Ensino da segurança do paciente na graduação em enfermagem no estado da Bahia / Enseñanza sobre la seguridad del paciente en el pregrado en enfermería en el estado de Bahia-Brasil / Teaching patient safety in undergraduate nursing in the state of Bahia

RESUMO Objetivo: identificar o tema segurança do paciente nos componentes curriculares de cursos de graduação em enfermagem no estado da Bahia. Método: pesquisa quantitativa, descritiva, exploratória de base documental desenvolvida em fevereiro de 2019, com dados extraídos da Matriz Curricular, Projeto Pedagógico e Ementa, disponíveis nos websites de instituições de ensino superior com situação ativa no sistema e-MEC. Resultados: das 75 instituições cadastradas, nove eram públicas, e 66 privadas. O tema segurança do paciente não foi encontrado em nenhum website de universidades públicas e apenas em 8,06% das privadas. O contato inicial com a temática dava-se no 3º semestre, a carga horária média das disciplinas que abordavam o tema variava de 30 a 306 horas e o componente curricular era obrigatório para estas disciplinas. Apenas 1,71% dos websites das instituições públicas apresentavam todos os documentos pesquisados, enquanto as privadas apresentaram 33,33%, a matriz curricular foi o documento mais disponibilizado. Conclusão: a inserção do tema segurança do paciente nos componentes curriculares mostrou-se insuficiente, apontando necessidade de revisão dos processos formativos e inclusão de abordagem interdisciplinar e transdisciplinar, tendo em vista a complexidade do cuidado em saúde e a importância do desenvolvimento de competências específicas com foco na segurança do paciente.

RESUMEN Objetivo: identificar el tema seguridad del paciente en los componentes curriculares de cursos de pregrado en enfermería en el estado de Bahia-Brasil. Método: investigación cuantitativa, descriptiva, exploratoria de base documental desarrollada en febrero de 2019, con datos extraídos de la Matriz Curricular, Proyecto Pedagógico y Directrices, disponibles en los sitios electrónicos de instituciones de enseñanza superior con situación activa en el sistema e-MEC. Resultados: de las 75 instituciones registradas, nueve eran públicas y 66 privadas. El tema de la seguridad del paciente no se encontró en ningún website de universidades públicas y solo en el 8,06% de las privadas. El contacto inicial con la temática se trabajaba en el 3º semestre, el promedio de la carga horaria de las asignaturas que trataban el tema variaba de 30 a 306 horas y el componente curricular era obligatorio para estas asignaturas. Solo el 1,71% de los sitios electrónicos de las instituciones públicas presentaba todos los documentos investigados, mientras que los privados presentaron el 33,33%, la matriz curricular fue el documento más disponible. Conclusión: la inserción del tema seguridad del paciente en los componentes curriculares se mostró insuficiente, señalando necesidad de revisión de los procesos formativos e inclusión de abordaje interdisciplinario y transdisciplinario, teniendo en cuenta la complejidad del cuidado de la salud y la importancia del desarrollo de competencias específicas centradas en la seguridad del paciente.

ABSTRACT Objective: to identify the theme of patient safety in the curricular components of undergraduate nursing courses in the state of Bahia. Method: quantitative, descriptive, exploratory research of documentary basis developed in February 2019, with data extracted from the Curricular Matrix, Pedagogical Project and Menu, available on the websites of higher education institutions with active situation in the e-MEC system. Results: of the 75 registered institutions, nine were public, and 66 were private. The theme of patient safety was not found in any website of public universities and only in 8.06% of private universities. The initial contact with the theme took place in the 3rd semester, the average workload of the subjects that addressed the theme ranged from 30 to 306 hours and the curricular component was mandatory for these disciplines. Only 1.71% of the websites of public institutions had all the documents surveyed, while the private ones presented 33.33%, the curriculum matrix was the most available document. Conclusion: the insertion of the patient safety theme in the curricular components proved insufficient, pointing out the need for review of training processes and inclusion of an interdisciplinary and transdisciplinary approach, in view of the complexity of health care and the importance of developing specific competencies focused on patient safety.

Analyzing medical device connectivity and its effect on cyber security in german hospitals.

BACKGROUND: Modern healthcare devices can be connected to computer networks and many western healthcare institutions run those devices in networks. At the same time, cyber attacks are on the rise and there is evidence that cybercriminals do not spare critical infrastructure such as major hospitals, even if they endanger patients. Intuitively, the more and closer connected healthcare devices are to public networks, the higher the risk of getting attacked. METHODS: To asses the current connectivity status of healthcare devices, we surveyed the field of German hospitals and especially University Medical Center UMCs. RESULTS: The results show a strong correlation between the networking degree and the number of medical devices. The average number of medical devices is 25.150, with a median of networked medical devices of 3.600. Actual key users of networked medical devices are the departments Radiology, Intensive Care, Radio-Oncology RO, Nuclear Medicine NUC, and Anaesthesiology in the group of UMCs. In the next five years, the usage of networked medical devices will increase significantly in the departments of Surgery, Intensive Care, and Radiology. We detected a strong correlation between the degree of connectivity and the likelihood of being attacked.The survey answers regarding the cyber security status reveal a lack of security basics in some of the inquired hospitals. We did discover successful attacks in hospitals with separated or subsidiary departments. A fusion of competencies on an organizational level facilitates the right behavior here. Most hospitals rated themselves predominantly positively in the self-assessment but also stated the usefulness of IT security insurance. CONCLUSIONS: Concluding our results, hospitals are already facing the consequences of omitted measures within their growing pool of medical devices. Continuously relying on historically grown structures without adaption and trusting manufactures to solve vectors is a critical behavior that could seriously endanger patients.

Experiencia en la utilización de la Distribución GNU/Linux VyOS como software para PC-routers en una institución de Salud / Experience in the use of the GNU / Linux VyOS Distribution as software for PC-routers in a Health institution

En este trabajo se presenta una distribución de GNU/Linux que permite configurar un router, en un hardware x86 de sobremesa, con casi todas las características de uno propietario; con el objetivo de mejorar la infraestructura de red, reducir costes, y aumentar la seguridad y disponibilidad de los servicios que se brindan; teniendo en cuenta además, las limitantes del país debido al bloqueo económico al cual está sometido por los Estados Unidos. Para ello se utilizó como método el análisis documental a partir de información recuperada en materiales digitales en Internet, así como experiencias realizadas en el Hospital Clínico Quirúrgico Universitario Dr. Ambrosio Grillo Portuondo(AU)

In this paper we present a GNU / Linux distribution that allows you to configure a router, in a desktop x86 hardware, with almost all the characteristics of a proprietary; with the aim of improving the network infrastructure, reducing costs, and increasing the security and availability of the services provided; also taking into account, the limitations of the country due to the economic blockade to which it is submitted by the United States. To do this, a documentary analysis was used as a method based on information retrieved from digital materials on the Internet, as well as experiences at the University Clinical Surgical Hospital Dr. Ambrosio Grillo Portuondo(AU)

Measuring electronic communication networks in virtual care teams using electronic health records access-log data.

OBJECTIVE: To develop methods for measuring electronic communication networks in virtual care teams using electronic health records (EHR) access-log data. METHODS: For a convenient sample of 100 surgical colorectal cancer patients, we used time-stamped EHR access-log data extracted from an academic medical center's EHR system to construct communication networks among healthcare professionals (HCPs) in each patient's virtual care team. We measured communication linkages between HCPs using the inverse of the average time between access events in which the source HCPs sent information to and the destination HCPs retrieved information from the EHR system. Social network analysis was used to examine and visualize communication network structures, identify principal care teams, and detect meaningful structural differences across networks. We conducted a non-parametric multivariate analysis of variance (MANOVA) to test the association between care teams' communication network structures and patients' cancer stage and site. RESULTS: The 100 communication networks showed substantial variations in size and structures. Principal care teams, the subset of HCPs who formed the core of the communication networks, had higher proportions of nurses, physicians, and pharmacists and a lower proportion of laboratory medical technologists than the overall networks. The distributions of conditional uniform graph quantiles suggested that our network-construction technique captured meaningful underlying structures that were different from random unstructured networks. MANOVA results found that the networks' topologies were associated with patients' cancer stage and site. CONCLUSIONS: This study demonstrates that it is feasible to use EHR access-log data to measure and examine communication networks in virtual care teams. The proposed methods captured salient communication patterns in care teams that were associated with patients' clinical differences.

Arquitectura de información como un proceso para organizar sitios web usables e intuitivos: El caso del Centro Centroamericano de Población (CCP) / Information architecture as a process to organize usable and intuitive websites. The case of the Central American Center for Population, University of Costa Rica

Resumen El artículo expone cómo se desarrolló un proceso de arquitectura de información para el sitio Web del Centro Centroamericano de Población (CCP) de la Universidad de Costa Rica (UCR), como parte de un estudio dentro del campo de la Bibliotecología. Explica, ampliamente, cómo se realizó el análisis del sitio, la identificación de los requerimientos, la estructura y los sistemas de etiquetado y navegación requeridos por el CCP para mejorar su sitio Web. Durante este proceso se diseñaron, también, todas las visualizaciones (wireframes) de las páginas que conforman la versión de escritorio de este sitio, además, se elaboraron visualizaciones para la versión responsive requerida por los dispositivos móviles. Se concluye que la arquitectura de información es un proceso que demanda de planificación y análisis del problema a tratar, al mismo tiempo, es un campo laboral importante para profesionales en Bibliotecología con interés en incorporar la tecnología a su práctica profesional.

Abstract The development of an information architecture process on the website of the Central American Center for Population from the University of Costa Rica is explained. This investigation is in the field of library and information sciences and explains how the website was analyzed, how the requirements were lifted, how the structure and the labeling and navigation systems were developed in order to improve the website. During this process, all the wireframes for the desktop version of the website were designed, also, wireframes for the responsive version were created. It concludes that information architecture is a process that requires a lot of planning and analysis of the problem, also, it is an important working area for librarians that are interested in getting involved with technology.

Computerization of primary health care in Brazil: the network of actors / Informatización de la atención primaria a la salud en Brasil: la red de actores / Informatização da atenção primária à saúde no Brasil: a rede de atores

ABSTRACT Objective: To analyze the network of human and non-human actors involved in the computerization of primary health care in the Brazilian federal government. Method: A qualitative study that used as a theoretical reference the actor-network theory and as a methodological reference the cartography of controversies. Data analysis was carried out using Gephi software, and through the extraction of reports, informed by the actor-network theory. Results: We found a network of 288 connections among 33 actors, composed mainly of nonhuman influencers of computerization. These actors are distributed throughout 3 inter-related communities, and manage the network by defining obligations, penalties, conflicts and intentionalities, thus influencing the success of the intended computerization. Final considerations: The network of actors at the federal level generates situations that, in many cases, hamper the successful implementation of a nationwide computerization strategy.

RESUMEN Objetivo: Analizar la red de actores humanos y no-humanos que están involucrados en la informatización de la atención primaria a la salud en la esfera federal del gobierno brasileño. Método: Estudio cualitativo que ha utilizado como referencial teórico la teoría actor-red y como referencial metodológico la cartografía de controversias. El análisis de los datos se dio por medio del programa Gephi y desde la técnica de extractos de relatos con punto de vista de la teoría actor-red. Resultados: Se ha constatado una red de 288 conexiones entre 33 actores, que está conformada mayoritariamente por no-humanos influyentes de la informatización. Los actores están distribuidos en 3 comunidades, que se relacionan entre sí, agenciando la red desde la definición de las obligatoriedades, las condenas, los conflictos y las intencionalidades, influyendo el éxito de la pretendida informatización. Consideraciones Finales: La red de actores en la esfera federal moviliza situaciones que, en muchos momentos, obstaculizan el éxito de la implantación de una estrategia de la informatización de abarcadura nacional.

RESUMO Objetivo: Analisar a rede de atores humanos e não-humanos envolvidos na informatização da atenção primária à saúde na esfera federal do governo brasileiro. Método: Estudo qualitativo que utilizou como referencial teórico a teoria ator-rede e como referencial metodológico a cartografia de controvérsias. A análise dos dados se deu por meio do software Gephi e a partir da técnica de extratos de relatos com ponto de vista da teoria ator-rede. Resultados: Constatou-se uma rede de 288 ligações entre 33 atores, composta majoritariamente por não-humanos influenciadores da informatização. Os atores estão distribuídos em 3 comunidades, que se relacionam entre si, agenciando a rede a partir da definição de obrigatoriedades, penalidades, conflitos e intencionalidades, influenciando o sucesso da pretendida informatização. Considerações finais: A rede de atores na esfera federal mobiliza situações que, em muitos momentos, obstaculizam o sucesso da implantação de uma estratégia de informatização de abrangência nacional.

Non-Orthogonal Random Access in MIMO Cognitive Radio Networks: Beamforming, Power Allocation, and Opportunistic Transmission.

We study secondary random access in multi-input multi-output cognitive radio networks, where a slotted ALOHA-type protocol and successive interference cancellation are used. We first introduce three types of transmit beamforming performed by secondary users, where multiple antennas are used to suppress the interference at the primary base station and/or to increase the received signal power at the secondary base station. Then, we show a simple decentralized power allocation along with the equivalent single-antenna conversion. To exploit the multiuser diversity gain, an opportunistic transmission protocol is proposed, where the secondary users generating less interference are opportunistically selected, resulting in a further reduction of the interference temperature. The proposed methods are validated via computer simulations. Numerical results show that increasing the number of transmit antennas can greatly reduce the interference temperature, while increasing the number of receive antennas leads to a reduction of the total transmit power. Optimal parameter values of the opportunistic transmission protocol are examined according to three types of beamforming and different antenna configurations, in terms of maximizing the cognitive transmission capacity. All the beamforming, decentralized power allocation, and opportunistic transmission protocol are performed by the secondary users in a decentralized manner, thus resulting in an easy implementation in practice.

H2020 EU Research & Innovation Program Boost the Transfer of Technological Breakthroughs, Enable New Solutions for Personalised Health and Impact the Industry and Healthcare Systems.

Our Healthcare systems worldwide are facing grand challenges that can be addressed by intelligent, miniaturized and interconnected devices. Many of today's pharmaceutical drugs create bigger problems than solutions, as drugs help only 40% of the patients and kill, in the USA alone, over 100,000 people per year. The widespread use of antibiotics has led to new strands of bacteria that defy all known antibiotics and kill well over 100,000 people yearly in the world. Outbreaks of infections by new viruses and anti-resistant bacteria are expected with even more grave consequences. The quality of food around the world is steadily deteriorating, as the soils are becoming depleted of essential nutrients and contain increasing amounts of pesticides, herbicides and fungicides. Our environment is burdened with 2.5 billion tonnes of chemicals per year that accumulate in the soil, groundwater, rivers and seas, and eventually end up in our food and our drinking water. As a consequence, there is a strong increase in the incidence of diseases hardly known fifty years ago. In parallel, an increasing number of people are taking the responsibility for their health and well-being in their own hands and are looking for mobile and in-obtrusive ways to objectively monitor their health status. The development of intelligent, miniaturized systems, by the heterogeneous integration of technologies such as micro- and nano-electronics, photonics, biotechnology, materials and information & communication, addresses these issues and has received intensive public support in the EU over the past two decades in the FP6 and FP7 programs. Proven concepts and functional prototypes exist with the potential to create new opportunities to improve our healthcare systems, in particular personalized or precision medicine. These device concepts offer unique abilities to sense, detect, analyze, communicate, respond, and monitor phenomena from the macro (e.g. body, tissues) to the nano scale (e.g. molecules, genes) on the spot, with short response times. For the majority of the projects, the planning for the next phase of prototype validation, through product design, supply chain setup, user targeting, clinical validation and commercial roll-out is now taking full attention. However, significant hurdles exist in the successful translation of the new technology to new products. As these technologies are new-to-the-world the resulting products carry a high risk, often necessitating the creation of new companies. Therefore the EU has developed the Horizon 2020 program as a framework for technology development and new business creation. Horizon 2020 is focusing on support for technology transfer, and on building ecosystems and value chains to ensure shorter times-to-market, thus enabling a higher impact of knowledge-based technologies. This paper will argue the necessity of developing these new class of devices, discuss its state-of-the-art, and the challenges for the implementation of Horizon 2020 and the new opportunities in intelligent miniaturized systems for pHealth.

Uses of cancer registries for public health and clinical research in Europe: Results of the European Network of Cancer Registries survey among 161 population-based cancer registries during 2010-2012.

AIM: To provide insight into cancer registration coverage, data access and use in Europe. This contributes to data and infrastructure harmonisation and will foster a more prominent role of cancer registries (CRs) within public health, clinical policy and cancer research, whether within or outside the European Research Area. METHODS: During 2010-12 an extensive survey of cancer registration practices and data use was conducted among 161 population-based CRs across Europe. Responding registries (66%) operated in 33 countries, including 23 with national coverage. RESULTS: Population-based oncological surveillance started during the 1940-50s in the northwest of Europe and from the 1970s to 1990s in other regions. The European Union (EU) protection regulations affected data access, especially in Germany and France, but less in the Netherlands or Belgium. Regular reports were produced by CRs on incidence rates (95%), survival (60%) and stage for selected tumours (80%). Evaluation of cancer control and quality of care remained modest except in a few dedicated CRs. Variables evaluated were support of clinical audits, monitoring adherence to clinical guidelines, improvement of cancer care and evaluation of mass cancer screening. Evaluation of diagnostic imaging tools was only occasional. CONCLUSION: Most population-based CRs are well equipped for strengthening cancer surveillance across Europe. Data quality and intensity of use depend on the role the cancer registry plays in the politico, oncomedical and public health setting within the country. Standard registration methodology could therefore not be translated to equivalent advances in cancer prevention and mass screening, quality of care, translational research of prognosis and survivorship across Europe. Further European collaboration remains essential to ensure access to data and comparability of the results.

How to establish an interactive eConference and eJournal Club.

With our hand team scattered across several different locations, it is difficult to find a time to get together for our weekly didactic hand conference and monthly hand journal club. In addition, traffic and tight clinical schedules sometimes force conferences to start late or be canceled. Our solution was to set up an on-line conference. Using TeamViewer to host our conference and Skype to host our journal clubs, we experienced increased attendance by both faculty and residents in our meetings. In this article, we establish a method of hosting effective on-line videoconferences to facilitate nearly universal participation of our hand team, and we hope to assist others who wish to establish similar setups in their communities.

The EuroNet paediatric hodgkin network - modern imaging data management for real time central review in multicentre trials.

Since 2007, children and adolescents with Hodgkin lymphomas are treated in the Europe-wide EuroNet-PHL trials. A real time central review process for stratification of the patients enhances quality control and efficient therapy management. This process includes reading of all cross-sectional-images. Since reference evaluation is time critical, a fast, easy to handle and safe data transfer is important. In addition, immediate and constant access to all the data has to be guaranteed in case of queries and for regulatory reasons. To meet the mentioned requirements the EuroNet Paediatric Hodgkin Data Network (funded by the European Union - Project Number: 2007108) was established between 2008 and 2011. A respective tailored data protection plan was formulated. The aim of this article is to describe the networks' mode of operation and the advantages for multi-centre trials that include centralized image review.