Impact of COVID-19 on Neurosurgery in Brazil's Health System: The Reality of a Developing Country Affected by the Pandemic.

BACKGROUND: The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery protocols to provide ongoing care for patients while ensuring the safety of health care workers. In Brazil, the rapid spread of the disease led to new challenges in the health system. Neurooncology practice was one of the most affected by the pandemic due to restricted elective procedures and new triage protocols. We aim to characterize the impact of the pandemic on neurosurgery in Brazil. METHODS: We analyzed 112 different types of neurosurgical procedures, with special detail in 11 neurooncology procedures, listed in the Brazilian Hospital Information System records in the DATASUS database between February and July 2019 and the same period in 2020. Linear regression and paired t-test analyses were performed and considered statistically significant at P < 0.05. RESULTS: There was an overall decrease of 21.5% (28,858 cases) in all neurosurgical procedures, impacting patients needing elective procedures (-42.46%) more than emergency surgery (-5.93%). Neurooncology procedures decreased by 14.89%. Nonetheless, the mortality rate during hospitalization increased by 21.26%. Linear regression analysis in hospitalizations (Slope = 0.9912 ± 0.07431; CI [95%] = 0.8231-1.159) and total cost (Slope = 1.03 ± 0.03501; CI [95%] = 0.9511-1.109) in the 11 different types of neurooncology procedures showed a P < 0.0001. The mean cost per type of procedure showed an 11.59% increase (P = 0.0172) between 2019 and 2020. CONCLUSIONS: The COVID-19 pandemic has increased mortality, decreased hospitalizations, and therefore decreased overall costs, despite increased costs per procedure for a variety of neurosurgical procedures. Our study serves as a stark example of the effect of the pandemic on neurosurgical care in settings of limited resources and access to care.

Perceptions and Experiences of Hospital Nurses During Transition to an Electronic Handover Informatics System.

An effective patient transfer, or handover, among healthcare professionals can help prevent communication-related medical errors, and a reliable electronic handover informatics system can standardize the handoff process. Adapting to a new handover system may cause stress for nurses. This descriptive qualitative study aimed to explore the perceptions and transition experiences of hospital nurses in adopting and adapting to a new handover informatics system. Thirty-eight nurses at a medical center in Taiwan participated in the study from December 2016 to January 2017. The researcher conducted five focus group interviews and analyzed all responses using content analysis. Results showed three major themes: "Perceptions of challenges and barriers related to the transition to a new handover informatics system," "Perceptions of benefits and strategies to the transition to a new handover informatics system," and "Suggestions for successful implementation of a new handover informatics system." Five subthemes emerged from the first theme, and six subthemes emerged from the second theme. The results of this study could enhance our understanding of nurses' perceptions and experiences with transition to a new handover informatics system and could provide a reference for hospitals to develop individualized strategies to facilitate the implementation of a handover informatics system.

[Relations between health information systems and patient safety]. / Sundheds-it øger patientsikkerheden, men introducerer nye muligheder for fejl.

Health information systems have the potential to reduce medical errors, and indeed many studies have shown a significant reduction. However, if the systems are not designed and implemented properly, there is evidence that suggest that new types of errors will arise--i.e., technology-induced errors. Health information systems will need to undergo a more rigorous evaluation. Usability evaluation and simulation test with humans in the loop can help to detect and prevent technology-induced errors before they are deployed in real health-care settings.

Pediatric aspects of inpatient health information technology systems.

US adoption of health information technology as a path to improved quality of patient care (effectiveness, safety, timeliness, patient-centeredness, efficiency, and equity) has been promoted by the medical community. Children and infants (especially those with special health care needs) are at higher risk than are adults for medical errors and their consequences (particularly in environments in which children are not the primary patient population). However, development and adoption of health information technology tools and practices that promote pediatric quality and patient safety are lagging. Two inpatient clinical processes-medication delivery and patient care transitions-are discussed in terms of health information technology applications that support them and functions that are important to pediatric quality and safety. Pediatricians and their partners (pediatric nurses, pharmacists, etc) must develop awareness of technical and adaptive issues in adopting these tools and collaborate with organizational leaders and developers as advocates for the best interests and safety of pediatric patients. Pediatric health information technology adoption cannot be considered in terms of applications (such as electronic health records or computerized physician order entry) alone but must be considered globally in terms of technical (health information technology applications), organizational (structures and workflows of care), and cultural (stakeholders) aspects of what is best.

Healthcare IT and connecticut's acute-care hospitals. An analysis of trends, barriers, impacts and perspectives.

In recent years there has been much discussion in regards to the uses of information technology in healthcare. This paper presents a snapshot and analysis of the current information technology outlook in Connecticut's acute-care hospitals. Seventy-seven percent of the state's acute-care hospitals participated in the study. The authors found that the hospitals, on average, have implemented IT applications at a much higher rate than the rest of the United States. The authors also found that patient safety is the leading motivation behind IT implementation.

E-health progresses in Romania.

The paper is presenting the recent evolution of e-health aspects in Romania. Data presented are based on governmental reports. Surveys organized by the "Lucian Blaga" University of Sibiu and studies carried on by the national Institute for Research and Development in Informatics (I.C.I.) have shown that Romania has important health problems, from cardio vascular diseases (CVD) to cancer and infectious diseases, a high score on mortality and morbidity and a low one on natality. Poor management of the health sector did not help to solve all these problems. In the last 14 years there were several attempts to reform healthcare but none succeeded until now. The health insurance system is operational but needs still to be improved. Acknowledging the deep crisis of the health system the Prime Minister nominated a new minister of health and important changes in the health management approach are to be envisaged. One of this is the introduction of the e-procurement system for all health related goods. In spite of the crisis of the health system, e-health applications are flourishing. We can distinguish applications at national and local level and also punctual applications. The main applications refer to hospital information systems (HIS), electronic health records (EHR), e-procurement, image processing, diagnosis and treatment aids, telediagnosis, teleconsultation, education, research and domain oriented web support services. Most academic clinical hospital is now members of a web community "mednet". Unfortunately a lot of medical web sites have disappeared for lack of funds. As the health sector is in general funded from the public budget and the health crisis is deepened in the last years, the driving force in implementing e-health concepts and technologies is not the Ministry of Health but the Information Technology (IT) community, with a strong support from the Ministry of Information Technology and Communications and also from the Ministry of Education and Research, the Romanian Academy and professional non-governmental organizations. Our government has established the strategy for achieving the e-society for almost all domains but healthcare is still the Cinderella. It is expected that IT will play the role of the Fair Godmother by improving the general health status of the population through a better management of health services and better access to information and knowledge, for both major actors: the health professionals and the citizens.

[On the role of clinical information system in near future].

Information and communication technology has been growing up so rapidly. But, we should not forget that what we call "information" implies "digital in format". The digitalized information is essential for transmitting, sharing by many people in real time, processing, fusing, and so on. Creating three-dimensional CGs from a set of large volume image data or doing curved reformation can be performed in a blink of an eye. Now, it is also easy for an operator to get to know the stiffness of the organ through a manipulator by using the power-feedback technology. Organic integration of a variety of medical information provide a new virtual reality world which is valuable space such as a collaboration work place in a operation field. This is one of a model of the information assisted operation system. Therefore, the reader can easily understand that once he get the digitalized information, all that is left is not the technique but the "sensibility". This article is designed for readers to get to know above-mentioned technical aspect and its applicable system. Finally, I believe that technologies regarding the medical information system could contribute to some activities in the surgery in near future.

The heart of the Heart Hospital--information technology.

The Indiana Heart Hospital, located in Indianapolis, Indiana, opened on February 17, 2003, as the first all digital Heart Hospital in the United States. Physicians, nurses, and all the ancillary departments use computers to do physician orders, progress notes, nursing bedside documentation, procedure notes, and consultant notes. They also use computers to view laboratory results, x-rays, cardiac catheterization films, echocardiograms, and EKGs. This information is available not only while the clinician is in the building, but also from anywhere outside the hospital with Internet access. This purpose-made physical plant has been developed to accommodate and integrate all the new digital applications that are currently advancing cardiac surgical care today.

Clinical information systems: instant ubiquitous clinical data for error reduction and improved clinical outcomes.

Immediate access to existing clinical information is inadequate in current medical practice; lack of existing information causes or contributes to many classes of medical error, including diagnostic and treatment error. A review of the literature finds ample evidence to support a description of the problems caused by data that are missing or unavailable but little evidence to support one proposed solution over another. A primary recommendation of the Consensus Committee is that hospitals and departments should adopt systems that provide fast, ubiquitous, and unified access to all types of existing data. Additional recommendations cover a variety of related functions and operational concepts, from backups and biosurveillance to speed, training, and usability.

Adding insight: a qualitative cross-site study of physician order entry.

The research questions, strategies, and results of a six-year qualitative study of computerized physician order entry implementation (CPOE) at successful sites are reviewed over time. The iterative nature of qualitative inquiry stimulates a consecutive stream of research foci which, with each iteration, add further insight into the overarching research question. A multidisciplinary team of researchers studied CPOE implementation in four organizations using a multi-method approach to address the question "what are the success factors for implementing CPOE?" Four major themes emerged after studying three sites; ten themes resulted from blending the first results with those from a fourth site; and twelve principles were generated when results of a qualitative analysis of consensus conference transcripts were combined with the field data. The study has produced detailed descriptions of factors related to CPOE success and insight into the implementation process.

Prontuário eletrônico de pacientes: integrando informações clínicas e imagens médicas / Eletronic patient record: integrating clinical information and image data

O Instituto do Coração tem envidado esforços para integrar todas as informações clínicas dentro da Instituição. Nos últimos anos o InCor implementou com sucesso um sistema para transmissão, arquivamento, recuperação, processamento e visualização de Imagens Médicas e um Sistema de Informações Hospitalares (HIS) que armazena as informações administrativas e clínicas. A integração desses subsistemas forma o Prontuário Eletrônico do Paciente (PEP). O InCor é um dos seis Institutos que compõem o Hospital das Clínicas da Universidade de São Paulo. Como cada um dos Institutos possui o seu próprio sistema de informações, a troca de informações entre os Institutos é também uma questão muito relevante. Este trabalho apresenta a experiência no desenvolvimento de um Prontuário Eletrônico funcional e completo, que inclui controle de acesso, exames laboratoriais, imagens (estáticas, dinâmicas e 3D), laudos, documentos e mesmo sinais vitais de tempo real. Este artigo também discute a modelagem e implantação de um protótipo de um PEP distribuído e homogêneo. Atualmente, um volume superior a 2,5 TB de imagens DICOM já foi armazenado utilizando a arquitetura proposta. Diariamente, o PEP armazena mais de 5GB de dados e tem uma quantidade de acessos superior a 300 usuários. O sistema de armazenamento permite uma visibilidade de seis meses para acesso imediato e mais de dois anos para acesso automático utilizando uma jukebox

The Heart Institute (InCor) of São Paulo has been committed to the goal of integrating all clinical information within the institution. In the last few years, InCor has successfully created a system for transmission, archiving, retrieval, processing and visualization of Medical Images and a Hospital Information System (HIS) that stores the institution administrative and clinical information. These integrated subsystems form InCor's Electronic Patient Record (EPR). Since InCor is one of the six institutes of the University of São Paulo Medical School Hospital (HC) and each institute has its own information system, exchanging information among the institutes is also a very important issue. This work describes the experience in the effort to develop a functional and comprehensive EPR, which includes access control, lab exams, images (static, dynamic and 3D), clinical reports, documents and even real-time vital signals. This paper addresses also the design and prototype for integration of distributed and heterogeneous EPR. Currently, more than 2.5 TB of DICOM images, have been stored using the proposed architecture. The EPR stores more than 5 GB/day of data and presents more than 300 hits per day. The proposed storage subsystem allow six months of visibility for rapid retrieval (online mode) and more than two years for automatic retrieval using the jukebox

Using a market model to track advances in patient safety.

The author proposes a four-stage model that may help hospitals and other health care providers recognize and anticipate market drivers of patient safety.

Informatização em hospitais de grande porte / Data processing in large-sized hospitals

A admnistração de um hospital de grande porte é uma tarefa árdua, exige constante acompanhamento dos responsáveis na gestão hospitalar. O volume de informações e processos executados nos hospitas exige controle ágil e flexível para evitar repetição de tarefas e desperdícios. O planejamento, organização, coordenação e controle de um grande hospital pode ser auxiliado fortemente por um processo de informatização adequado às necessidades da instituição em questão. Não há um padrão de informatização hospitalar, pois cada hospital possui características próprias, logo, muito específicas e, por isso, não podem ser adquiridas no mercado prontas para atender a todas as necessidades de cada hospital...

[Telemedicine in pediatric oncology]. / Telemedizin in der Pädiatrischen Onkologie - Ergebnisse einer Fragebogenaktion des Kompetenznetzes Pädiatrische Onkologie -

UNLABELLED: The telemedicine project of the Competence Net Pediatric Oncology of the German/Austrian Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) has as an initial step of its work-programme sent out a questionnaire to the 54 largest pediatric hematology/oncology units in Germany. Institutions were asked for their experience, motivation, existing infrastructure, and anticipated benefits and obstacles regarding the implementation of telemedicine in patient care and research. Of the 54 largest German Pediatric Oncology institutions asked, 46 completed the questionnaire (85 %). RESULTS: 1. The need for further detailed information on implementation and for help in technical realization of telemedicine applications was expressed by all participants. 2. The majority expected practical advantages from telemedicine communication and anticipated that telemedicine will increase quality in treating children with cancer. 3. Expert consultation (study chairman, reference radiologists) is stated as to be most important. 4. Thirty-three of 46 physicians (72 %) believe that telemedicine will reduce costs in medical care within the next years. 5. It is anticipated that the introduction of telemedicine is time consuming. 6. The lack of available medical informatics competence and manpower was regarded as the most important obstacle. 7. Data security and standardization, transfer speed and transmission quality are considered most important. 8. Most of the institutions (91 %) use computers in the management of patients. Fourty-four (96 %) are connected to the Internet. 9. Thirty-seven of 46 institutions were prepared to invest in the implementation of telemedicine. This analysis demonstrates that the use of telemedicine is expected to become standard in pediatric oncology, while the existing infrastructure and status of information regarding this subject at present are insufficient. The most pressing practical need for telemedicine applications is seen in the field of electronic expert consultation. Hence, the Telemedicine-Project of the GPOH Competence Net will focus on this aspect first.

Necesidades de información de los servicios del Hospital de Turrialba para el compromiso de Gestión 2000 / Information need of the services of the Hospital of Turrialba for the management commitment 2000

En el Hospital "William Allen" no se cuenta con un sistema de información, que permita la toma de decisiones en la gestión de los servicios en forma eficiente y ágil. Por lo que esta investigación responde al propósito de elaborar una propuesta para la puesta en práctica de ese sistema y su ulterior automatización. Metodológicamente, la investigación fue aplicada, descriptiva, transversal, y la población de estudio estuvo constituida por las jefaturas del Hospital. Se identificó las caractreísticas de los usuarios del sistema, (jefes de servicio), se hizo análisis documental del compromiso de Gestión y por medio de entrevista a grupos focales se determinó las necesidades de información de cada uno de los servicios. Basados en los resultados concluimos que la mayoría de los jefes, tienen edad, antigüedad y formación profesional aptas para su puesto, pero con muy bajo nivel de capacitación en sistemas de información e informática, las variables e indicadores del Compromiso de Gestión estudiadas, incluyen una gama amplia y balanceada de los mismos. Hay un grado considerable de interrelación de necesidades de información entre los servicios y producen más información de producción y costos. Dos terceras partes de los servicios cuentan con computadora, pero los usuarios consideran inadecuado el "software," los servicios médicos no tienen computadoras y no existe una red de computación. Se recomienda capacitar a los jefes de servicio en adminsitración, sistemas de información e informática y sobre el concepto y la aplicación de las U.P.H. Así mismo incorporar indicacdores de evaluación de eficiencia y eficacia y calidad, equipar con computadora los servicios que faltan y elaborar el proyecto de instalación de red de computación con un software adecuado por un analista de sistemas que considere como base este estudio.