Building a Care Management and Guidance Security System for Assisting Patients with Cognitive Impairment
Round 1
Reviewer 1 Report
Thank you for the opportunity to review this manuscript. I believe the authors did a great job in the conceptualization and approach to the study design. The use of figures, images and tables significantly contributed to the understanding of the interchange of the various models used.
Here are some recommendations:
- The reader was not able to find a statement regarding IRB for this study. Please provide IRB approval and number.
- Change the use of 'demented elderly' or 'mentally retarded' to cognitively impaired, which is broadly used in the USA, Canada and other countries. These terms may come across as insensitive to the reader.
- There are multiple syntax errors throughout the manuscript. There are also grammatical/punctuation errors throughout. The statement from lines 53-56 needs citation. Provide a description or remove "and so on.." line 67. There appears to be two separate paragraphs under section 2.3 (see line 154). Remove redundant statement from lines 224-226.
- Table 2. Indicate if this table is modified from its source or if permission was obtained for use in your study.
- The entire manuscript is written in present tense as if it is a research proposal, which is confusing to the reader.
- Section 3.1.2 does not indicate if there is an inclusion/exclusion criteria for the participants in the study. Describe characteristics of participants such as age, disease or other comorbidities that may influence cognition including depression, medications etc).
- For the use of semi-structure interviews, it will be helpful to provide a couple of samples of the questions and answers provided. There is mention of surveys administered in addition to the interviews. Please provide information on the surveys (type, measures of validity etc).
- Describe process used for thematic analysis.
- There were 6 service needs identified and implemented. What level of cognitive impairment were the participants? and were there any problems experienced by the participants in their ability to operate their wearable devices?
- In the discussion section, please address any studies that have been conducted on the use of this technology with patients with cognitive impairment. How did your results compare with previous studies?
- For the conclusion please add limitations of your study and future recommendations.
Author Response
Response to Reviewer 1 Comments
We are very grateful for reviewer1’s comments which make the results of this paper more solid. The manuscript was revised in accordance with the reviewers' comments and suggestions, followed by professional extensive English editing (English language editing by MDP, English-24588, Attachment 1). Followings are our description of revision according to the reviewer1’s comments.
This paper was rewritten and integrated the introduction with the literature discussion. At the same time, the research methods/results/discussions/conclusions are also readjusted.
a. Introduction: The introduction is rewritten and combined with the literature reviewed section, and the redundant words and sentences are also modified（Please referred to 1. Introduction，Line39-123）.
b. Research method: In this paper, we add a Data analysis section and Reliability and validity of the experiment section to make the method and analysis clearer (Please referred to Line 159-291).
c. Discussion and Conclusion section: we also rewrote these two sections, and focus on the important conclusions of this article and delete irrelevant parts. (Please refer to Discussion and Conclusion)
Point 1: The reader was not able to find a statement regarding IRB for this study. Please provide IRB approval and number.
Response 1: Thank you very much for your comments. Please refer to Method section: 　line 151-154, with the following announcement:
All participants gave their informed consent for inclusion before they participated in this study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Researc044), 2018, October 29th.
Point 2: Change the use of 'demented elderly' or 'mentally retarded' to cognitively impaired, which is broadly used in the USA, Canada, and other countries. These terms may come across as insensitive to the reader.
Response 2: Thank you very much for the comments of the reviewers to change the necessary 'demented elderly' or 'mentally retarded' to cognitively impaired, but some vocabulary adjustments will hinder the maintenance of understanding because getting lost is mainly a spatial cognitive impairment.
Point 3:There are multiple syntax errors throughout the manuscript. There are also grammatical/punctuation errors throughout. The statement from lines 53-56 needs citation. Provide a description or remove "and so on.." line 67. There appear to be two separate paragraphs under section 2.3 (see line 154). Remove redundant statement from lines 224-226.
Response 3:
>>>>There are multiple syntax errors throughout the manuscript. There are also grammatical/punctuation errors throughout.
Response:　The full text has been revised and edited in English. Please refer to the attached English editing certificate.
>>>>The statement from lines 53-56 needs citation.
Response: It has been modified, please refer to line61-64.
>>>>Provide a description or remove "and so on.." line 67.
Response: It has been Deleted and rewritten, please refer to line61-64.
>>>>There appear to be two separate paragraphs under section 2.3 (see line 154). Remove redundant statement from lines 224-226.
Response: Thank you for your correction, it has been deleted and corrected. And rewrite the Introduction and Method section, please refer to the Introduction, Method.
Point 4: Table 2. Indicate if this table is modified from its source or if permission was obtained for use in your study.
Response 4: This table is the result of the analysis of the activity, environment, interaction, object, and user (AEIOU) of the observation participants in the nursing center in this study.
Point 5: The entire manuscript is written in present tense as if it is a research proposal, which is confusing to the reader.
Response 5: Thank you for your comments. The full text has been revised and edited in English. Please refer to the attached English editing certificate.
Point 6: Section 3.1.2 does not indicate if there is an inclusion/exclusion criteria for the participants in the study. Describe characteristics of participants such as age, disease or other comorbidities that may influence cognition including depression, medications etc).
Response 6: Thank you for your comments. I have rewritten and explained in 2.1.1. Semi-structured interview (line159-177) and 2.4. Data Analysis (line 230-236).
Point 7: For the use of semi-structure interviews, it will be helpful to provide a couple of samples of the questions and answers provided. There is mention of surveys administered in addition to the interviews. Please provide information on the surveys (type, measures of validity etc).
Response 7: Thanks for your comments, the author re-written the method section, please refer to 2.1.1. Semi-structured interview (line159-177), 2.3. Reliability and Validity of the Experiment (line203-222) .
Point 8: Describe process used for thematic analysis.
Response8: Thank you for your comments. The author adds 2.4. Data Analysis (line223-291) for the analysis part.2.4.
Point 9: There were 6 service needs identified and implemented. What level of cognitive impairment were the participants? and were there any problems experienced by the participants in their ability to operate their wearable devices?
Response 9: Thank you for your comments. The six service needs were the potential needs formed by the five-person expert focus team according to AEIOU analysis and behavior modeling. This research was used to develop the care management and indoor guidance system based on these needs. This study only tested the technical verification of the indoor positioning system used. An actual wearable experiment of patients with cognitive impairment has not been formally conducted. Actual clinical practice will be carried out in the future to verify the effectiveness of the care management and indoor guidance system.
Point 10: In the discussion section, please address any studies that have been conducted on the use of this technology with patients with cognitive impairment. How did your results compare with previous studies?
Response 10: Thank you for your comments. The discussion section has been rewritten. This section discusses the necessity of home-based care management and indoor guidance service system from two aspects: the need to assist road finding for cognitively impaired elderly and to reduce the burden of care management (4. Discussion, line 563-602).
Point 11: 11. For the conclusion please add limitations of your study and future recommendations.
Response 11: Thank you for your comments. The conclusion has added the limitations and future works recommendations (line 604-620).
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The authors have submitted a manuscript on a Security System guidance for demented patients. However, the manuscript presents important methodological errors that prevent its publication in its current version. The reviewer will report the points that need to be modified following the order of the manuscript:
Abstract section.
It does not appear what type of study has been designed. Subsequently, reference is made to six studies carried out. However, individualized results of each study are not observed, nor is it defined what they consist of. The reviewer advises the authors to adequately define the methods used. Likewise, the verb tense of a scientific manuscript must be past simple.
Introduction section
The authors write "... Taiwan will enter and" aging society "in 2018. This sentence cannot be written in the future simple. On page 2, line 62 the authors do not define the objective of the study. If the authors are presenting a study protocol, it should be stated in the title. Point 2. -literature Review This point is meaningless after the introduction. The literature review is the introduction itself and ends with a study objective.
Methods section
The authors do not define the type of study or studies carried out, they do not show the sample size, or the calculation of the sample size. They also do not define the power of the study. The reviewer advises the authors to specify these points in the methods section. 3.1. Demand Exploration stage The reviewer advises the authors to clearly define each point, to explain why such short study samples were chosen. Also, if the studies are sequential, the authors should provide a flow chart to facilitate understanding of the sequence of studies.
Results section
The results are not quantified. There is an excess of text in this section that contrasts with the brevity and absence of bibliographic references to contrast the discussion.
Figure 13 lacks legend
Author Response
Response to Reviewer 2 Comments
We are very grateful to reviewer2’s comments which make the results of this paper more solid. The manuscript was revised in accordance with the reviewers' comments and suggestions, followed by professional extensive English editing (English language editing by MDP, English-24588, Attachment 1). Followings are our description of revision according to the reviewer2’s comments.
This paper was rewritten and integrated the introduction with the literature discussion. At the same time, the research methods/results/discussions/conclusions are also readjusted.
- Introduction: The introduction is rewritten and combined with the literature reviewed section, and the redundant words and sentences are also modified（Please referred to 1. Introduction，Line39-123.
- Research method: In this paper, we add a Data analysis section and Reliability and validity of the experiment section to make the method and analysis clearer (Please referred to Line 159-291).
- Discussion and Conclusion section: we also rewrote these two sections, and focus on the important conclusions of this article and delete irrelevant parts. (Please refer to Discussion and Conclusion)
Point 1: Abstract section.
It does not appear what type of study has been designed. Subsequently, reference is made to six studies carried out. However, individualized results of each study are not observed, nor is it defined what they consist of. The reviewer advises the authors to adequately define the methods used. Likewise, the verb tense of a scientific manuscript must be past simple.
Response 1: Thank you very much for your comments. The abstract has been rewritten and the verb tenses have been modified. The method used in the experiment has also been explained clearly. Please refer to the abstract, refer to line12-35.
Point 2: Introduction section
The authors write "... Taiwan will enter and" aging society "in 2018. This sentence cannot be written in the future simple. On page 2, line 62 the authors do not define the objective of the study. If the authors are presenting a study protocol, it should be stated in the title. Point 2. -literature Review This point is meaningless after the introduction. The literature review is the introduction itself and ends with a study objective.
Response 2: Thank you very much for the comments. The introduction is rewritten and combined with the literature reviewed section, and the redundant words and sentences are also modified（Please referred to 1. Introduction，Line39-123.
Point 3: Methods section
The authors do not define the type of study or studies carried out, they do not show the sample size, or the calculation of the sample size. They also do not define the power of the study. The reviewer advises the authors to specify these points in the methods section. 3.1. Demand Exploration stage The reviewer advises the authors to clearly define each point, to explain why such short study samples were chosen. Also, if the studies are sequential, the authors should provide a flow chart to facilitate understanding of the sequence of studies.
Response 3: The methods section has been rewritten. In this paper, we explain that this is qualitative research, and use the research process of service design to explore the unmet needs, and add data analysis section and reliability and validity of the experience section to make the method and analysis cleaner (please refer to line 159-291)
Point 4: Results section
The results are not quantified. There is an excess of text in this section that contrasts with the brevity and absence of bibliographic references to contrast the discussion.
Figure 13 lacks legend
Response 4: This paper used qualitative research methods (i.e., participatory interviews, case studies, and contextual observation methods) in the demand exploration phase and quantitative research methods in the product’s technological verification phase. Therefore, only the indoor positioning experiments have quantitative results, and the rest are qualitative results. In this study, we implemented a three-stage service design process—demand exploration, demand definition, and design execution stage—to analyze the care status and road recognition obstacles of elders with dementia to identify hidden needs as a turning point for new product innovations in care management and guidance security.
Figure 13 lacks legend
Response: Please refer to line 530.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Thank you for the opportunity to provide this follow up review regarding your manuscript. The manuscript is significantly improved by previous recommendations. I suggest modification to the following line items.
Line 207. Suggested "Reliability and Validity Measures"
Line 208. "The purpose of this study was to improve the reliability..." please reword as it is in conflict with the purpose of the study described elsewhere in the manuscript.
Line 258 "will be presented". Should this statement say "are presented"? are the various objects presented in the form of graphs? if so, please state it and identify the graphs/images.
Lines 260 - 269 recruitment of experts for the focus groups. Recommend this part to be in the methods section. The results from the focus groups is not apparent in the results section. Recommend to describe the priority concepts identified in the focus groups and refer to them in a form of graph or table.
Author Response
Response to Reviewer 1 Comments
We are very grateful for reviewer1’s comments which make the results of this paper more solid. The manuscript was revised in accordance with the reviewers' comments and suggestions. Followings are our description of revision according to the reviewer1’s comments.
Point 1: Line 207. Suggested "Reliability and Validity Measures"
Response 1: Thank you very much for your comments. The title has been revised, please refer to line 213.
Point 2: Line 208. "The purpose of this study was to improve the reliability..." please reword as it is in conflict with the purpose of the study described elsewhere in the manuscript.
Response 2: Thank you very much for your comments. The sentence has been revised, please refer to line 214-215.
Point 3: Line 258 "will be presented". Should this statement say "are presented"? are the various objects presented in the form of graphs? if so, please state it and identify the graphs/images.
Response 3: The paragraph has been revised with additional illustrations. Please refer to line 260-269
Point 4-1: Lines 260 - 269 recruitment of experts for the focus groups. Recommend this part to be in the methods section.
Response 4-1: Thanks for your comments, 260-269 has been moved to the Method section, please refer to line 195-204.
Point 4-2: The results from the focus groups is not apparent in the results section. Recommend to describe the priority concepts identified in the focus groups and refer to them in a form of graph or table.
Response 4-2: Thank you for your comments. The paragraph has been modified and the discussion of the affinity graph has been added. Please refer to line 372-379
Author Response File: Author Response.pdf
Reviewer 2 Report
.
Author Response
Response to Reviewer 2 Comments
We are very grateful for reviewer2’s comments which make the results of this paper more solid. The manuscript was revised in accordance with the reviewers' comments and suggestions.
