Study of Patients' Privacy during the COVID-19 Pandemic in Iranian Health Care Settings.

Background: Patient's privacy protection is a challenging ethical issue. The complex situation of the COVID-19 pandemic was a probable predictor of breaching confidentiality. This study aimed to assess the viewpoints of COVID-19-confirmed patients, who were hospitalized, and their healthcare providers about the compliance of different aspects of patient's privacy. Methods: This cross-sectional study included 3433 COVID-19-confirmed patients who were hospitalized in Kerman, between 2020 and 2021, and about 1228 related physicians, nurses, and paraclinical staff. Two separate validated researcher-made questionnaires were developed, each including subscales for physical, informational, and spatial privacy, as well as a satisfaction rate of privacy protection. The data were analyzed using SPSS software version 26, with independent samples t test, Mann-Whitney-U, Kruskal Wallis, and Multiple Linear Regression tests at a 95% confidence interval. Results: The mean percentages of the patients' privacy scores in physical, spatial, and informational areas were significantly lower (P<0.001) than the average of the medical staff's scores in all three areas (Difference: 10.27%, 14.83%, and 4.91%, respectively). Physical and spatial privacy scores could be predicted based on the participants' classification, patients or medical staff, and sex. The mean patients' satisfaction score was 9.25% lower than the medical staff's (P<0.001). Moreover, only academic hospitals showed a statistically significant difference between the patient's satisfaction with privacy protection and medical staff's viewpoints (P<0.001). Conclusion: Although this study indicated the benefits of protecting patients' privacy in the healthcare setting, patients' privacy scores and satisfaction were lower than their healthcare providers. The pandemic conditions might have been an obstacle to preserving patients' rights. These findings demonstrated the importance of sensitizing healthcare providers to manage these ethical challenges in a complicated critical state such as the COVID-19 pandemic.

[Intentional search and reclassification of maternal deaths: quality information and its analysis to reduce maternal mortalityBusca intencional e reclassificação de mortes maternas: informação de qualidade e sua análise para reduzir a mortalidade materna]. / Búsqueda intencionada y reclasificación de muertes maternas: información de calidad y su análisis para reducir la mortalidad materna.

Objective: To describe the methodology of the intentional search and reclassification of maternal deaths (BIRMM, acronym in Spanish), which allows the identification and correction of misclassification and underreporting of maternal deaths. Methods: The BIRMM methodology, initially developed in Mexico in 2003 and disseminated in other Latin American countries since 2012, was used. BIRMM consists of four key components: i) reclassification of confirmed maternal deaths; ii) identification and investigation of suspected cases of maternal death; iii) cross-referencing with other information sources; and iv) publication of results and statistical analysis. Results: The application of BIRMM makes it possible to identify and analyze maternal deaths in maternal mortality committees, which has facilitated the implementation of effective response plans, contributing to a sustained reduction in maternal mortality in the countries. Conclusions: The BIRMM methodology is an effective tool for correcting underreporting and misclassification of maternal deaths, allowing better surveillance and response to this problem. Its adoption and routine implementation are essential to improve the quality of maternal mortality information and reduce maternal deaths in the Region of the Americas. The sustainability of this methodology depends on institutional commitment and political will in the countries.

Objetivo: Descrever a metodologia da busca intencional e reclassificação de mortes maternas (BIRMM), que permite identificar e corrigir erros de classificação e subnotificação de mortes maternas. Método: Foi utilizada a metodologia BIRMM, desenvolvida inicialmente no México em 2003 e disseminada em outros países da América Latina a partir 2012. A BIRMM consiste em quatro componentes principais: i) reclassificação de mortes maternas confirmadas ii) identificação e investigação de mortes maternas suspeitas; iii) confrontação com outras fontes de informação e iv) publicação de resultados e análise estatística. Resultados: A aplicação da BIRMM permite identificar e analisar as mortes maternas nos comitês de mortalidade materna, o que facilitou a implementação de planos de resposta eficazes, contribuindo para uma redução sustentada da mortalidade materna nos países. Conclusões: A metodologia BIRMM é uma ferramenta eficaz para corrigir a subnotificação e a classificação incorreta de mortes maternas, permitindo uma melhor vigilância e resposta a este problema. Sua adoção e implementação rotineira são essenciais para melhorar a qualidade da informação sobre mortalidade materna e reduzir as mortes maternas na Região das Américas. A sustentabilidade desta metodologia depende do compromisso institucional e da vontade política dos países.

Advancing health equity and the role of digital health technologies: a scoping review protocol.

INTRODUCTION: Healthcare systems around the world exhibit inherent systemic inequities that disproportionately impact marginalised populations. Digital health technologies (DHTs) hold promising potential to address these inequities and to play a pivotal role in advancing health equity. However, there is a notable gap regarding a comprehensive and structured overview of existing frameworks and guidelines on advancing health equity and a clear understanding of the potential of DHTs in their implementation. To this end, our primary objectives are first to identify prevalent frameworks and guidelines that promote health equity and second to pinpoint the contemporary role of DHTs as an avenue for implementing these frameworks and guidelines. This synthesis will guide future DHTs, ensuring equitable accessibility and effectiveness and ultimately contributing to enhancing health equity among marginalised populations. METHODS AND ANALYSIS: This work adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Reviews. To identify pertinent evidence, we will employ seven electronic databases (PubMed, EMBASE, Cochrane, PsycINFO, Scopus, Web of Science and WISO) encompassing the fields of medicine, healthcare and social sciences. Moreover, selected grey literature will be considered. We will include primary and secondary studies published in English between 2010 and 2023 that focus on (technology and non-technology-based) frameworks and guidelines for health equity improvement. Each article will undergo an independent assessment for eligibility, followed by the extraction of pertinent data from eligible sources. Subsequently, the extracted data will be subjected to qualitative and quantitative analyses, and findings will be presented using narrative and descriptive formats. ETHICS AND DISSEMINATION: Ethical approval is deemed unnecessary for this scoping review, as it involves synthesising existing knowledge. The findings from this study will be disseminated through peer-reviewed publications. PROTOCOL REGISTRATION: https://osf.io/94pht.

Web log mining techniques to optimize Apriori association rule algorithm in sports data information management.

To optimize the current college sports data information management system, this study combines the Apriori association rule algorithm with web application development technology to upgrade the management system. Firstly, this study explores novel log mining techniques in genetic algorithms and web application development technology. Secondly, by integrating log mining techniques to optimize the Apriori algorithm, associations between sports data and information are discovered. Through the optimized algorithm, this study identifies key association rules of sports data information and validates the optimized system's reliability and effectiveness through experiments. The experimental results show that the running time of the traditional Apriori algorithm exponentially grows with the increase in information volume, while the optimized execution efficiency is improved by approximately 10-15%. Additionally, the average retrieval accuracy of this optimized system can reach 98.3%, although the retrieval time also increased by 23%. Therefore, the technology and algorithms proposed in this study have certain application value in the sports information management system and contribute to the optimization of data information management in this field.

Effects of Implementing a Barcode Information Management System on Operating Room Staff: Comparative Study.

BACKGROUND: Barcode information management systems (BIMS) have been implemented in operating rooms to improve the quality of medical care and administrative efficiency. Previous research has demonstrated that the Agile development model is extensively used in the development and management of information systems. However, the effect of information systems on staff acceptance has not been examined within the context of clinical medical information management systems. OBJECTIVE: This study aimed to explore the effects and acceptance of implementing a BIMS in comparison to the original information system (OIS) among operating and supply room staff. METHODS: This study was a comparative cohort design. A total of 80 staff members from the operating and supply rooms of a Northern Taiwan medical center were recruited. Data collection, conducted from January 2020 to August 2020 using a mobile-based structured questionnaire, included participant characteristics and the Information Management System Scale. SPSS (version 20.0, IBM Corp) for Windows (Microsoft Corporation) was used for data analysis. Descriptive statistics included mean, SD, frequency, and percentage. Differences between groups were analyzed using the Mann-Whitney U test and Kruskal-Wallis test, with a P value <.05 considered statistically significant. RESULTS: The results indicated that the BIMS generally achieved higher scores in key elements of system success, system quality, information quality, perceived system use, perceived ease of use, perceived usefulness, and overall quality score; none of these differences were statistically significant (P>.05), with the system quality subscale being closest to significance (P=.06). Nurses showed significantly better perceived system use than technicians (1.58, SD 4.78 vs -1.19, SD 6.24; P=.02). Significant differences in perceived usefulness were found based on educational level (P=.04) and experience with OIS (P=.03), with junior college-educated nurses and those with over 6 years of OIS experience reporting the highest perceived usefulness. CONCLUSIONS: The study demonstrates that using the Agile development model for BIMS is advantageous for clinical environments. The high acceptance among operating room staff underscores its practicality and broader adoption potential. It advocates for continued exploration of technology-driven solutions to enhance health care delivery and optimize clinical workflows.

Trend of RTS,S vaccine uptake in the malaria vaccine implementing programme (MVIP) pilot regions, Ghana; 2019-2022.

Introduction: The uptake trend of a new vaccine is unpredictable and may reflect the quality of introduction process and community acceptance. The objective of this study was to conduct a trend analysis of RTS,S malaria vaccine uptake in the seven pilot regions of Ghana from 2019 to 2022. The findings are envisaged to strengthen malaria vaccine introductions in the future. Methods: A retrospective analysis was conducted on routine childhood immunisation data for 2019-2022. Coverages for the first (RTS,S1), second (RTS,S2), third (RTS,S3) and fourth (RTS,S4) doses of malaria vaccine; third dose of diphtheria, tetanus, pertussis-containing vaccine (DTP3/Penta3); first dose measles-rubella (MR1) and second dose measles-rubella (MR2) vaccines were calculated. Dropout rates and uptake gaps were estimated to assess variations in the uptake of consecutive RTS,S schedules; and the differences in the uptake of RTS,S and the comparator vaccines, respectively. Results: Nationally, the coverages of the first three doses of the RTS,S malaria vaccine rose sharply from 2019 (RTS,S1 = 54.9 %; RTS,S2 = 54.6 %; RTS,S3 = 38.6 %) through 2020 (RTS,S1 = 70.7 %; RTS,S2 = 67.4 %; RTS,S3 = 66.3 %) to peaks in 2021 (RTS,S1 = 76.0 %; RTS,S2 = 73.1 %; RTS,S3 = 74.2 %), and declined marginally in 2022 (RTS,S1 = 74.0 %; RTS,S2 = 69.9 %; RTS,S3 = 71.3 %). For the fourth dose, the low uptake in 2020 (7.5 %) was followed by a steep rise in 2021 (46.9 %) that continued, but at a reduced rate to 50.6% in 2022. The dropout rates and uptake gaps were initially high but declined consistently over the study period. Generally, the trends in vaccination coverages, and dropout rates and uptake gaps at the national level were reflected in the respective regions. Conclusion: The coverage of RTS,S malaria vaccine improved consistently over the study period despite the low uptake in the early phase of the pilot. While the decreasing dropout rates and uptake gaps may indicate improved community acceptance, strengthening immunisation service delivery is crucial in sustaining the observed trajectory.

Design and implementation of college students' physical education teaching information management system by data mining technology.

This study intends to improve the efficiency of physical education teaching management, accelerate the normal teaching process, and meet the modern management requirements that traditional teaching management methods cannot meet. Based on data mining technology, this study designs a college student physical education teaching information management system, and makes a detailed design of each functional module. The main task of this study is to investigate how to effectively integrate data mining techniques with existing university student physical education teaching databases. Then, this study finds useful data information from massive data information to provide information support for university student physical education teaching. In order to effectively mine the relevant information of the data, the student evaluation module in the system is designed based on decision trees, and the teacher-student related data analysis module in the system is designed based on association rules. The research results indicate that 1039 records and 8205 student records are extracted from the teaching management database as mining objects. Rule 1: The support rate for "a professor's degree is a doctoral degree" is 20.4 %, indicating that there are 20.4 % of records in the teacher database that "the title is a professor and a doctoral degree"; the confidence level of Rule 1 is 78.2 %, indicating that 78.2 % of professors have a doctoral degree. Through the analysis of the rules that evaluate teaching as good, it can be found that the three attributes of professional title, education level, and teaching experience are the most important relevant factors affecting teaching effectiveness. Research has shown that the longer and richer the teaching experience, the stronger the teaching ability. Secondly, the mining results obtained through data mining techniques are analyzed. The maximum difference between the original algorithm's support mining results and the true values is 0.08, while the maximum difference between the improved algorithm's support mining results and the true values is 0.01. Compared to the original algorithm, the improved algorithm's mining results are accurate and effective. The application of data mining ideas in this system has laid a solid foundation for the development of physical education and teaching. Moreover, a three-layer system architecture model is adopted to better adapt to the development of school physical education, which is beneficial for later system maintenance and greatly reduces the work pressure of teachers. The system has been successfully launched and running in universities, and it is in good working condition.

Influence of doctor-patient trust on the adoption of mobile medical applications during the epidemic: a UTAUT-based analysis.

This study examines the factors influencing users' intention to continue using mobile medical apps within the framework of the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Through a combination of questionnaire surveys and interviews, the research finds that doctor-patient trust, Performance Expectancy (PE), social influence, and facilitating conditions significantly impact users' intention to utilize mobile medical apps. Furthermore, the study reveals the moderating effect of doctor-patient trust on social influence, indicating an increased trust level during the epidemic, attributed to positive media coverage, complimentary medical services, and risk-sharing initiatives. These results provide valuable insights for the field of internet healthcare, COVID-19 response strategies, health information management, and the advancement of digital health technologies, spotlighting the pivotal roles of trust, PE, and social influence in fostering sustained engagement with mobile health apps.

The Spiral Model of Evolution: Stable Life Forms of Organisms and Unstable Life Forms of Cancers.

If one must prioritize among the vast array of contributing factors to cancer evolution, environmental-stress-mediated chromosome instability (CIN) should easily surpass individual gene mutations. CIN leads to the emergence of genomically unstable life forms, enabling them to grow dominantly within the stable life form of the host. In contrast, stochastic gene mutations play a role in aiding the growth of the cancer population, with their importance depending on the initial emergence of the new system. Furthermore, many specific gene mutations among the many available can perform this function, decreasing the clinical value of any specific gene mutation. Since these unstable life forms can respond to treatment differently than stable ones, cancer often escapes from drug treatment by forming new systems, which leads to problems during the treatment for patients. To understand how diverse factors impact CIN-mediated macroevolution and genome integrity-ensured microevolution, the concept of two-phased cancer evolution is used to reconcile some major characteristics of cancer, such as bioenergetic, unicellular, and multicellular evolution. Specifically, the spiral of life function model is proposed, which integrates major historical evolutionary innovations and conservation with information management. Unlike normal organismal evolution in the microevolutionary phase, where a given species occupies a specific location within the spiral, cancer populations are highly heterogenous at multiple levels, including epigenetic levels. Individual cells occupy different levels and positions within the spiral, leading to supersystems of mixed cellular populations that exhibit both macro and microevolution. This analysis, utilizing karyotype to define the genetic networks of the cellular system and CIN to determine the instability of the system, as well as considering gene mutation and epigenetics as modifiers of the system for information amplification and usage, explores the high evolutionary potential of cancer. It provides a new, unified understanding of cancer as a supersystem, encouraging efforts to leverage the dynamics of CIN to develop improved treatment options. Moreover, it offers a historically contingent model for organismal evolution that reconciles the roles of both evolutionary innovation and conservation through macroevolution and microevolution, respectively.

Recommendations of the Pre-anaesthesia Teleconsultation Task Force.

The main objectives of the pre-anaesthesia consultation are to establish the patient's anaesthesia and surgical risk, evaluate and optimize their health status, provide the patient with information and preoperative recommendations, and fulfil the legally established bureaucratic obligations. The incorporation of information technologies - e-Health - has maximised the efficiency of pre-anaesthesia assessments and provided patients with an added benefit. The SEDAR Task Force has developed a digital framework as an alternative to the conventional pre-anaesthesia assessment process, and has put forward a series of policies and technical recommendations for the incorporation of different types of pre-anaesthesia teleconsultation services in hospital anaesthesiology departments. We also put forward an evaluation tool that includes several quality indicators on which to base continuous improvements in healthcare.

System interoperability and data linkage in the era of health information management: A bibliometric analysis.

Background: Across the world, health data generation is growing exponentially. The continuous rise of new and diversified technology to obtain and handle health data places health information management and governance under pressure. Lack of data linkage and interoperability between systems undermines best efforts to optimise integrated health information technology solutions. Objective: This research aimed to provide a bibliometric overview of the role of interoperability and linkage in health data management and governance. Method: Data were acquired by entering selected search queries into Google Scholar, PubMed, and Web of Science databases and bibliometric data obtained were then imported to Endnote and checked for duplicates. The refined data were exported to Excel, where several levels of filtration were applied to obtain the final sample. These sample data were analysed using Microsoft Excel (Microsoft Corporation, Washington, USA), WORDSTAT (Provalis Research, Montreal, Canada) and VOSviewer software (Leiden University, Leiden, Netherlands). Results: The literature sample was retrieved from 3799 unique results and consisted of 63 articles, present in 45 different publications, both evaluated by two specific in-house global impact rankings. Through VOSviewer, three main clusters were identified: (i) e-health information stakeholder needs; (ii) e-health information quality assessment; and (iii) e-health information technological governance trends. A residual correlation between interoperability and linkage studies in the sample was also found. Conclusion: Assessing stakeholders' needs is crucial for establishing an efficient and effective health information system. Further and diversified research is needed to assess the integrated placement of interoperability and linkage in health information management and governance. Implications: This research has provided valuable managerial and theoretical contributions to optimise system interoperability and data linkage within health information research and information technology solutions.

Leadership style, change management and job performance of health information management practitioners in tertiary hospitals in South-East, Nigeria.

PURPOSE: Managing patients' health information is one of the building blocks of the health system and the adoption of health information technologies like electronic health records (EHRs) is expected to reduce the various challenges in keeping and accessing quality health-care data that aid decision-making among medical practitioners. This study aims to investigate how leadership styles and change management affected the job performance of health information management practitioners on their adoption of EHRs in tertiary hospitals in Nigeria. DESIGN/METHODOLOGY/APPROACH: The study used primary data collected using a Likert scale questionnaire from 117 health information management officers and health information technicians in selected tertiary hospitals in South-Eastern Nigeria. The data were analysed using bivariate correlation and multiple regression techniques of inferential statistics. FINDINGS: The analyses revealed that transformational leadership style, transactional leadership style and change management had significant positive influence on the job performance of health information management practitioners. However, laissez-faire leadership style did not show any significant positive influence. A further analysis showed that the combined effects of leadership styles and change management were also affirmed to significantly influence the adoption of EHRs for quality health-care delivery in Nigerian tertiary hospitals. ORIGINALITY/VALUE: The study contributes to health information management and the need to understand how leadership styles and change management can influence the adoption of EHRs. However, there is no adequate research that examined the role of leadership style and change management in influencing the job performance of Nigerian HIM practitioners regarding their usage of EHRs in tertiary hospitals in Nigeria.

Evaluating information management system in epidemic infectious diseases in Iran.

Health information management is a vital and constructive component of the health system, refers to the process of producing and collecting, organising and storing, analysing, disseminating and using information. The aim of this study was to evaluate the strengths and weaknesses of the information management system in epidemic infectious diseases in Iran, specifically focusing on the registration, reporting, quality, confidentiality, and security of infectious disease data. This assessment was conducted from the perspective of policymakers and experts responsible for data registration and reporting. After examining the processes of registering and reporting infectious disease data and interviewing experts, a researcher-designed questionnaire was prepared to evaluate the infectious disease information management system. To assess the content validity of the Content Validity Index and Content Validity Ratio Index, a questionnaire was utilized. The reliability of the questionnaire was confirmed using Cronbach's alpha. By employing purposeful sampling and adhering to the inclusion criteria, 150 participants were included in the study. Questionnaires were distributed via email, WhatsApp, or Telegram to employees at various levels of Iran's health and treatment systems who were responsible for registering and reporting infectious disease data. The study encompassed 100 participants who successfully concluded the research. The results highlight that the key strength of healthcare data registration lies in its ability to "depict the epidemic curve during outbreaks of infectious diseases." Conversely, a notable weakness was the "insufficient collaboration from non-academic sectors (e.g., clinics, private laboratories) in registering and reporting infectious diseases. The present study's findings suggest that the issue lies not in the framework itself, but rather in the execution and functionality of the strategies. We can cultivate a repository of reliable and beneficial data by incorporating initiatives like training programs, enforcing regulations with consequences for inadequate data documentation, offering both material and motivational rewards, and streamlining all data collection and reporting systems.

Data quality assessment of interventional trials in public trial databases.

OBJECTIVE: High-quality data entry in clinical trial databases is crucial to the usefulness, validity, and replicability of research findings, as it influences evidence-based medical practice and future research. Our aim is to assess the quality of self-reported data in trial registries and present practical and systematic methods for identifying and evaluating data quality. STUDY DESIGN AND SETTING: We searched ClinicalTrials.Gov (CTG) for interventional total knee arthroplasty (TKA) trials between 2000 and 2015. We extracted required and optional trial information elements and used the CTG's variables' definitions. We performed a literature review on data quality reporting on frameworks, checklists, and overviews of irregularities in healthcare databases. We identified and assessed data quality attributes as follows: consistency, accuracy, completeness, and timeliness. RESULTS: We included 816 interventional TKA trials. Data irregularities varied widely: 0%-100%. Inconsistency ranged from 0% to 36%, and most often nonrandomized labeled allocation was combined with a "single-group" assignment trial design. Inaccuracy ranged from 0% to 100%. Incompleteness ranged from 0% to 61%; 61% of finished TKA trials did not report their outcome. With regard to irregularities in timeliness, 49% of the trials were registered more than 3 months after the start date. CONCLUSION: We found significant variations in the data quality of registered clinical TKA trials. Trial sponsors should be committed to ensuring that the information they provide is reliable, consistent, up-to-date, transparent, and accurate. CTG's users need to be critical when drawing conclusions based on the registered data. We believe this awareness will increase well-informed decisions about published articles and treatment protocols, including replicating and improving trial designs.

Managing disclosure outcomes in intelligence interviews.

We introduce the disclosure-outcomes management model. The model views disclosure in intelligence interviews as a behaviour interviewees use to profitably navigate self-interest dilemmas. We theorized that interviewees compare the potential outcomes of disclosing to their self-interests. They evaluate the extent to which disclosure will facilitate or impede those self-interests: an interviewee's self-interest dilemma elicits cooperation with respect to some information but not other information. A Preliminary Study (N = 300) supported the model's predictions. We proposed a Replication Study (N = 369) to examine the model further. Participants assumed the role of an intelligence source undergoing an interview. They decided what information to disclose, contending the typical dilemma in an intelligence interview wherein disclosure could jeopardize or advance their self-interests. The results from the Preliminary and Replication studies were broadly in line with our proposition: perceived benefits positively influenced the likelihood of disclosing. However, a negative interaction between costs and benefits observed in the Preliminary Study did not replicate. That finding may be due to power constraints, not evidence against the existence of an interaction effect. Our proposal that-generally speaking-interviewees are likelier to disclose information units that seem less versus more risky requires further examination. Individual-level sensitivity to benefits, costs and their co-occurrence varied substantially in our studies. We discuss avenues for future research.

Family Information Management in the Context of Inherited Conditions: An Integrative Review.

This review aimed to develop a framework to understand the process of information management in families with inherited conditions. Electronic databases were searched for relevant peer-reviewed articles. Articles were included if they were original research on families affected by any confirmed inherited condition, described how a family accesses, interprets, conveys, and/or uses information about the disease, included the recruitment of more than one family member, and used family as the unit of analysis. Data were analyzed through directed content analysis. Thirty-four articles from 27 studies were analyzed. We propose a framework for family information management consisting of the following domains: contextual influences, family information management behaviors, and family information management outcomes. This proposed framework expands the understanding of how families manage their genetic information in making health care decisions for their affected and at-risk relatives.

A holonic approach to clinical pathway data analysis.

BACKGROUND: Healthcare faces challenges due to the advancements of Industry 4.0 as large volumes of data are generated within healthcare facilities that, combined with the complex nature of healthcare environments, make it difficult to utilise and interpret this data effectively. PURPOSE: A novel holonic approach to clinical pathway data analysis is presented and implemented as a clinical pathway digital twin. A holon is here taken to be an autonomous and co-operative building block of a software system for transforming, transporting, storing and/or validating information. The digital twin's aim is to ingest, structure and analyse the information associated with a clinical pathway to support healthcare professionals in making informed decisions, for example monitoring and predicting the duration from admission to discharge for individual patients. METHOD: Real world observations and a review of literature led to the identification of a generic set of clinical pathway analysis needs and, derived therefrom, a set of design requirements. A proof-of-concept clinical pathway analysis digital twin was implemented using a holonic approach derived from the ARTI reference architecture. The holonic approach is evaluated in a hip and knee replacement pathway case study. The evaluation includes automated statistical analyses and machine learning predictions. RESULTS: The evaluation demonstrates that the holonic approach provides an intuitive and extensible means to aggregate and disaggregate information tactically, and to derive context-tailored analysis features. The holonic approach enhances checking for data completion and handling data anomalies. The evaluation also demonstrates on-demand report generation, which reduces repetitive manual tasks for healthcare professionals. CONCLUSION: The novel holonic data analysis approach facilitates context-rich analyses tailored to specific clinical pathway activities, with effective tailoring of data ingestion and analysis. Healthcare professionals can use the data analysis approach to extract valuable insights for decision-making related to clinical pathways.

Descriptive analysis of diseases, non-battle injuries and climate among deployed Swedish military personnel.

INTRODUCTION: Historically, diseases and non-battle injuries (DNBI) typically stand for 70%‒95% of all medical events during military missions. There is, however, no comprehensive compilation of medical statistics for Swedish soldiers during deployment. METHOD: During United Nations Multidimensional Integrated Stabilization Mission in Mali, climate data and medical outpatient health surveillance data were compiled for Swedish soldiers deployed to Timbuctoo, between 2015 and 2019. Correlations between climate data and medical outpatient health surveillance data were analysed. RESULTS: Battle injuries accounted for 0.4% of the visits to healthcare, while diseases accounted for 53.6%, and non-battle injuries for 46%, the majority being musculoskeletal injuries. The combination of high temperature, humidity, sun radiation and good visibility, during summer rotation weeks, caused more events of injuries and heat stress than any other period. CONCLUSION: Musculoskeletal injuries were the major cause for visits to the Swedish camp hospital. Injuries and heat stress increased during periods of high temperature, humidity, sun radiation and good visibility. Lack of medical data, i.e. unknown number of unique patients seeking healthcare, cause codes not always connected to a primary diagnosis, and revisits not being connected to a diagnose, complicated interpretation of health risk factors.

Medical record-keeping educational interventions for medical students and residents: a systematic review.

BACKGROUND: Medical records, encompassing patient histories, progress notes, and more, play a crucial role in patient care and treatment, healthcare communication, medico-legal matters, and supporting financial documentation. OBJECTIVE: Despite their significance, literature suggests inconsistencies in record quality and insufficient formal medical record-keeping education for medical students and residents. The study aimed to identify and evaluate the effectiveness of educational interventions by conducting a systematic review. METHOD: A literature search covering 2003-2023 and review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. RESULTS: The literature search identified 44 relevant studies for inclusion. Educational methods, including lectures, feedback, workshops and discussions, addressed different components of the clinical record. The review revealed positive impacts on participant satisfaction, skills and attitudes related to record-keeping. However, some studies reported no significant positive outcomes, emphasising the need for higher-level evidence. Most studies adopted a single-group pretest-posttest design, presenting challenges in control group implementation. The Kirkpatrick evaluation levels were primarily at level 2, with few studies reaching level 3. The absence of studies at level 4 suggested the need for more robust evidence. Studies targeted medical residents more frequently than medical students, with a lack of interventions during the first year of medical education. CONCLUSION: Despite limitations including language bias and methodological variations, the review revealed diverse educational strategies and highlighted the necessity for more randomised controlled trials and studies providing higher-level evidence to enhance clinical record-keeping skills among medical students and residents. IMPLICATIONS: Medical record-keeping educational interventions can significantly improve the documentation skills of medical students and residents, thereby enhancing patient care, communication and medico-legal compliance.