio
n
a
n
d
th
e
med
ica
l
tea
m
ca
n
r
esp
o
n
d
q
u
ickly
.
”
(
P8
)
Ho
wev
er
,
p
ar
ticip
a
n
ts
ac
k
n
o
wled
g
ed
o
p
e
r
atio
n
al
co
n
s
tr
ain
ts
an
d
em
p
h
asized
th
at
c
o
m
m
u
n
icatio
n
s
h
o
u
ld
f
o
llo
w
h
o
s
p
ital w
o
r
k
f
lo
ws.
As n
o
ted
b
y
a
m
a
n
ag
er
,
“T
h
e
ch
a
t sys
tem
s
h
o
u
ld
o
p
er
a
te
d
u
r
in
g
h
o
s
p
ita
l wo
r
kin
g
h
o
u
r
s
,
n
o
t c
o
n
tin
u
o
u
s
ly
.
”
(
P3
)
T
eleh
o
m
ec
ar
e
was
f
u
r
th
er
v
i
ewe
d
as
a
m
ed
iu
m
f
o
r
h
ea
lth
ed
u
ca
tio
n
a
n
d
f
am
ily
en
g
a
g
em
en
t.
Par
ticip
an
ts
h
ig
h
lig
h
ted
th
at
e
f
f
ec
tiv
e
h
o
m
ec
ar
e
r
elies
o
n
co
llab
o
r
at
io
n
b
etwe
en
p
atien
ts
,
f
am
ili
es,
an
d
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
.
On
e
p
ar
ticip
a
n
t stated
,
“T
h
is
is
n
o
t
o
n
ly
ed
u
c
a
tio
n
fo
r
th
e
p
a
tie
n
t,
b
u
t
a
ls
o
fo
r
th
e
w
h
o
le
h
o
u
s
eh
o
ld
”
(
P1
2
)
,
wh
ile
a
n
u
r
s
e
em
p
h
asized
,
“Fa
mily
co
o
p
era
tio
n
is
ess
en
tia
l,
esp
ec
ia
lly
in
r
ep
o
r
tin
g
s
ymp
to
ms
o
r
vita
l
s
ig
n
s
th
a
t
n
ee
d
fo
llo
w
-
up”
(
P4
)
.
Fin
ally
,
p
atien
ts
em
p
h
asized
th
e
im
p
o
r
tan
ce
o
f
tr
an
s
p
ar
en
cy
a
n
d
ac
ce
s
s
to
h
ea
lth
in
f
o
r
m
atio
n
.
B
ein
g
in
f
o
r
m
e
d
ab
o
u
t th
eir
h
ea
lt
h
s
tatu
s
was p
er
ce
iv
ed
as e
m
p
o
wer
in
g
an
d
r
ea
s
s
u
r
in
g
.
As o
n
e
p
at
ien
t e
x
p
r
ess
ed
,
“W
e
w
a
n
t
to
kn
o
w
w
h
en
o
u
r
co
n
d
itio
n
is
g
ettin
g
w
o
r
s
e”
(
P
9
)
,
wh
ile
an
o
th
e
r
ad
d
e
d
,
“Pa
t
ien
ts
n
ee
d
to
s
ee
th
e
d
a
t
a
s
o
th
ey
u
n
d
ers
ta
n
d
w
h
eth
er th
ey
a
r
e
in
g
o
o
d
co
n
d
itio
n
”
(
P1
0
)
.
3
.
2
.
T
ec
hn
ica
l
r
equirem
ent
s
Par
ticip
an
ts
d
escr
ib
ed
tech
n
i
ca
l
r
eq
u
ir
em
e
n
ts
as
f
ea
tu
r
es
th
at
en
ab
le
teleh
o
m
ec
ar
e
f
u
n
ctio
n
s
to
o
p
er
ate
ef
f
ec
tiv
ely
with
in
e
v
e
r
y
d
ay
cli
n
ical
wo
r
k
f
l
o
ws.
A
k
ey
r
eq
u
i
r
em
en
t
c
o
n
ce
r
n
e
d
lo
c
atio
n
ac
cu
r
ac
y
an
d
tr
av
el
co
o
r
d
in
atio
n
.
Acc
u
r
ate
p
atien
t
lo
ca
tio
n
d
ata
was
co
n
s
id
er
ed
n
ec
ess
ar
y
to
o
p
tim
ize
v
is
it
p
lan
n
in
g
an
d
r
esp
o
n
s
e
tim
e.
As n
o
ted
,
“
Th
ere
i
s
cu
r
r
en
tly
n
o
GP
S
p
o
in
t
in
th
e
p
a
tien
t
s
en
s
o
r
,
s
o
th
e
lo
ca
tio
n
h
a
s
to
b
e
a
d
ju
s
ted
to
th
e
p
a
tien
t’
s
a
d
d
r
ess
to
ma
ke
tr
a
ck
in
g
mo
r
e
a
cc
u
r
a
te
.
”
(
P7
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
User
-
ce
n
tr
ed
s
o
cio
-
tech
n
ica
l req
u
ir
eme
n
ts
fo
r
teleh
o
mec
a
r
e
in
h
o
s
p
ita
l
-
b
a
s
ed
…
(
I
ma
n
P
e
r
ma
n
a
)
505
Usab
ilit
y
an
d
s
im
p
licity
em
er
g
ed
as
tech
n
ical
co
n
ce
r
n
s
,
p
ar
ticu
lar
ly
s
in
ce
m
o
s
t
h
o
m
ec
ar
e
p
atien
ts
ar
e
o
ld
er
ad
u
lts
.
Par
ticip
an
ts
em
p
h
asized
th
at
s
y
s
tem
a
d
o
p
tio
n
wo
u
ld
d
ep
e
n
d
o
n
wh
eth
er
th
e
tech
n
o
lo
g
y
r
ed
u
ce
d
,
r
ath
er
th
an
ad
d
e
d
to
,
p
atien
ts
’
d
aily
b
u
r
d
en
.
As o
n
e
p
atien
t st
ated
,
“W
e
a
r
e
w
il
lin
g
to
u
s
e
th
e
s
ystem
a
s
lo
n
g
a
s
it d
o
es n
o
t c
o
m
p
lica
te
th
in
g
s
fo
r
th
e
p
a
tien
t
.
”
(
P1
2
)
T
o
m
in
im
ize
ac
ce
s
s
b
ar
r
ier
s
,
p
ar
ticip
an
ts
p
r
o
p
o
s
ed
s
im
p
le
au
th
en
ticatio
n
an
d
n
av
ig
atio
n
m
ec
h
a
n
is
m
s
.
Fo
r
ex
am
p
le,
o
n
e
p
ar
ticip
a
n
t su
g
g
ested
,
“A
b
a
r
co
d
e
o
n
th
e
s
ma
r
tw
a
tch
co
u
ld
ma
ke
it
ea
s
ier
fo
r
p
a
tien
ts
to
a
cc
ess
imp
o
r
ta
n
t
in
fo
r
ma
tio
n
q
u
ickly
”
(
P1
2
)
.
Par
ticip
an
ts
also
ex
p
r
ess
ed
a
s
tr
o
n
g
p
r
ef
er
e
n
ce
f
o
r
m
o
b
ile
a
p
p
licatio
n
–
b
ased
ac
ce
s
s
o
v
er
web
-
b
ased
p
latf
o
r
m
s
.
Mo
b
ile
ap
p
licatio
n
s
wer
e
p
er
ce
iv
e
d
as
m
o
r
e
p
er
s
o
n
al,
p
r
ac
tical,
an
d
b
etter
s
u
ited
to
e
v
er
y
d
ay
u
s
e.
As o
n
e
p
ar
ticip
an
t e
x
p
lain
ed
,
“A
mo
b
ile
a
p
p
lica
tio
n
is
s
imp
ler
a
n
d
mo
r
e
p
ers
o
n
a
l
th
a
n
a
w
eb
s
ite,
esp
ec
ia
lly
s
in
ce
b
r
o
w
s
er
p
erfo
r
ma
n
ce
o
n
mo
b
ile
d
ev
ice
s
is
n
o
t o
p
tima
l”
(
P2
)
.
I
n
ter
f
ac
e
an
d
d
ash
b
o
ar
d
d
e
s
ig
n
wer
e
i
d
en
tifie
d
as
tec
h
n
ical
elem
en
ts
s
u
p
p
o
r
tin
g
s
y
s
tem
u
s
ab
ilit
y
.
Par
ticip
an
ts
ex
p
ec
t
ed
d
ash
b
o
ar
d
s
to
alig
n
with
h
o
s
p
ital
s
tan
d
ar
d
s
wh
ile
r
em
ain
in
g
ac
ce
s
s
ib
le
f
o
r
eld
er
l
y
u
s
er
s
.
A
m
an
a
g
er
s
aid
,
"T
h
e
d
ash
b
o
ar
d
s
h
o
u
ld
b
e
tailo
r
ed
to
th
e
n
ee
d
s
at
R
SA
UGM
,
with
clea
r
m
e
n
u
s
an
d
a
d
is
p
lay
th
at
is
ea
s
y
to
u
s
e
”
(
P3
)
.
R
ea
d
ab
ilit
y
was e
m
p
h
asize
d
as
a
p
r
ac
tical
co
n
ce
r
n
:
“M
o
s
t o
f o
u
r
p
a
tien
ts
a
r
e
eld
erly,
s
o
th
e
text
in
th
e
a
p
p
lica
tio
n
s
h
o
u
l
d
n
o
t
b
e
to
o
s
ma
ll”
(
P5
)
.
Fin
ally
,
in
teg
r
atio
n
with
th
e
Ho
s
p
ital
I
n
f
o
r
m
atio
n
Sy
s
tem
(
HI
S)
was
v
iewe
d
as
a
f
u
n
d
am
en
tal
tech
n
ical
r
eq
u
ir
em
e
n
t
to
en
s
u
r
e
co
n
tin
u
ity
o
f
ca
r
e
an
d
o
p
e
r
atio
n
al
ef
f
icien
cy
.
Par
ticip
an
ts
ex
p
r
ess
ed
ap
p
r
eh
e
n
s
io
n
th
at
non
-
in
te
g
r
ated
s
y
s
tem
s
wo
u
ld
lead
to
r
ed
u
n
d
an
t
d
o
cu
m
e
n
tatio
n
an
d
an
i
n
cr
ea
s
ed
ad
m
in
is
t
r
ativ
e
b
u
r
d
en
.
As
a
p
h
y
s
ician
s
tated
,
“Pro
b
lems
a
r
is
e
w
h
en
h
o
mec
a
r
e
d
a
ta
a
r
e
n
o
t
in
te
g
r
a
ted
w
ith
med
ica
l
r
ec
o
r
d
s
,
b
ec
a
u
s
e
it
crea
tes
d
o
u
b
le
w
o
r
k
th
a
t sh
o
u
ld
b
e
a
v
o
id
ed
”
(
P1
)
.
3
.
3
.
Da
t
a
s
ec
urit
y
,
priv
a
c
y
,
a
nd
dig
it
a
l inclu
s
io
n
Par
ticip
an
ts
id
en
tifie
d
lim
ited
in
ter
n
et
co
n
n
ec
tiv
ity
as
a
m
ajo
r
b
ar
r
ier
to
ef
f
ec
tiv
e
teleh
o
m
ec
ar
e
u
s
e,
p
ar
ticu
lar
ly
in
h
o
u
s
eh
o
ld
s
w
ith
o
u
t
s
tab
le
W
i
-
Fi
o
r
s
u
f
f
ic
ien
t
m
o
b
ile
d
ata.
T
h
ese
lim
itatio
n
s
co
n
s
tr
ain
ed
s
u
s
tain
ed
m
o
n
ito
r
in
g
a
n
d
r
ea
l
-
tim
e
d
ata
tr
an
s
m
is
s
io
n
,
esp
ec
ially
wh
en
f
am
ily
m
em
b
er
s
wer
e
n
o
t
co
n
s
is
ten
tly
p
r
esen
t a
t h
o
m
e
.
On
e
p
a
r
ticip
an
t said
,
“
S
o
me
p
a
tien
ts
d
o
n
't
h
a
ve
Wi
-
F
i
o
r
a
n
in
tern
et
q
u
o
t
a
,
esp
ec
ia
lly
w
h
en
th
eir
kid
s
a
r
e
o
ften
a
w
a
y
fr
o
m
h
o
me”
(
P4
)
.
An
o
th
e
r
n
o
ted
,
“S
o
me
p
a
tien
ts
ca
n
n
o
t
u
s
e
telemo
n
ito
r
in
g
co
n
tin
u
o
u
s
l
y
b
ec
a
u
s
e
th
ey
d
o
n
o
t h
a
ve
Wi
-
F
i”
(
P6
)
.
T
h
ese
ac
co
u
n
ts
h
ig
h
lig
h
t d
ig
it
al
in
clu
s
i
o
n
as a
p
r
er
e
q
u
is
ite
f
o
r
eq
u
itab
le
tele
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(
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Patien
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r
am
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r
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ld
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co
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r
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506
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o
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b
y
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in
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.
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ab
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2
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CU
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ir
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ices
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I
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ec
tiv
en
ess
in
h
ea
lth
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r
e
d
eliv
er
y
[
1
3
]
,
[
2
9
]
,
o
u
r
f
in
d
in
g
s
r
ein
f
o
r
ce
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at
t
h
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.
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r
e
p
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p
ab
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d
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a
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r
ac
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[
3
0
]
.
Ou
r
f
in
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s
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at
u
s
ab
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s
e.
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n
s
with
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r
io
r
r
esear
ch
d
em
o
n
s
tr
atin
g
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at
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m
p
lex
ity
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d
p
o
o
r
u
s
ab
i
lity
ar
e
m
ajo
r
b
ar
r
ie
r
s
to
teleh
ea
lth
ad
o
p
tio
n
[
3
1
]
.
C
o
n
v
er
s
ely
,
th
e
em
p
h
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o
n
s
im
p
licity
,
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s
e
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s
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ly
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s
u
p
p
o
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tin
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ical
d
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n
s
[
3
2
]
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Fro
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ased
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ased
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ter
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h
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ito
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an
d
s
er
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o
r
d
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n
[
3
3
]
.
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ctica
lly
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e
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in
d
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g
s
o
f
f
er
ac
tio
n
a
b
le
d
esig
n
g
u
id
an
ce
f
o
r
s
ca
lin
g
teleh
o
m
ec
ar
e
in
r
eso
u
r
ce
-
co
n
s
tr
ain
ed
h
ea
lth
s
y
s
tem
s
f
ac
in
g
p
o
p
u
latio
n
a
g
ein
g
a
n
d
c
h
r
o
n
ic
d
is
ea
s
e
b
u
r
d
e
n
s
.
T
h
e
s
tu
d
y
’
s
f
in
d
in
g
s
also
ali
g
n
clo
s
ely
with
th
e
W
o
r
l
d
H
ea
lth
Or
g
an
izatio
n
’
s
Glo
b
al
Stra
teg
y
o
n
Dig
ital
Hea
lth
2
0
2
0
–
2
0
2
5
,
p
ar
ticu
lar
ly
its
em
p
h
asis
o
n
p
eo
p
le
-
ce
n
ter
e
d
d
esig
n
,
in
t
er
o
p
er
a
b
ilit
y
,
d
ata
g
o
v
er
n
an
ce
,
a
n
d
eq
u
ity
[
3
4
]
.
Similar
ly
,
p
a
r
ticip
an
ts
’
e
x
p
ec
tatio
n
s
f
o
r
tr
an
s
p
a
r
en
t
d
ata
ac
ce
s
s
,
n
o
n
-
s
tig
m
atizin
g
d
esig
n
,
an
d
p
atie
n
t
in
v
o
lv
em
en
t
alig
n
with
W
HO
g
u
id
an
ce
o
n
tr
u
s
t,
eth
ics,
an
d
h
u
m
a
n
r
ig
h
ts
in
d
ig
ital
h
ea
lth
[
3
4
]
.
B
y
g
r
o
u
n
d
in
g
th
ese
p
r
in
cip
les
in
h
o
s
p
ital
-
b
ased
h
o
m
ec
a
r
e
in
I
n
d
o
n
esia,
th
is
s
tu
d
y
co
n
tr
ib
u
tes co
n
tex
t
-
s
p
ec
if
ic
ev
id
en
ce
f
r
o
m
a
lo
w
-
a
n
d
m
i
d
d
l
e
-
in
co
m
e
co
u
n
tr
y
s
ettin
g
.
Priv
ac
y
an
d
d
ata
s
ec
u
r
ity
em
er
g
ed
as
f
o
u
n
d
atio
n
al
r
e
q
u
ir
e
m
en
ts
in
f
l
u
en
cin
g
tr
u
s
t
a
n
d
a
cc
ep
tan
ce
.
C
o
n
s
is
ten
t
with
p
r
io
r
teleh
ea
l
th
r
esear
ch
[
3
0
]
,
[
3
5
]
,
p
ar
tici
p
an
ts
ex
p
r
ess
ed
c
o
n
ce
r
n
s
r
eg
ar
d
in
g
d
ata
m
is
u
s
e,
u
n
au
th
o
r
ized
ac
ce
s
s
,
an
d
r
eg
u
lato
r
y
co
m
p
lian
ce
.
I
m
p
o
r
ta
n
tly
,
th
is
s
tu
d
y
s
h
o
ws
th
at
p
r
iv
ac
y
ex
ten
d
s
b
ey
o
n
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
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lic
Hea
lth
Sci
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N:
2252
-
8
8
0
6
User
-
ce
n
tr
ed
s
o
cio
-
tech
n
ica
l req
u
ir
eme
n
ts
fo
r
teleh
o
mec
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in
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s
p
ita
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b
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…
(
I
ma
n
P
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ma
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a
)
507
tech
n
ical
s
af
eg
u
ar
d
s
to
in
cl
u
d
e
s
o
cial
an
d
s
y
m
b
o
lic
co
n
ce
r
n
s
.
Patien
ts
’
em
p
h
asis
o
n
n
o
n
-
s
tig
m
atizin
g
wea
r
ab
le
d
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ig
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ity
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tab
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in
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lu
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t
with
teleh
o
m
ec
ar
e
t
ec
h
n
o
lo
g
ies.
T
h
ese
f
in
d
in
g
s
r
ein
f
o
r
ce
th
e
n
ee
d
f
o
r
“p
r
iv
ac
y
b
y
d
esig
n
”
ap
p
r
o
ac
h
es
th
at
in
teg
r
ate
tech
n
ical
s
af
eg
u
ar
d
s
with
atten
tio
n
t
o
u
s
er
s
’
liv
ed
ex
p
e
r
ien
ce
s
an
d
c
u
ltu
r
al
co
n
tex
ts
[
3
6
]
.
E
q
u
it
y
an
d
d
ig
ital
in
clu
s
io
n
co
n
s
titu
te
an
o
th
er
k
ey
co
n
t
r
ib
u
tio
n
o
f
th
is
s
tu
d
y
.
L
im
ited
in
ter
n
et
co
n
n
ec
tiv
ity
,
r
elian
ce
o
n
f
am
i
ly
m
em
b
er
s
f
o
r
d
e
v
ice
o
p
er
at
io
n
,
an
d
v
a
r
y
in
g
lev
els
o
f
d
i
g
ital
liter
ac
y
am
o
n
g
o
ld
er
ad
u
lts
h
ig
h
lig
h
t
th
e
r
is
k
th
at
teleh
o
m
ec
ar
e
im
p
lem
e
n
tatio
n
will
r
ep
r
o
d
u
ce
ex
is
tin
g
h
ea
lth
in
eq
u
ities
.
Dig
ital
ex
clu
s
io
n
in
th
is
co
n
tex
t
is
n
o
t
m
er
ely
an
in
d
iv
i
d
u
al
co
n
s
tr
ain
t;
it
is
in
teg
r
at
ed
in
to
h
o
u
s
eh
o
l
d
in
f
r
astru
ctu
r
e,
ca
r
eg
iv
in
g
f
r
a
m
ewo
r
k
s
,
an
d
s
o
cio
ec
o
n
o
m
ic
co
n
d
itio
n
s
.
T
h
is
f
in
d
in
g
ex
t
en
d
s
d
ig
ital
p
u
b
lic
h
ea
lth
liter
atu
r
e
b
y
d
em
o
n
s
tr
atin
g
th
at
eq
u
itab
le
teleh
o
m
ec
ar
e
im
p
lem
e
n
tatio
n
r
e
q
u
ir
es
s
y
s
tem
-
lev
el
r
esp
o
n
s
es r
ath
er
th
an
ass
u
m
in
g
in
d
iv
id
u
al
tech
n
o
lo
g
ical
r
ea
d
in
ess
[
3
7
]
,
[
3
8
]
.
I
n
ter
m
s
o
f
tech
n
ical
d
esig
n
,
th
e
s
tr
o
n
g
p
r
e
f
er
en
ce
f
o
r
m
o
b
il
e
ap
p
licatio
n
s
,
r
ea
d
ab
le
d
ash
b
o
ar
d
s
,
an
d
s
im
p
le
ac
ce
s
s
m
ec
h
an
is
m
s
r
ef
lects
well
-
d
o
cu
m
en
ted
u
s
ab
ilit
y
ch
allen
g
es
in
d
i
g
ital
h
ea
lth
in
ter
v
en
ti
o
n
s
f
o
r
o
ld
er
ad
u
lts
[
3
9
]
.
Ou
r
f
i
n
d
in
g
s
s
u
p
p
o
r
t
p
r
io
r
ev
id
e
n
ce
th
a
t
s
u
cc
ess
f
u
l
eHe
a
lth
s
er
v
ices
f
o
r
ch
r
o
n
ic
d
is
ea
s
e
m
an
ag
em
en
t
m
u
s
t
b
e
g
r
o
u
n
d
ed
in
u
s
er
-
ce
n
ter
ed
a
n
d
iter
a
tiv
e
d
esig
n
p
r
o
ce
s
s
es
th
at
alig
n
with
ev
er
y
d
ay
r
o
u
tin
es
[
4
0
]
.
I
m
p
o
r
tan
tly
,
p
ar
ticip
an
ts
’
em
p
h
asis
o
n
in
te
r
o
p
er
a
b
ilit
y
with
h
o
s
p
ital
in
f
o
r
m
atio
n
s
y
s
tem
s
u
n
d
er
s
co
r
es th
e
n
ee
d
t
o
m
atch
tech
n
ical
u
s
ab
ilit
y
with
o
r
g
an
izatio
n
al
in
teg
r
atio
n
t
o
en
s
u
r
e
s
u
s
tain
ab
ilit
y
.
T
h
eo
r
etica
lly
,
th
is
s
t
u
d
y
ad
v
a
n
ce
s
u
n
d
er
s
tan
d
in
g
o
f
teleh
o
m
ec
ar
e
b
y
co
n
ce
p
tu
alizin
g
it
as
a
ca
r
e
-
o
r
ien
ted
s
o
cio
-
tech
n
ical
s
y
s
te
m
r
ath
er
th
an
a
p
u
r
ely
f
u
n
cti
o
n
al
d
ig
ital
s
o
lu
tio
n
.
B
u
ild
in
g
o
n
h
u
m
a
n
-
ce
n
tr
ed
d
esig
n
th
eo
r
y
in
d
ig
ital
h
ea
lt
h
[
4
1
]
,
th
e
r
esu
lts
s
h
o
w
th
at
u
s
ab
ilit
y
in
h
o
m
e
-
b
ased
ca
r
e
in
clu
d
es
clin
ical
r
ea
s
s
u
r
an
ce
,
th
e
ab
ilit
y
t
o
u
n
d
er
s
tan
d
h
ea
lth
d
ata,
an
d
th
e
p
r
o
tectio
n
o
f
p
atien
t
d
ig
n
ity
.
Ad
d
itio
n
ally
,
t
h
e
s
tu
d
y
im
p
r
o
v
es
tech
n
o
lo
g
y
a
cc
ep
tan
ce
th
eo
r
ies
lik
e
th
e
te
ch
n
o
lo
g
y
ac
ce
p
tan
ce
m
o
d
el
(
T
AM
)
[
4
2
]
an
d
th
e
Un
if
ied
T
h
eo
r
y
o
f
Acc
ep
tan
c
e
an
d
Use
o
f
T
ec
h
n
o
lo
g
y
(
U
T
AUT
)
[
4
3
]
b
y
s
h
o
win
g
th
at
h
o
w
u
s
ef
u
l
p
eo
p
le
f
in
d
teleh
o
m
ec
ar
e
d
ep
en
d
s
n
o
t
ju
s
t
o
n
h
o
w
ef
f
icien
t
o
r
c
o
n
v
en
ie
n
t
it
is
,
b
u
t
also
o
n
o
n
g
o
in
g
ca
r
e,
s
h
ar
ed
m
o
n
ito
r
in
g
,
an
d
tr
u
s
t b
etwe
en
p
atien
ts
,
f
am
ilies
,
an
d
h
ea
lth
c
ar
e
p
r
o
v
id
er
s
.
T
h
e
s
in
g
le
-
s
ite
d
esig
n
a
n
d
s
m
all
s
am
p
le
s
ize
o
f
th
is
s
tu
d
y
li
m
it
its
g
en
er
aliza
b
ilit
y
.
T
h
e
f
i
n
d
in
g
s
ar
e
in
ten
d
ed
to
p
r
o
v
i
d
e
in
-
d
e
p
th
,
co
n
tex
t
-
s
p
ec
if
ic
in
s
ig
h
ts
r
at
h
er
th
an
r
e
p
r
esen
t
b
r
o
a
d
er
p
o
p
u
latio
n
s
.
Fu
tu
r
e
s
tu
d
ies
s
h
o
u
ld
in
clu
d
e
d
if
f
er
en
t
lo
ca
tio
n
s
an
d
a
wid
er
r
an
g
e
o
f
p
ar
ticip
a
n
ts
to
ev
alu
ate
h
o
w
well
u
s
er
-
ce
n
ter
ed
teleh
o
m
ec
ar
e
n
ee
d
s
ca
n
b
e
ap
p
lied
elsewh
er
e
an
d
t
o
h
elp
cr
ea
te
f
air
an
d
lar
g
e
-
s
ca
le
s
o
lu
tio
n
s
.
5.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
d
e
m
o
n
s
tr
ates
th
at
ef
f
ec
tiv
e
im
p
lem
en
tatio
n
o
f
teleh
o
m
ec
ar
e
in
h
o
s
p
ital
-
b
ased
s
er
v
ices
d
ep
en
d
s
o
n
alig
n
i
n
g
tech
n
o
lo
g
ical
f
u
n
ctio
n
s
with
clin
ical
wo
r
k
f
lo
ws,
p
atien
t
au
to
n
o
m
y
,
a
n
d
s
o
cio
-
c
o
n
tex
tu
al
r
ea
liti
es.
T
eleh
o
m
ec
ar
e
s
h
o
u
ld
b
e
u
n
d
e
r
s
to
o
d
as
a
s
o
cio
-
tech
n
ical
ca
r
e
in
f
r
astru
ctu
r
e
th
at
s
u
p
p
o
r
ts
co
n
tin
u
ity
o
f
ca
r
e,
ea
r
ly
clin
ical
r
esp
o
n
s
e,
an
d
s
h
ar
ed
m
o
n
ito
r
i
n
g
b
et
wee
n
p
atien
ts
,
f
am
ilies
,
an
d
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
.
Fro
m
a
h
ea
lth
s
y
s
tem
s
p
er
s
p
e
ctiv
e,
th
e
f
in
d
in
g
s
s
u
g
g
est
th
a
t
teleh
o
m
ec
ar
e
ca
n
s
tr
en
g
th
e
n
h
o
s
p
ital
o
u
tr
ea
c
h
,
r
ed
u
ce
av
o
id
a
b
le
s
er
v
ice
u
tili
za
tio
n
,
an
d
s
u
p
p
o
r
t
p
r
ev
en
tiv
e
ca
r
e
f
o
r
ag
ein
g
p
o
p
u
latio
n
s
w
h
en
in
teg
r
ated
with
ex
is
tin
g
h
o
s
p
ital
in
f
o
r
m
atio
n
s
y
s
tem
s
.
At
th
e
p
o
licy
lev
el
,
n
atio
n
al
d
i
g
ital
h
ea
lth
s
tr
ateg
ies
s
h
o
u
ld
m
o
v
e
b
ey
o
n
d
tech
n
ical
s
tan
d
ar
d
s
to
in
clu
d
e
g
u
id
a
n
ce
o
n
in
ter
o
p
er
ab
ilit
y
,
d
ata
g
o
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AUTHO
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CO
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C
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tag
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C
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th
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ap
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was o
b
tain
ed
f
r
o
m
th
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th
ics C
o
m
m
ittee
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f
th
e
Facu
lty
o
f
Me
d
icin
e,
Pu
b
lic
Hea
lth
,
an
d
Nu
r
s
in
g
,
Un
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s
itas
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(
KE
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.
DATA AV
AI
L
AB
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L
I
T
Y
T
h
e
d
ata
th
at
s
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p
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f
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is
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[
WS
]
.
T
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d
ata,
w
h
ich
co
n
tain
i
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f
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m
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co
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ld
co
m
p
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m
is
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p
r
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ac
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o
f
r
esear
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p
ar
ticip
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ts
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ar
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n
o
t p
u
b
licly
a
v
ailab
le
d
u
e
to
ce
r
tain
r
estrictio
n
s
.
R
E
FE
R
E
N
C
E
S
[
1
]
B
a
d
a
n
P
u
sa
t
S
t
a
t
i
st
i
k
,
“
S
t
a
t
i
s
t
i
k
p
e
n
d
u
d
u
k
l
a
n
j
u
t
u
s
i
a
2
0
2
5
,
”
B
a
d
a
n
P
u
sa
t
S
t
a
t
i
st
i
k
,
J
a
k
a
r
t
a
,
2
0
2
5
.
[
2
]
B
a
d
a
n
P
u
sa
t
S
t
a
t
i
s
t
i
k
,
B
a
p
p
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,
a
n
d
U
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F
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,
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I
n
d
o
n
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si
a
p
o
p
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l
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t
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o
n
p
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c
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n
2
0
1
5
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2
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4
5
:
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su
l
t
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f
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p
a
s
2
0
1
5
,
”
Ja
k
a
r
t
a
,
2
0
1
8
.
[
O
n
l
i
n
e
]
.
A
v
a
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l
a
b
l
e
:
h
t
t
p
s:
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/
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n
d
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si
a
.
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p
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0
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5
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5
_
.
p
d
f
[
3
]
R
.
W
.
B
a
sr
o
w
i
,
E.
M
.
R
a
h
a
y
u
,
L
.
C
.
K
h
o
e
,
E.
W
a
si
t
o
,
a
n
d
T.
S
u
n
d
j
a
y
a
,
“
T
h
e
r
o
a
d
t
o
h
e
a
l
t
h
y
a
g
e
i
n
g
:
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h
a
t
h
a
s
I
n
d
o
n
e
s
i
a
a
c
h
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e
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e
d
so
f
a
r
?
,
”
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u
t
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i
e
n
t
s
,
v
o
l
.
1
3
,
n
o
.
1
0
,
p
.
3
4
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1
,
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2
0
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1
,
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i
:
1
0
.
3
3
9
0
/
n
u
1
3
1
0
3
4
4
1
.
[
4
]
P
.
O
n
s
e
n
g
e
t
a
l
.
,
“
Ex
p
e
c
t
a
t
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n
,
a
t
t
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t
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e
,
a
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d
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a
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m
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c
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g
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v
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s
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f
h
o
me
b
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u
n
d
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r
b
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d
r
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d
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n
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a
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l
t
s
:
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u
a
l
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t
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y
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”
J
MIR
Ag
i
n
g
,
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l
.
7
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4
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:
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0
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2
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9
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/
4
8
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.
[
5
]
M
.
Za
k
e
t
a
l
.
,
“
R
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h
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b
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l
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t
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d
r
o
m
e
,
a
i
d
e
d
b
y
v
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r
t
u
a
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r
e
a
l
i
t
y
t
e
c
h
n
o
l
o
g
y
:
a
n
a
r
r
a
t
i
v
e
r
e
v
i
e
w
,
”
J
o
u
r
n
a
l
o
f
C
l
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n
i
c
a
l
Me
d
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c
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n
e
,
v
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l
.
1
2
,
n
o
.
1
7
,
p
.
5
6
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5
,
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2
0
2
3
,
d
o
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:
1
0
.
3
3
9
0
/
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c
m
1
2
1
7
5
6
7
5
.
[
6
]
A
.
B
e
k
d
e
mi
r
a
n
d
N
.
I
l
h
a
n
,
“
P
r
e
d
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c
t
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s
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f
c
a
r
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g
i
v
e
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b
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n
c
a
r
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g
i
v
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r
s
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f
b
e
d
r
i
d
d
e
n
p
a
t
i
e
n
t
s,”
J
o
u
r
n
a
l
o
f
N
u
rsi
n
g
R
e
se
a
rc
h
,
v
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l
.
2
7
,
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3
,
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2
4
,
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n
.
2
0
1
9
,
d
o
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:
1
0
.
1
0
9
7
/
j
n
r
.
0
0
0
0
0
0
0
0
0
0
0
0
0
2
9
7
.
[
7
]
Y
.
K
o
a
n
d
W
.
N
o
h
,
“
A
s
c
o
p
i
n
g
r
e
v
i
e
w
o
f
h
o
m
e
b
o
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n
d
o
l
d
e
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p
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o
p
l
e
:
d
e
f
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n
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t
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o
n
,
m
e
a
s
u
r
e
m
e
n
t
a
n
d
d
e
t
e
r
mi
n
a
n
t
s,”
I
n
t
e
rn
a
t
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o
n
a
l
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,
a
n
d
p
o
li
c
y
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
z
ih
a
d
islam
i1
6
@
g
m
a
i
l.
c
o
m
.
Win
n
y
S
e
ty
o
n
u
g
r
o
h
o
is
a
re
se
a
rc
h
e
r
a
n
d
a
c
a
d
e
m
ic
sp
e
c
ializin
g
in
h
e
a
lt
h
tec
h
n
o
lo
g
y
a
n
d
m
e
d
ica
l
i
n
fo
rm
a
ti
c
s.
W
it
h
a
n
e
d
u
c
a
ti
o
n
a
l
b
a
c
k
g
r
o
u
n
d
in
m
e
d
icin
e
a
n
d
i
n
fo
rm
a
ti
o
n
tec
h
n
o
lo
g
y
a
n
d
a
P
h
.
D
.
i
n
M
e
d
ica
l
In
f
o
rm
a
ti
c
s
a
n
d
Ed
u
c
a
ti
o
n
,
h
is
re
se
a
rc
h
fo
c
u
se
s
o
n
tele
h
e
a
lt
h
,
h
o
s
p
it
a
l
in
fo
rm
a
ti
o
n
sy
ste
m
s,
Io
T
-
b
a
se
d
b
io
m
e
tri
c
m
o
n
it
o
ri
n
g
,
p
s
y
c
h
o
m
e
tri
c
a
n
a
ly
sis,
a
n
d
d
i
g
it
a
l
h
e
a
lt
h
e
d
u
c
a
ti
o
n
.
He
h
a
s
p
u
b
l
ish
e
d
e
x
te
n
siv
e
ly
o
n
h
e
a
lt
h
c
a
re
tec
h
n
o
lo
g
i
e
s,
p
a
ti
e
n
t
m
o
n
i
to
ri
n
g
sy
ste
m
s,
a
n
d
m
e
d
ica
l
e
d
u
c
a
ti
o
n
a
ss
e
ss
m
e
n
t.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
s
e
t
y
o
n
u
g
r
o
h
o
win
n
y
@
g
m
a
il
.
c
o
m
.
Ika
Pu
sp
ita
S
a
r
i
is
a
p
ro
fe
s
so
r
in
th
e
De
p
a
rtme
n
t
o
f
P
h
a
rm
a
c
o
lo
g
y
a
n
d
Cli
n
ica
l
P
h
a
rm
a
c
y
,
F
a
c
u
lt
y
o
f
P
h
a
rm
a
c
y
,
Un
i
v
e
rsitas
G
a
d
jah
M
a
d
a
(U
G
M
),
In
d
o
n
e
sia
.
S
h
e
is
a
f
u
l
l
p
ro
fe
ss
o
r
i
n
p
h
a
rm
a
c
o
lo
g
y
a
n
d
t
o
x
ico
lo
g
y
,
wi
th
e
x
p
e
rti
se
in
a
n
ti
b
io
ti
c
s,
m
o
lec
u
lar
b
i
o
lo
g
y
,
a
n
d
o
b
ste
tri
c
s
a
n
d
g
y
n
e
c
o
lo
g
y
–
re
late
d
p
h
a
rm
a
c
o
th
e
ra
p
y
.
S
h
e
e
a
rn
e
d
h
e
r
P
h
.
D
.
fr
o
m
M
o
n
a
s
h
Un
iv
e
rsity
,
A
u
stra
li
a
.
He
r
re
se
a
rc
h
fo
c
u
se
s
o
n
th
e
d
e
v
e
lo
p
m
e
n
t
o
f
a
n
t
i
-
in
f
lam
m
a
to
ry
a
n
d
a
n
ti
o
x
id
a
n
t
a
g
e
n
ts.
S
h
e
h
a
s
a
lso
se
rv
e
d
a
s
Dire
c
to
r
o
f
Hu
m
a
n
Re
so
u
rc
e
s
a
n
d
Ac
a
d
e
m
ic
Aff
a
irs
a
t
th
e
Ac
a
d
e
m
ic
Ho
sp
it
a
l
o
f
Un
iv
e
r
sitas
G
a
d
jah
M
a
d
a
(RS
A
UG
M
).
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
ik
a
_
t
u
n
g
g
u
l@u
g
m
.
a
c
.
id
.
J
a
n
a
t
a
r
u
m
S
r
i
H
a
n
d
o
n
o
i
s
a
m
e
d
i
c
a
l
d
o
c
to
r
w
i
th
p
r
o
f
e
s
si
o
n
a
l
e
x
p
e
ri
e
n
c
e
in
c
l
in
i
c
a
n
d
h
o
sp
i
t
a
l
m
a
n
a
g
e
m
e
n
t.
H
e
is
c
u
r
r
e
n
t
ly
a
d
o
c
to
r
a
l
c
a
n
d
id
a
te
a
t
th
e
F
a
c
u
lt
y
o
f
M
e
d
i
c
i
n
e
,
P
u
b
l
i
c
H
e
a
lt
h
,
a
n
d
Nu
r
s
in
g
,
U
n
iv
e
r
s
i
t
a
s
Ga
d
j
a
h
M
a
d
a
(
F
K
-
K
M
K
U
GM
)
,
In
d
o
n
e
s
i
a
.
H
i
s
r
e
s
e
a
r
c
h
f
o
c
u
s
e
s
o
n
t
h
e
a
d
o
p
t
io
n
o
f
e
m
e
rg
in
g
t
e
c
h
n
o
lo
g
i
e
s
to
i
m
p
r
o
v
e
h
e
a
l
th
c
a
r
e
s
e
r
v
i
c
e
d
e
l
iv
e
ry
,
in
t
e
g
r
a
ti
n
g
c
li
n
i
c
a
l
p
r
a
c
t
i
c
e
,
h
e
a
l
th
c
a
r
e
m
a
n
a
g
e
m
e
n
t
,
a
n
d
t
e
c
h
n
o
lo
g
y
-
o
r
i
e
n
t
e
d
r
e
s
e
a
r
c
h
t
o
b
ri
d
g
e
i
n
n
o
v
a
t
io
n
w
it
h
r
e
a
l
-
w
o
r
ld
h
e
a
lt
h
c
a
r
e
p
r
o
c
e
s
s
e
s
.
He
c
a
n
b
e
c
o
n
t
a
c
t
e
d
a
t
e
m
a
i
l:
j
a
n
a
t
a
ru
m
s
r
ih
a
n
d
o
n
o
@
m
a
i
l.
u
g
m
.
a
c
.
id
.
S
e
n
ta
g
i
S
e
so
ty
a
Uta
m
i
is
a
se
n
io
r
a
c
a
d
e
m
ic
a
n
d
re
se
a
r
c
h
e
r
a
t
Un
iv
e
rsitas
Ga
d
jah
M
a
d
a
(UG
M
),
sp
e
c
ializin
g
in
b
u
i
ld
in
g
p
h
y
sic
s
a
n
d
a
c
o
u
stics
.
S
h
e
h
o
l
d
s
d
e
g
re
e
s
fro
m
Un
i
v
e
rsitas
G
a
d
jah
M
a
d
a
a
n
d
Brig
h
a
m
Yo
u
n
g
Un
i
v
e
rsity
(USA),
a
n
d
a
P
h
.
D
.
in
a
rc
h
it
e
c
tu
ra
l
a
c
o
u
stics
fro
m
th
e
Un
iv
e
rsit
y
o
f
M
ich
ig
a
n
(US
A).
He
r
re
se
a
r
c
h
in
tere
sts
in
c
lu
d
e
a
c
o
u
stics
,
b
u
il
d
i
n
g
p
h
y
sic
s,
sm
a
rt
a
n
d
g
re
e
n
b
u
il
d
in
g
sy
ste
m
s,
a
n
d
e
n
v
ir
o
n
m
e
n
tal
m
o
n
it
o
rin
g
.
S
h
e
c
o
-
fo
u
n
d
e
d
a
n
d
c
o
o
rd
i
n
a
tes
th
e
In
teg
ra
ted
S
m
a
rt
a
n
d
G
re
e
n
Bu
il
d
i
n
g
(
INSG
REE
B)
re
se
a
r
c
h
u
n
it
a
t
UG
M
a
n
d
is
a
n
a
c
ti
v
e
m
e
m
b
e
r
o
f
p
ro
f
e
ss
io
n
a
l
so
c
ieties
su
c
h
a
s
th
e
Ac
o
u
stica
l
S
o
c
iet
y
o
f
Am
e
rica
(ASA)
a
n
d
th
e
Au
d
i
o
En
g
i
n
e
e
rin
g
S
o
c
iety
(AE
S
).
S
h
e
a
lso
c
o
n
tri
b
u
tes
to
s
u
sta
in
a
b
il
it
y
a
n
d
S
DG
s
in
it
iativ
e
s
a
t
UG
M
,
in
c
lu
d
in
g
se
rv
i
n
g
a
s
C
o
o
r
d
in
a
to
r
f
o
r
S
DG
s
re
p
o
rti
n
g
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
se
n
tag
i@u
g
m
.
a
c
.
i
d
.
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