Path coefficients.
\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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The widespread implementation and adoption of health information systems (HISs) around the world are believed to improve access and use of health data in ensuring high quality of care and health system efficiency and fostering clinical research [1, 2]. The acceleration of HIS implementations will further enhance sharing of health information electronically across different clinical settings [3] that eventually generate quality benefits and minimize medical costs from avoiding unnecessary clinical trials, examinations, and treatments [4]. Therefore, the management and presentation of HISs are vital to accelerate patient care and its continuity across health institutions [5]. The success of system implementation relies upon a high quality of information outputs from HISs required to make timely and accurate clinical decisions by various health practitioners [6]. Besides enabling care continuity, HIS is regarded as the wealthiest source of clinical evidence to support continuous communication among individual clinicians and surgical team works [7]. With the use of HIS, it is not only capable to reduce human errors [8] but also contributes to an increased adherence to clinical guidelines and deterrence of medical errors [9, 10], thereby delivering greater patient safety and medication management [11].
\nIn Malaysia, the expenditures of customized HISs are fully supported by the government in the efforts to retain a higher standard of patient care [12, 13]. All new public hospitals should be equipped with HISs designed from multiple vendors hired by the government. Although the investment of IS can improve health service, it will also present more costs in maintenance, hardware replacements, end‐user trainings, and system upgrades [14, 15]. Increasing medical costs [16] and enormous budget cuts among local hospitals have demanded for a comprehensive evaluation of HIS to investigate the most possible strengths and weaknesses for further improvements. In reality, the effectiveness of HIS adoption among implemented government hospitals had never been assessed since its first kick‐off at Selayang Hospital in 1999. Hospitals with HISs are repeatedly distributing user satisfaction surveys without concentrating on significant success factors and impact on the performance of the health personnel. They conducted these surveys to satisfy the auditing needs but the results were still insufficient in recommending which critical attributes for improving system use and user productivity. As a consequence, the government hospitals were still incapable of choosing the right HIS and vendors and even assessing its performance after implementation [17]. A systematic IS evaluation will not only promote efficient use and medical cost savings but also cope with unresolved issues of clinicians’ heavy workloads and shortage of specialists in this multi‐racial country [14, 15].
\nIdentifying the needs of health workforce and acknowledging the characteristics of HIS are essential to their productivity that must be emphasized in any evaluation studies [18, 19]. For that reason, recognizing the main attributes of HIS can improve health practitioners’ performance from their daily use. Strategies to upgrade an HIS could not precede with an absence of in‐depth knowledge about the most significant HIS characteristics in predicting user productivity. Consequently, there will be wasted expenses on any system upgrades without careful understanding of the potential system impacts or benefits to the user performance, thereby introducing dissatisfaction and risks of system failure [18].
\nUnfortunately, there is little evidence on the prior HIS research in measuring the influence of IS attributes toward satisfaction and productivity of medical practitioners [20, 21]. Besides, the previous evaluation works did not completely assess the importance and performance of multiple HIS attributes especially in ranking those attributes with high importance for managerial attention. There are only two current studies attempted to prioritize different HIS quality measures among small samples acquired in one public hospital [18, 19]. Furthermore, the current trends in examining HIS use and user satisfaction in the scholarly publications are still plenty by ignoring core success drivers that will predict user and organizational impacts. By contrast, there are many empirical studies on HIS evaluation concerning the effects of system quality, information quality, service quality, usage, user satisfaction, and net benefits in the developed and developing countries [22, 23], but none of them address on the critical quality or success factors required for managerial response. Most studies only present significant results without recommending specific measures or indicators that will guide the hospitals in prioritizing the most important indicators for improving effective use and health personnel productivity.
\nThe DeLone and McLean IS success models (DMISMs) are the most outstanding theoretical frameworks adopted by IS researchers since the past two decades for IS evaluation including the health‐care domain [22, 23]. The models embrace system quality, information quality, service quality, actual use, and user satisfaction to predict individual impact, organizational impact, and net benefits [24, 25]. In our empirical study, the traditional DMISM models will be extended to incorporate knowledge quality and effective use in predicting individual performance based on the perception of medical practitioners as HIS system users.
\nEffective use and user performance are the two outcome constructs measured in our evaluation study. When actual system use denotes the extent or frequency of HIS usage [26], effective use more refers to the outputs of HIS usage that allows the medical practitioners to complete their clinical tasks easily without any misdiagnosis and inaccurate medication. Because of the mandatory use of HIS, the actual use remains unreliable in assessing IS success [27, 28].
\nPrevious research indicated that user satisfaction had a strong relationship with system quality, information quality, and individual impact [29, 30]. This construct is indeed composed of system quality and individual impact measures [31] that finally disclosed a little explanatory power [32]. Consequently, user satisfaction is omitted as the outcome construct in the study.
\nOn the other hand, individual impact is the outcome generated by IS workers from their applied IT knowledge, skills, and experiences [33]. Likewise, user performance in this study refers to the level to which the practitioners gain benefits from the effective use of HIS by considering patient care and safety, work productivity, and performance score.
\nSystem quality is the attributes or characteristics of HIS including functionality, features, interface design, and its performance to facilitate ease of clinical task completion [34]. With regard to past empirical studies on the most important predictors of HIS quality [19, 22, 23, 35], we will limit the scope of measuring this predictor with the four measures namely adequate IT infrastructure, system interoperability, perceived security concerns, and system compatibility.
\nIn the conventional DMISMs, information quality describes the usable, meaningful, and understanding the content and format of IS outputs [24, 36]. Clinicians can deliver the right care depending on the quality of information produced from HIS [37]. For that reason, successful adoption of HIS is determined from the quality of records it produced [7]. The researchers will more specify the generic term of information quality with records quality based on timely access, consistency, standardized, accuracy, duplication prevention, and completeness of patient notes, reports, prescriptions, images, laboratory test results, and discharge summaries.
\nIn general, service quality is about the type of IS support delivered by the responsible IS providers or personnel [38]. We will extend service quality construct with quick assistance, problem‐solving capability, follow‐up service, and adequate training in the study.
\nThe advancement of interoperable HISs from time to time will not only create, store, and manage data and information but also knowledge [12, 35]. The aim of HIS adoption in most hospitals is to acquire, classify, store, access, and simplify the use of knowledge from a HIS repository of patient health information for supporting clinical decision‐making, actions, and problem solving [39, 40]. Besides, HISs can be utilized to promote knowledge management activities in a health organization through medical research and education [41]. In essence, medical knowledge is classified into two types such as tacit and explicit. Tacit knowledge is gathered through professional practices and experiences of medical practitioners while explicit knowledge is generally embedded and presented into the forms of electronic health records (EHRs), electronic medical records (EMRs), clinicians’ workflows, clinical guidelines, and protocols [42, 43]. HIS also integrates clinical decision support system (CDSS) and computerized provider order entry (CPOE) as the knowledge tools to hold medical knowledge [39, 42–44]. It should be noted that the wide adoption of HIS worldwide is not only due to EHRs but also its integration with CDSS and CPOE to raise higher quality of patient care [45]. Hence, the quality of knowledge must be included in any HIS evaluation [12, 41]. As a new measuring predictor in this study, knowledge quality is defined as the level to which the medical practitioners believe that using HIS will increase their medical knowledge and competencies [41] and then practice it to deliver the best patient care.
\nOur study would bridge the knowledge gap with current empirical proof in the local health system to determine the importance and performance of several effectiveness factors for immediate managerial actions with regard to the effective use of HISs and medical practitioners’ performance as the measuring outcomes. The research design would employ a quantitative method with the distribution of survey questionnaire to the four groups of health personnel in the three different government hospitals with multiple HISs. By utilizing importance‐performance map analysis (IPMA) feature in partial least squares structural equation modeling (PLS‐SEM), the expected outcomes could establish the most critical quality attributes for effective use and user performance improvements.
\nAn ethic approval was obtained from the Medical Research and Ethics Committee Malaysia as the study engaged the human subject responses from varying clinical professionals. Subsequently, the data were gathered from three hospitals situated in different states with different HIS packages. These hospitals had more than 1000 health personnel with more than 500 beds for patients. Specifically, Kedah Hospital used iSOFT system, Pahang Hospital used F1S1C1EN® system, and Johor Hospital used Cerner system. Connected via a centralized and secured 1Gov*Net network, all HISs are integrated with various clinical modules including patient management, laboratory, radiology, pharmacy, picture archiving and communication, nursing, and operating theater management. The implemented systems are in the current phase of operation and maintenance while the contract is renewed for every 3 years. The government did not standardize the use of single HIS package across their administered hospitals in order to avoid monopoly by a sole vendor that will render a negative image to the public.
\nAdopted from past surveys [36, 38, 41, 46–50] with 19 new item additions anchoring by seven‐point Likert scales from 1 of strongly disagree to 7 of strongly agree, the questionnaire draft was proven valid and reliable after pretesting between key HIS experts and pilot testing among 100 samples of end users using exploratory factor analysis in statistical package for social science (SPSS) software. The field survey data contained 888 samples from specialists, medical officers, and nursing staffs collected by the mean of convenience sampling technique. Overall, 353 participated respondents were from Kedah Hospital, 213 from Pahang Hospital, and 322 respondents from Johor Hospital. Specifically, 71 and 96 were specialists and assistant medical officers, respectively, 328 were medical officers, and 393 were nurses. More than 70% of respondents were female due to imbalance recruitments of clinical professionals and nurses were majorly female while 64% of total samples aged between 25 and 35 years old. About 53% of assistant medical officers and nurses had Diploma qualifications in medical and nursing, respectively, whereas the remaining 47% medical officers and specialists had Bachelor, Masters, or PhD Degree in medical.
\nThe collected data were subjected to confirmatory factor analysis using SmartPLS software. In this study, system quality characteristics namely adequate IT infrastructure, system interoperability, perceived security concerns, and system compatibility are identified as the formative measures. The formative model exhibited no collinearity issue for all measuring indicators and passed weight significance at a level of 1%. Then, in the reflective model, all question items satisfy the required outer loadings, composite reliability (CR), and average variance extracted (AVE) scores above the suggested thresholds [51, 52], confirming the convergent validity. However, one attribute of knowledge quality (knowqual_4) was deleted due to lower factor loading below 0.70.
\nDiscriminant validity was then executed using the Fornell and Larcker [53] criterion, and cross‐loading methods. Every construct average variance extracted is more than 0.50 that satisfied the required criterion [53, 54] while cross‐loading scores of bolded indicators are higher than its opposing indicators in other constructs [55].
\nThe next assessment was preceded to evaluate the path model. After running a complete bootstrapping test with 5000 subsamples and no sign option setting, the PLS results in Table 1 demonstrate that the observed path coefficients were statistically significant at either 0.05 or 0.01 level, and had positive effects on the outcomes or target constructs except for service quality and effective use relationships. The outcome of user performance had the largest predictive power explained by quality predictors and effective use. More importantly, knowledge quality as a new predictor became the strongest predictor for user performance at a 1% level of significance. This construct also had large effect size among other predictors that justified a need for measuring knowledge quality in future system evaluation studies.
\n\n | (effective use)R‐squared: 0.260 | \nPath coefficients (user performance) R‐squared: 0.640 | \n
---|---|---|
System quality | \n0.320 (6.025***) | \n0.122 (3.127***) | \n
Records quality | \n0.103 (2.115**) | \n0.137 (3.515***) | \n
Service quality | \n0.047 (1.244) | \n0.139 (4.632***) | \n
Knowledge quality | \n0.121 (2.520**) | \n0.489 (12.464***) | \n
Effective use | \n‐ | \n0.104 (4.170***) | \n
Path coefficients.
Significance Level: ***p < 0.01,
**p < 0.05.
The path coefficient scores for each latent construct would be subjected to further assessment in importance‐performance map analysis. IPMA in PLS‐SEM adopts the traditional IPA method in ranking both critical constructs and their measured indicators’ importance and performance for managerial intervention [51, 56]. Moreover, PLS‐SEM simplifies the researchers to model both higher‐order constructs and their individual indicators simultaneously for calculating attribute importance scores. It helps to reduce the collinearity issues between the attribute items if using a simple regression analysis [57]. The study results can be valuable in contributing to the practical implications to decision‐makers and administrators by incorporating IPMA. IPMA extends the PLS‐SEM results for path coefficient scores by contrasting the total effects of constructs’ importance in measuring target constructs with their average latent scores representing their performance.
\nIn a graphical representation, IPMA contrasts the (unstandardized) total effects on the horizontal axis with the latent construct scores, rating on a scale of 0–100, on the vertical axis. The estimated results will be emphasized on the bottom of IPMA diagram [58]. The key objective of this analysis is to improve the performance of constructs with greater importance (strong total effect) but lower performance (small construct score) in predicting a single or more target constructs [51, 55]. Hence, the subsequent analysis would apply IPMA to highlight which latent constructs and their manifest attributes necessary for remedial attentions by both decision‐makers and hospital administrators.
\nThe IPMA diagram in Figure 1 exhibits system quality has the strongest total effect over the outcome construct. Consequently, knowledge quality, records quality, and service quality should be improved to increase the effective use of HISs.
\nIPMA for effective use at construct level.
When selecting user performance as a target construct as displayed in Figure 2, knowledge quality becomes the highest importance among others. System quality, records quality, service quality, and effective use are deserved for critical managerial attention to enhance the performance of medical practitioners. No underperforming construct below 50% is identified.
\nIPMA for user performance at construct level.
As this construct level of analysis does not reveal which specific attributes required for further improvement, a subsequent analysis is continued with the individual measuring items for each latent construct. In Figure 3, syscom_1 (workflows fit) and syscom_2 (work styles fit) should be maintained for the continued effective use of HISs. By contrast, other quality attributes that fall into low performance must be stressed for managerial actions. For example, the attribute secc_4 (secure and save) has an average importance on effective use, while offering room for improving its performance. IT departments can focus on offering hands‐on training to educate HIS users about securing their access when using the systems [18]. In addition, user access control policy should be enforced and applied across the government hospitals with HISs to prevent unauthorized access and misuse of patient health information by non‐responsible doctors. Unfortunately, secc_1 (unauthorized access) attribute was removed from the analysis due to negative outer weight score in the measurement model assessment as suggested by Ringle and Sarstedt [58].
\nIPMA for effective use at indicator level.
Next, in Figure 4, by retaining knowledge quality for sustaining greater user performance, all effective use, service quality, system quality, and records quality attributes demand for urgent intervention. For instance, indicator effuse_2 (misdiagnosis prevention) should receive particular attention by promoting HIS adoption across the country so that any misdiagnosis will be averted from timely and full access to comprehensive EHR of every patient. As a result, the importance of effective use increases and then improves user performance outcome. Interestingly, no attribute falls into the bottom zone, signifying that all measuring items for every predictor achieved more than 60% of performance score in the diagram.
\nIPMA for user performance at indicator level.
More specifically, Table 2 lists the importance and performance scores for every predictor attribute with its discrepancy, calculating by subtracting performance value against importance value [59, 60]. In doing so, performance score in percentage of individual attribute has to be converted into three decimal places before computation. The results confirmed that attribute secc_3 (robust security control) of the largest discrepancy in effective use warranted for immediate managerial intervention mainly when the respondents expressed their concerns over lack of security control in HISs. When referring to previous IPMA diagram, this attribute had the lowest total effect (importance) score. Again, a proper security policy must be in place to limit the access level by specific clinical roles. Regular monitoring and reporting of access activities can be further improved with audit trail feature. On‐site training can be emphasized on instructing users by changing passwords frequently with a combination of numbers, alphabets, and symbols as well as securing their accounts through routine check of logging off after using the systems. By contrast, attribute adin_2 (adequate computers) had the highest discrepancy in user performance outcome, demanding for more computers to use HISs. In coping with a tight budget facing by most hospitals and the increasing rates of doctors, the hospitals may consider to provide grants in purchasing high‐performance desktop and laptop computers at low costs from their contracted system vendors.
\nTarget construct: user performance | \n|||
---|---|---|---|
Attribute (question item) | \nPerformance | \nImportance | \nDiscrepancy | \n
Faster network (adin_1) | \n0.074 | \n0.024 | \n0.050 | \n
Adequate computers (adin_2) | \n0.072 | \n0.014 | \n0.058 | \n
Learning of knowledge (knowqual_1) | \n0.066 | \n0.019 | \n0.047 | \n
Researching of knowledge (knowqual_2) | \n0.067 | \n0.018 | \n0.049 | \n
Applying of knowledge (knowqual_3) | \n0.067 | \n0.021 | \n0.046 | \n
Decision‐making capability (knowqual_5) | \n0.067 | \n0.022 | \n0.045 | \n
Problem‐solving capability (knowqual_6) | \n0.066 | \n0.026 | \n0.040 | \n
Complete medical source (knowqual_7) | \n0.067 | \n0.019 | \n0.048 | \n
Timely access (recqual_1) | \n0.070 | \n0.019 | \n0.051 | \n
Records consistency (recqual_2) | \n0.073 | \n0.013 | \n0.060 | \n
Standardized format (recqual_3) | \n0.074 | \n0.020 | \n0.054 | \n
Records accuracy (recqual_4) | \n0.064 | \n0.018 | \n0.046 | \n
Repeated tests prevention (recqual_5) | \n0.063 | \n0.016 | \n0.047 | \n
Records completeness (recqual_6) | \n0.073 | \n0.020 | \n0.053 | \n
Data protection (secc_2) | \n0.065 | \n0.029 | \n0.036 | \n
Robust security control (secc_3) | \n0.066 | \n0.005 | \n0.061 | \n
Secure and safe (secc_4) | \n0.066 | \n0.036 | \n0.030 | \n
Quick assistance (servqual_1) | \n0.067 | \n0.010 | \n0.057 | \n
Problem solver (servqual_2) | \n0.069 | \n0.011 | \n0.058 | \n
Follow‐up service (servqual_3) | \n0.066 | \n0.012 | \n0.054 | \n
Adequate training (servqual_4) | \n0.068 | \n0.011 | \n0.057 | \n
Workflows fit (syscom_1) | \n0.068 | \n0.066 | \n0.002 | \n
Work styles fit (syscom_2) | \n0.068 | \n0.063 | \n0.005 | \n
Clinical practices fit (syscom_3) | \n0.067 | \n0.028 | \n0.039 | \n
Patient needs fit (syscom_4) | \n0.069 | \n0.047 | \n0.022 | \n
Interoperable systems (sysi_1) | \n0.070 | \n0.012 | \n0.058 | \n
Treatment cost reduction (sysi_2) | \n0.070 | \n0.032 | \n0.038 | \n
Coordinated care (sysi_3) | \n0.075 | \n0.024 | \n0.051 | \n
Target construct: user performance | \n|||
Faster network (adin_1) | \n0.074 | \n0.012 | \n0.062 | \n
Adequate computers (adin_2) | \n0.072 | \n0.007 | \n0.065 | \n
Ease of task completion (effuse_1) | \n0.074 | \n0.032 | \n0.042 | \n
Misdiagnosis prevention (effuse_2) | \n0.068 | \n0.040 | \n0.028 | \n
Right medication (effuse_3) | \n0.064 | \n0.038 | \n0.026 | \n
Learning of knowledge (knowqual_1) | \n0.066 | \n0.084 | \n‐0.018 | \n
Researching of knowledge (knowqual_2) | \n0.067 | \n0.080 | \n‐0.013 | \n
Applying of knowledge (knowqual_3) | \n0.067 | \n0.091 | \n‐0.024 | \n
Decision‐making capability (knowqual_5) | \n0.067 | \n0.094 | \n‐0.027 | \n
Problem‐solving capability (knowqual_6) | \n0.066 | \n0.112 | \n‐0.046 | \n
Complete medical source (knowqual_7) | \n0.067 | \n0.083 | \n‐0.016 | \n
Timely access (recqual_1) | \n0.070 | \n0.029 | \n0.041 | \n
Records consistency (recqual_2) | \n0.073 | \n0.020 | \n0.053 | \n
Standardized format (recqual_3) | \n0.074 | \n0.030 | \n0.044 | \n
Records accuracy (recqual_4) | \n0.064 | \n0.026 | \n0.038 | \n
Repeated tests prevention (recqual_5) | \n0.063 | \n0.024 | \n0.039 | \n
Records completeness (recqual_6) | \n0.073 | \n0.031 | \n0.042 | \n
Data protection (secc_2) | \n0.065 | \n0.015 | \n0.050 | \n
Robust security control (secc_3) | \n0.066 | \n0.003 | \n0.063 | \n
Secure and safe (secc_4) | \n0.066 | \n0.018 | \n0.048 | \n
Quick assistance (servqual_1) | \n0.067 | \n0.031 | \n0.036 | \n
Problem solver (servqual_2) | \n0.069 | \n0.035 | \n0.034 | \n
Follow‐up service (servqual_3) | \n0.066 | \n0.039 | \n0.027 | \n
Adequate training (servqual_4) | \n0.068 | \n0.035 | \n0.033 | \n
Workflows fit (syscom_1) | \n0.068 | \n0.034 | \n0.034 | \n
Work styles fit (syscom_2) | \n0.068 | \n0.032 | \n0.036 | \n
Clinical practices fit (syscom_3) | \n0.067 | \n0.014 | \n0.053 | \n
Patient needs fit (syscom_4) | \n0.069 | \n0.024 | \n0.045 | \n
Interoperable systems (sysi_1) | \n0.070 | \n0.006 | \n0.064 | \n
Treatment cost reduction (sysi_2) | \n0.070 | \n0.016 | \n0.054 | \n
Coordinated care (sysi_3) | \n0.075 | \n0.012 | \n0.063 | \n
Performance and importance scores for individual attribute.
Unfortunately, the Ministry and hospitals in Malaysia did not perform strategic planning in the design, implementation, and upgrade of the HISs. In fact, the future direction of the Ministry is to develop HIS product for extending the system to other hospitals. At present, they are only focused on delivering maintenance services and operational support to existing HISs to ensure uninterrupted hospital services. These services will be continued until a new in‐house system is entirely designed and deployed in all IT hospitals. So far, the selected vendor has been initiating the plan for HIS development and implementation, while the Ministry has been the sole licensed user of the product.
\nIn addressing the gaps through proper strategic planning in order to achieve effective use and enhanced user performance objectives, the balanced scorecard (BSC) framework, designated as HIS scorecard (Figure 5), is extended on the basis of the applicability of the empirical study results that is highly recommended for the Ministry and IT hospitals. The scorecard is designed by extracting the key results from the IPMA on the basis of the importance scores of the estimated constructs at the indicator level of the analysis. With this scorecard, the respective parties can focus on the development of concrete goals and strategies from validated evidence‐based findings for the planning and evaluation of the system implementation rather than on the initiation of a new BSC template. More importantly, it can serve two central purposes:
\nHIS scorecard.
As a metric for the policymakers at the Ministry level that facilitates effective decisions concerning the expenditures of HISs in new hospitals or upgrading the current ones. In this regard, the team implementing HIS must define their specific, measurable, achievable, realistic, and time‐frame (SMART) actions in order to achieve high effectiveness in their goal concerning predefined system quality, records quality, service quality, knowledge quality, and effective use indicators. After all actions for each strategy have been undertaken, the hospital management will present the completed scorecard with the assistance of the implementing team in front of the Board of Directors of the Ministry during the annual strategic plan meeting. Thus, HIS scorecard can be a significant measurable indicator to guide the strategic direction and the objectives of the national health technology investments in the present and future.
As a performance measurement for the auditors that assess whether or not the implemented HIS in a single IT hospital is effective. Specifically, it serves as a checklist that determines whether the previous actionable plans are well executed. The next session will further explain on how to execute simple evaluation survey using a concise guideline.
Consequently, the transformation of the study findings into a measurable scorecard will empower the hospital administrators and decision‐makers, thus facilitating their thorough understanding on how the performance of HISs positively influences their strategic decision‐making through systematic monitoring and increased effective use. Thus, it may contribute to adequate governance because of increased quality of patient care, and facilitates the efficient or prudent use of government budgets.
\nIn acquiring the inputs for every indicator in the scorecard, we have developed simple ways to evaluate the effectiveness of HIS by proposing “Easy Guide to Efficiently Evaluate Your HIS” in the form of flowchart diagram (see Figure 6) for practitioners. The subsequent steps are described as follows:
\nEasy guide to efficiently evaluate your HIS.
Collect the surveys using a validated questionnaire (see Appendix A). This evaluation can be performed either by manual distribution in paper‐based during medical education programs held by clinical departments to gain better responses. But before that, a memo that is written and signed by the hospital director should be endorsed to all departments informing the purposes, significance, and implications of this survey.
When using paper‐based surveys, the acquired responses must be entered into SPSS software after data collection is completed.
Import the Excel file of a dataset into SPSS software and check for outliers, unengaged responses, and normality. Fix those problems accurately and save it into CSV format.
Import the converted dataset into SmartPLS software and start the algorithm and bootstrap routine procedures.
Observe the final results report for the path coefficients significance. If more than 50% of the estimated hypotheses are negative and not significant, execute IPMA for target constructs. If all the effects are significant and positive, perform IPMA as well, observe the endogenous constructs with high performance, and improve the constructs’ scores by their indicators. On the contrary, for instance with a non‐significant relationship; Service Quality ‐> Effective Use, the HIS implementation team must continually improve their quick assistance to the users when they are facing problems with the system or computers especially through online or telephone helpdesk supports. Nevertheless, if the total effects score is similar to other indicators within its measured construct, please refer to the lowest performance score between these indicators and take immediate improvement.
Hence, “Easy Guide to Efficiently Evaluate Your HIS” can allow a hospital to assess the system effectiveness efficiently not only at the individual but also at the organizational level by responsible IT department in cooperation with clinical research centers’ staffs. Through applying this clear guideline, the precision of HIS performance measurement will be greater and contributes to the effectiveness of the subsequent decision‐making by HIS users, stakeholders, and policymakers resulting from a good reputation of successful implementation while reducing costs for future upgrades and sustaining effective use and user performance. The guideline can be the best practical evaluation tool at very minimal cost to be executed for a comprehensive HIS evaluation survey at the national level.
\nThe chapter endeavors to identify areas of HIS adoption in which focused effort would yield the most benefit in terms of effective use and user performance. In addressing the present gaps, the study did this by surveying system users at three Malaysian government hospitals using three different HIS packages during postimplementation. When the significance score did not clearly propose which construct and indicators required for operational improvement, the results were extended to include IPMA in ranking the possible constructs and attributes by highlighting the most critical areas for specific responses [58]. As a result, system quality should be maintained for continued effective use and knowledge quality for enhanced user performance. Specifically, effective use must be sustained by improving the design of HISs to fit with clinicians’ workflows. Then, the uses of CDSS and CPOE have to be regularly updated with latest features in accelerating patient care with right diagnosis and medications, thus guaranteeing that user performance does not decline. These additional findings also recommend an urgent action by the hospitals relating to the lack of security control and insufficient available computers.
\nFor managerial implications, the extended findings are useful for decision‐makers at the government level in allocating proper budgets during strategic planning with HIS scorecard tool for further system upgrades and new implementation at other health facilities. “Easy Guide to Efficiently Evaluate Your HIS” can be a standardized guideline in performing the system effectiveness evaluation survey among IT hospitals. As the performance scores of measuring attributes for all systems did not reach below 50%, the surveyed hospitals must promote the benefits of interoperable systems across the setting, as user performance will be increased exponentially. With high performance but low‐importance constructs, it will produce relevant prescriptions for courses of action that the IT departments and system vendors can re‐look and immediately fix these issues to avert user dissatisfaction and low productivity. Finally, the hospitals can focus on selected quality criteria and their measuring indicators for these purposes so that more spending may be concentrated on upgrading other health facilities for patient care.
\nTo the best of our knowledge, this study is the first summative evaluation of a country’s HISs by utilizing IPMA in the clinical setting. To produce a complete HIS evaluation before and after implementation, it is highly recommended for future health informatics researchers to include IPMA [18] along with new predictor of knowledge quality and improved effective use measures. This technique will therefore increase the rates of health worker’s engagement in HIS evaluation survey by indirectly forcing them to choose what they believe to be the most important attributes for the system effectiveness and to rank those attributes by importance score in a clearly map representation. This powerful technique can be extrapolated and applied to other organizations or countries with extreme budget tight while offering efficient resource consumption. In achieving minimal health expenditure, IPMA can be further explored on how it will achieve potential cost savings by prioritizing health‐care spending in both developed and developing nations.
\nThe authors would like to thank the Director of Health Malaysia for the permission to publish this book chapter. Special appreciation goes to Kedah, Pahang, and Johor Hospitals for their participation in this research. The study received no funding support.
\neffuse_1: HIS enables me to complete my tasks successfully in a few easy steps.
effuse_2: HIS allows me to prevent misdiagnosis.
effuse_3: HIS allows me to provide the right medications to patients.
adin_1: Faster network access is critical for me to use HIS.
adin_2: Adequate computer hardware is critical for me to use HIS.
sysi_1: I only need to enter and save data once, then use the system with multiple HIS modules.
sysi_2: The cost for patient’s treatment is reduced with the use of HIS.
sysi_3: The connection between different HISs is critical to enable coordinated patient care.
secc_1: I believe my HIS does not allow unauthorized access.
secc_2: I believe my HIS protects patient’s information.
secc_3: I believe my HIS has a robust security control.
secc_4: I feel secure and safe using HIS.
syscom_1: HIS fits my workflows.
syscom_2: HIS fits the way I work and my work styles.
syscom_3: HIS fits my clinical practices.
syscom_4: HIS fits my patients’ needs.
recqual_1: Access to HIS contents is timely.
recqual_2: HIS contents are consistent when viewing from other computers.
recqual_3: HIS contents are available in a standardized format.
recqual_4: HIS contents are accurate.
recqual_5: HIS contents avoid duplication of diagnostic tests.
recqual_6: HIS contents are complete.
servqual_1: IT support staff/vendor provides quick assistance when I face problems with HIS.
servqual_2: IT support staff/vendor is always able to solve my problems with HIS.
servqual_3: IT support staff/vendor provides follow‐up service to HIS users like me.
servqual_4: IT support staff/vendor provides adequate training for me to use HIS.
knowqual_1: HIS is useful for learning new medical knowledge.
knowqual_2: HIS is useful when researching or creating new medical knowledge.
knowqual_3: HIS is helpful when applying medical knowledge to my tasks.
knowqual_4: HIS helps me share my medical knowledge with others.
knowqual_5: HIS provides knowledge that increases my ability to make clinical decisions.
knowqual_6: HIS provides knowledge that improves my ability to solve clinical problems.
knowqual_7: HIS provides a complete medical source that I can refer to for more information.
hcperf_1: HIS increases my time with patients.
hcperf_2: HIS enhances the safety of patient care.
hcperf_3: HIS increases my work productivity.
hcperf_4: HIS increases my chance of obtaining better annual performance marks.
Sputter deposition is a physical vapor deposition (PVD) method of thin film deposited by sputtering. The general sputtering method can be used to prepare a variety of materials such as metals, semiconductors, insulators, etc., and has the advantages of simple equipment, easy control, large coating area, and strong adhesion, and the magnetron sputtering method developed in the 1970s achieves high speed, low temperature, and low damage.
Adding a closed magnetic field parallel to the target surface in the bipolar sputtering, the secondary electron is bound to a specific area of the target surface to enhance the ionization efficiency by means of the orthogonal electromagnetic field formed on the surface of the target, increasing the ion density and energy, and finally realizing the high-rate sputtering. The above statement is the concept of magnetron sputtering.
Magnetron sputtering is a dominant technique to grow thin films because a large quantity of thin films can be prepared at relatively high purity and low cost. This involves ejecting material from a “target” that is a source onto a “substrate” such as a silicon wafer, as shown in Figure 1.
Schematic diagram of magnetron sputtering.
Magnetron sputtering is the collision process between incident particles and targets. Since high-speed sputtering is performed at a low pressure, it is necessary to effectively increase the ionization rate of the gas. The incident particle undergoes a complex scattering process in the target, collides with the target atom, and transmits part of the momentum to the target atom, which in turn collides with other target atoms to form a cascade process. During this cascade, certain target atoms near the surface gain sufficient momentum for outward motion and are sputtered out of the target. Magnetron sputtering increases the plasma density by introducing a magnetic field on the surface of the target cathode and utilizing the constraints of the magnetic field on the charged particles to increase the sputtering rate.
Magnetron sputtering includes many types, such as direct current (DC) magnetron sputtering and radio frequency (RF) magnetron sputtering, each has a different working principle and application objects. The main advantage of RF magnetron sputtering over DC magnetron sputtering is that it does not require the target as an electrode be electrically conductive. Therefore, any material can be sputter-deposited theoretically using RF magnetron sputtering.
But there is one thing in common for any type of magnetron sputtering: the interaction between the magnetic field and the electric field causes the electrons to spiral in the vicinity of the target surface, thereby increasing the probability that electrons will strike the argon gas to generate ions. The generated ions collide with the target surface under the action of an electric field to sputter the target. The target source is divided into balanced and unbalanced types; the balanced target source is uniformly coated, and the unbalanced target coating layer and the substrate have strong bonding force.
Balanced target sources are mostly used in semiconductor optical films, and unbalanced are mostly used in wear decorative films. Sputtering metals and alloys with a magnetron target is easy, and it is convenient for ignition and sputtering. Magnetron reactive sputtering insulators appear to be easy, but it is difficult for practical operations.
The magnetron cathodes are roughly classified into an equilibrium state and an unbalanced magnetron cathode according to the distribution of the magnetic field configuration. Cooling is necessary for all sources (magnetron, multiarc, ion) because a large part of the energy is converted to heat. If there is no cooling or insufficient cooling, this heat will cause the target temperature to reach more than 1000°C to dissolve the entire target.
Main uses of magnetron sputtering are the following:
Various functional films: such as films having absorption, transmission, reflection, refraction, polarization, and so on. For example, a silicon nitride antireflection film is deposited at a low temperature to improve the photoelectric conversion efficiency of the solar cell.
Applications in the field of decoration, such as various total reflection films and translucent films, such as cell phone cases, mice, etc.
As a nonthermal coating technology in the field of microelectronics, mainly used in chemical vapor deposition (CVD) or metal organics.
Chemical vapor deposition (MOCVD) growth is difficult and unsuitable material film deposition, and a very uniform film of a large area can be obtained.
In the field of optics: if closed-field unbalanced magnetron sputtering technology has also been applied in optical films (such as antireflection film), low-emissivity glass, and transparent conductive glass. In particular, transparent conductive glass is widely used in flat panel display devices, solar cells, microwave and RF shielding devices, and devices, sensors, and the like.
In the machining industry, the surface deposition technology of surface functional film, super hard film, and self-lubricating film has been developed since its inception, which can effectively improve surface hardness, composite toughness, wear resistance, and high temperature chemical stability. Performance greatly increases the service life of coated products.
In addition to the abovementioned fields that have been widely used, magnetron sputtering plays an important role in the research of high-temperature superconducting thin films, ferroelectric thin films, giant magnetoresistive thin films, thin film luminescent materials, solar cells, and memory alloy thin films.
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He was born in 1969 in Naama, Algeria. He received his BS degree in 1993, the MS degree in 1997, the PhD degree in 2007 from the Electrical Engineering Institute of Djilali Liabes University of Sidi Bel Abbes (ALGERIA). He is an active member of IRECOM (Interaction Réseaux Electriques - COnvertisseurs Machines) Laboratory and IEEE senior member. He is an editor member for many international journals (IJET, RSE, MER, IJECE, etc.), he serves as a reviewer in international journals (IJAC, ECPS, COMPEL, etc.). He serves as member in technical committee (TPC) and reviewer in international conferences (CHUSER 2011, SHUSER 2012, PECON 2012, SAI 2013, SCSE2013, SDM2014, SEB2014, PEMC2014, PEAM2014, SEB (2014, 2015), ICRERA (2015, 2016, 2017, 2018,-2019), etc.). His current research interest includes power electronics, control of electrical machines, artificial intelligence and Renewable energies.",institutionString:"University of Béchar",institution:{name:"University of Béchar",country:{name:"Algeria"}}},{id:"99749",title:"Dr.",name:"Abdel Hafid",middleName:null,surname:"Essadki",slug:"abdel-hafid-essadki",fullName:"Abdel Hafid Essadki",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Nationale Supérieure de Technologie",country:{name:"Algeria"}}},{id:"101208",title:"Prof.",name:"Abdel Karim",middleName:"Mohamad",surname:"El Hemaly",slug:"abdel-karim-el-hemaly",fullName:"Abdel Karim El Hemaly",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/101208/images/733_n.jpg",biography:"OBGYN.net Editorial Advisor Urogynecology.\nAbdel Karim M. A. El-Hemaly, MRCOG, FRCS � Egypt.\n \nAbdel Karim M. A. El-Hemaly\nProfessor OB/GYN & Urogynecology\nFaculty of medicine, Al-Azhar University \nPersonal Information: \nMarried with two children\nWife: Professor Laila A. Moussa MD.\nSons: Mohamad A. M. El-Hemaly Jr. MD. Died March 25-2007\nMostafa A. M. El-Hemaly, Computer Scientist working at Microsoft Seatle, USA. \nQualifications: \n1.\tM.B.-Bch Cairo Univ. June 1963. \n2.\tDiploma Ob./Gyn. Cairo Univ. April 1966. \n3.\tDiploma Surgery Cairo Univ. Oct. 1966. \n4.\tMRCOG London Feb. 1975. \n5.\tF.R.C.S. Glasgow June 1976. \n6.\tPopulation Study Johns Hopkins 1981. \n7.\tGyn. Oncology Johns Hopkins 1983. \n8.\tAdvanced Laparoscopic Surgery, with Prof. Paulson, Alexandria, Virginia USA 1993. \nSocieties & Associations: \n1.\t Member of the Royal College of Ob./Gyn. London. \n2.\tFellow of the Royal College of Surgeons Glasgow UK. \n3.\tMember of the advisory board on urogyn. FIGO. \n4.\tMember of the New York Academy of Sciences. \n5.\tMember of the American Association for the Advancement of Science. \n6.\tFeatured in �Who is Who in the World� from the 16th edition to the 20th edition. \n7.\tFeatured in �Who is Who in Science and Engineering� in the 7th edition. \n8.\tMember of the Egyptian Fertility & Sterility Society. \n9.\tMember of the Egyptian Society of Ob./Gyn. \n10.\tMember of the Egyptian Society of Urogyn. \n\nScientific Publications & Communications:\n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Asim Kurjak, Ahmad G. Serour, Laila A. S. Mousa, Amr M. Zaied, Khalid Z. El Sheikha. \nImaging the Internal Urethral Sphincter and the Vagina in Normal Women and Women Suffering from Stress Urinary Incontinence and Vaginal Prolapse. Gynaecologia Et Perinatologia, Vol18, No 4; 169-286 October-December 2009.\n2- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nFecal Incontinence, A Novel Concept: The Role of the internal Anal sphincter (IAS) in defecation and fecal incontinence. Gynaecologia Et Perinatologia, Vol19, No 2; 79-85 April -June 2010.\n3- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nSurgical Treatment of Stress Urinary Incontinence, Fecal Incontinence and Vaginal Prolapse By A Novel Operation \n"Urethro-Ano-Vaginoplasty"\n Gynaecologia Et Perinatologia, Vol19, No 3; 129-188 July-September 2010.\n4- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n5- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n6- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n7-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n8-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n9-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n10-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n11-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n12- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n13-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n14- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n15-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n\n16-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n17- Abdel Karim M. El Hemaly. Nocturnal Enureses: An Update on the pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecology/?page=/ENHLIDH/PUBD/FEATURES/\nPresentations/ Nocturnal_Enuresis/nocturnal_enuresis\n\n18-Maternal Mortality in Egypt, a cry for help and attention. The Second International Conference of the African Society of Organization & Gestosis, 1998, 3rd Annual International Conference of Ob/Gyn Department � Sohag Faculty of Medicine University. Feb. 11-13. Luxor, Egypt. \n19-Postmenopausal Osteprosis. The 2nd annual conference of Health Insurance Organization on Family Planning and its role in primary health care. Zagaziz, Egypt, February 26-27, 1997, Center of Complementary Services for Maternity and childhood care. \n20-Laparoscopic Assisted vaginal hysterectomy. 10th International Annual Congress Modern Trends in Reproductive Techniques 23-24 March 1995. Alexandria, Egypt. \n21-Immunological Studies in Pre-eclamptic Toxaemia. Proceedings of 10th Annual Ain Shams Medical Congress. Cairo, Egypt, March 6-10, 1987. \n22-Socio-demographic factorse affecting acceptability of the long-acting contraceptive injections in a rural Egyptian community. Journal of Biosocial Science 29:305, 1987. \n23-Plasma fibronectin levels hypertension during pregnancy. The Journal of the Egypt. Soc. of Ob./Gyn. 13:1, 17-21, Jan. 1987. \n24-Effect of smoking on pregnancy. Journal of Egypt. Soc. of Ob./Gyn. 12:3, 111-121, Sept 1986. \n25-Socio-demographic aspects of nausea and vomiting in early pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 35-42, Sept. 1986. \n26-Effect of intrapartum oxygen inhalation on maternofetal blood gases and pH. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 57-64, Sept. 1986. \n27-The effect of severe pre-eclampsia on serum transaminases. The Egypt. J. Med. Sci. 7(2): 479-485, 1986. \n28-A study of placental immunoreceptors in pre-eclampsia. The Egypt. J. Med. Sci. 7(2): 211-216, 1986. \n29-Serum human placental lactogen (hpl) in normal, toxaemic and diabetic pregnant women, during pregnancy and its relation to the outcome of pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:2, 11-23, May 1986. \n30-Pregnancy specific B1 Glycoprotein and free estriol in the serum of normal, toxaemic and diabetic pregnant women during pregnancy and after delivery. Journal of the Egypt. Soc. of Ob./Gyn. 12:1, 63-70, Jan. 1986. Also was accepted and presented at Xith World Congress of Gynecology and Obstetrics, Berlin (West), September 15-20, 1985. \n31-Pregnancy and labor in women over the age of forty years. Accepted and presented at Al-Azhar International Medical Conference, Cairo 28-31 Dec. 1985. \n32-Effect of Copper T intra-uterine device on cervico-vaginal flora. Int. J. Gynaecol. Obstet. 23:2, 153-156, April 1985. \n33-Factors affecting the occurrence of post-Caesarean section febrile morbidity. Population Sciences, 6, 139-149, 1985. \n34-Pre-eclamptic toxaemia and its relation to H.L.A. system. Population Sciences, 6, 131-139, 1985. \n35-The menstrual pattern and occurrence of pregnancy one year after discontinuation of Depo-medroxy progesterone acetate as a postpartum contraceptive. Population Sciences, 6, 105-111, 1985. \n36-The menstrual pattern and side effects of Depo-medroxy progesterone acetate as postpartum contraceptive. Population Sciences, 6, 97-105, 1985. \n37-Actinomyces in the vaginas of women with and without intrauterine contraceptive devices. Population Sciences, 6, 77-85, 1985. \n38-Comparative efficacy of ibuprofen and etamsylate in the treatment of I.U.D. menorrhagia. Population Sciences, 6, 63-77, 1985. \n39-Changes in cervical mucus copper and zinc in women using I.U.D.�s. Population Sciences, 6, 35-41, 1985. \n40-Histochemical study of the endometrium of infertile women. Egypt. J. Histol. 8(1) 63-66, 1985. \n41-Genital flora in pre- and post-menopausal women. Egypt. J. Med. Sci. 4(2), 165-172, 1983. \n42-Evaluation of the vaginal rugae and thickness in 8 different groups. Journal of the Egypt. Soc. of Ob./Gyn. 9:2, 101-114, May 1983. \n43-The effect of menopausal status and conjugated oestrogen therapy on serum cholesterol, triglycerides and electrophoretic lipoprotein patterns. Al-Azhar Medical Journal, 12:2, 113-119, April 1983. \n44-Laparoscopic ventrosuspension: A New Technique. Int. J. Gynaecol. Obstet., 20, 129-31, 1982. \n45-The laparoscope: A useful diagnostic tool in general surgery. Al-Azhar Medical Journal, 11:4, 397-401, Oct. 1982. \n46-The value of the laparoscope in the diagnosis of polycystic ovary. Al-Azhar Medical Journal, 11:2, 153-159, April 1982. \n47-An anaesthetic approach to the management of eclampsia. Ain Shams Medical Journal, accepted for publication 1981. \n48-Laparoscopy on patients with previous lower abdominal surgery. Fertility management edited by E. Osman and M. Wahba 1981. \n49-Heart diseases with pregnancy. Population Sciences, 11, 121-130, 1981. \n50-A study of the biosocial factors affecting perinatal mortality in an Egyptian maternity hospital. Population Sciences, 6, 71-90, 1981. \n51-Pregnancy Wastage. Journal of the Egypt. Soc. of Ob./Gyn. 11:3, 57-67, Sept. 1980. \n52-Analysis of maternal deaths in Egyptian maternity hospitals. Population Sciences, 1, 59-65, 1979. \nArticles published on OBGYN.net: \n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n2- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n3- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n4-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n5-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n6-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n7-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n8-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n9- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n10-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n11- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n12-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n13-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n14- Abdel Karim M. El Hemaly. 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