An Emergent Network for the Diffusion of Innovations Among Local Health Departments at the Onset of the COVID-19 Pandemic.

INTRODUCTION: Communication networks among professionals can be pathways for accelerating the diffusion of innovations if some local health departments (LHDs) drive the spread of knowledge. Such a network could prove valuable during public health emergencies such as the novel coronavirus disease 2019 (COVID-19) pandemic. Our objective was to determine whether LHDs in the United States were tied together in an informal network to share information and advice about innovative community health practices, programs, and policies. METHODS: In January and February 2020, we conducted an online survey of 2,303 senior LHD leaders to ask several questions about their sources of advice. We asked respondents to rank up to 3 other LHDs whose practices informed their work on new public health programs, evidence-based practices, and policies intended to improve community health. We used a social network analysis program to assess answers. RESULTS: A total of 329 LHDs responded. An emergent network appeared to operate nationally among 740 LHDs. Eleven LHDs were repeatedly nominated by peers as sources of advice or examples (ie, opinion leaders), and 24 acted as relational bridges to hold these emergent networks together (ie, boundary spanners). Although 2 LHDs played both roles, most LHDs we surveyed performed neither of these roles. CONCLUSION: Opinion leading and boundary spanning health departments can be accessed to increase the likelihood of affecting the rate of interest in and adoption of innovations. Decision makers involved in disseminating new public health practices, programs, or policies may find our results useful both for emergencies and for practice-as-usual.

Mortality, Resource Utilization, and Inpatient Costs Vary Among Pediatric Heart Transplant Indications: A Merged Data Set Analysis From the United Network for Organ Sharing and Pediatric Health Information Systems Databases.

BACKGROUND: Merging United Network for Organ Sharing (UNOS) and Pediatric Health Information Systems databases has enabled a more granular analysis of pediatric heart transplant outcomes and resource utilization. We evaluated whether transplant indication at time of transplantation was associated with mortality, resource utilization, and inpatient costs during the first year after transplantation. METHODS AND RESULTS: We analyzed transplant outcomes and resource utilization from 2004 to 2015. Patients were categorized as congenital (CHD), myocarditis, or cardiomyopathy based on UNOS-defined primary indication. CHD complexity subgroup analyses (single-ventricle, complex, and simple biventricular CHD) were also performed. Of 2251 transplants (49% CHD, 5% myocarditis, 46% cardiomyopathy), CHD recipients were younger (2 [IQR 0-10], 6 [IQR 0-12], and 7 [IQR 1-14] years, respectively; P < .001) and less likely to have a ventricular assist device (VAD) at transplantation (3%, 27%, and 13%, respectively; P < .001). Patients with single-ventricle CHD had the longest time on the waitlist and were least likely to receive a VAD before transplantation. After adjusting for patient-level factors, transplant recipients with single-ventricle CHD had the greatest mortality during transplantation admission and within 1 year (odds ratio [OR] 11.8 [95% confidence interval (CI) 5.9-23.6] and OR 6.0 [95% CI 3.6-10.2], respectively, vs cardiomyopathy). Mortality was similar between patients with myocarditis and cardiomyopathy. Post-transplantation length of stay (LOS) was longer in transplant recipients with CHD than myocarditis or cardiomyopathy (25 [interquartile range [IQR] 15-45] vs 21 [IQR 12-35] vs 16 [IQR 12-25] days; P < .001), related in part to longer duration of intensive care unit-level care (ICU LOS 8 [IQR 4-20] vs 6 [IQR 4-13] vs 5 [IQR 3-8] days; P < .001). Similarly, patients with CHD had higher median post-transplantation costs than myocarditis or cardiomyopathy ($415K [IQR $201K-503K] vs $354K [IQR $179K-390K] vs $284K [IQR $145K-319K]; P < .001) that persisted after adjusting for patient-level factors (adjusted cost ratio 1.4 [95% CI 1.4-1.5], CHD vs cardiomyopathy) and was primarily driven by longer LOS. More than 50% were readmitted during the first year after transplantation, although readmission rates were similar across transplant indications (P = .42). CONCLUSIONS: Children with CHD, particularly single-ventricle patients, require substantially greater hospital resource utilization and have significantly worse outcomes during the first year after heart transplantation compared with other indications. Further work is aimed at identifying modifiable pre-transplantation risk factors, such as pre-transplantation conditioning with VAD support and cardiac rehabilitation, to improve post-transplantation outcomes and reduce resource utilization in this complex population.

Conference season.

Health library and information workers no longer find themselves restricted to presenting at purely local or national health-related library events, a diversity evidenced by the two conferences supported by CILIP's Health Libraries Group this month, June 2019. The Health Libraries Group is an official sponsor of #EBLIP10, the 10th international Evidence Based Library and Information Practice conference, which encourages us to think about the evidence we collect and use to inform practice. The Health Libraries Group also strengthens its links with EAHIL: The European Association of Health Information and Libraries by aligning the content of this year's Virtual Issue of the Health Information and Libraries Journal with EAHIL 2019s themes of evidence-based practice, impact & assessment, and technology uptake, available at: https://bit.ly/2PAZw2X.

The Nigerian health information system policy review of 2014 : the need, content, expectations and progress.

BACKGROUND: Nigeria's national health information system (HIS) data sources are grouped into institutional and population based data that traverse many government institutions. Communication and collaboration between these institutions are limited, fraught with fragmentation and challenges national HIS functionality. OBJECTIVES: The objective of this paper was to share insights from and the implications of a recent review of Nigeria's HIS policy in 2014 that resulted in its substantial revision. We also highlight some subsequent enactments. REVIEW PROCESS AND OUTCOMES: In 2013, Nigeria's Federal Ministry of Health launched an inter-ministerial and multi-departmental review of the National Health Management Information System policy of 2006. The review was guided by World Health Organization's 'Framework and Standards for Country Health Information Systems'. The key finding was a lack of governance mechanisms in the execution of the policy, including an absent data management governance process. The review also found a multiplicity of duplicative, parallel reporting tools and platforms. CONCLUSION: Recommendations for HIS Policy revisions were proposed to and implemented by the Federal Government of Nigeria. The revised HIS policy now provides for a strong framework for the leadership and governance of the HIS with early results.

[A peek to the origin, functioning and challenges of the new Chilean transplantation system]. / Una mirada al origen, funcionamiento y desafíos del nuevo sistema de donación y trasplantes chileno.

Chile made several legal, practical and educational changes to the organ donation and transplant system in recent years, to improve its results. However, studies evaluating these reforms and suggesting further corrections are still pending. Our aim is to assess the new regulations and their reception by both the population and health care providers. Proposals are made to promote the development of a model of Chilean transplantation able to respond to the needs of the population.

Patient information comes of age.

This virtual issue (VI) has been assembled to coincide with the 8th Annual Patient Information Conference 2013 organised by the UK Patient Information Forum (PiF). The conference theme 'Information and support - a service in its own right' is a response to policy documents and initiatives in both Scotland and England which signal the coming of age of patient/consumer information. The VI consists of a collection of open access articles and addresses the question 'What can health science librarians do to ensure that the public are able to find, appraise and use health information?' This material provides research evidence, and examples of the types of initiatives librarians have undertaken to make information a health and care service in its own right. Two recurrent messages are that health science librarians need to form partnerships with healthcare providers and they have a role to play in improving health literacy skills.

Constructing RBAC based security model in u-healthcare service platform.

In today's era of aging society, people want to handle personal health care by themselves in everyday life. In particular, the evolution of medical and IT convergence technology and mobile smart devices has made it possible for people to gather information on their health status anytime and anywhere easily using biometric information acquisition devices. Healthcare information systems can contribute to the improvement of the nation's healthcare quality and the reduction of related cost. However, there are no perfect security models or mechanisms for healthcare service applications, and privacy information can therefore be leaked. In this paper, we examine security requirements related to privacy protection in u-healthcare service and propose an extended RBAC based security model. We propose and design u-healthcare service integration platform (u-HCSIP) applying RBAC security model. The proposed u-HCSIP performs four main functions: storing and exchanging personal health records (PHR), recommending meals and exercise, buying/selling private health information or experience, and managing personal health data using smart devices.

A novel authentication scheme using self-certified public keys for telecare medical information systems.

Telecare medical information systems (TMIS), with the explosive growth of communication technology and physiological monitoring devices, are applied increasingly to enable and support healthcare delivery services. In order to safeguard patients' privacy and tackle the illegal access, authentication schemes for TMIS have been investigated and designed by many researchers. Many of them are promising for adoption in practice, nevertheless, they still have security flaws. In this paper, we propose a novel remote authentication scheme for TMIS using self-certified public keys, which is formally secure in the ID-mBJM model. Besides, the proposed scheme has better computational efficiency. Compared to the related schemes, our protocol is more practical for telemedicine system.

Robust and efficient biometrics based password authentication scheme for telecare medicine information systems using extended chaotic maps.

The Telecare Medicine Information Systems (TMISs) provide an efficient communicating platform supporting the patients access health-care delivery services via internet or mobile networks. Authentication becomes an essential need when a remote patient logins into the telecare server. Recently, many extended chaotic maps based authentication schemes using smart cards for TMISs have been proposed. Li et al. proposed a secure smart cards based authentication scheme for TMISs using extended chaotic maps based on Lee's and Jiang et al.'s scheme. In this study, we show that Li et al.'s scheme has still some weaknesses such as violation the session key security, vulnerability to user impersonation attack and lack of local verification. To conquer these flaws, we propose a chaotic maps and smart cards based password authentication scheme by applying biometrics technique and hash function operations. Through the informal and formal security analyses, we demonstrate that our scheme is resilient possible known attacks including the attacks found in Li et al.'s scheme. As compared with the previous authentication schemes, the proposed scheme is more secure and efficient and hence more practical for telemedical environments.

Development of Information System for Patients with Cleft Lip and Palate undergoing Operation.

BACKGROUND: Srinagarind Hospital has 150-200 patients with cleft lip and palate each year. When patients are admitted to hospital for surgery patients and family feel they are in a crisis of life, they feel fear anxiety and need to know about how to take care of wound, they worry if patient will feel pain, how to feed patients and many things about patients. Information is very important for patients/family to prevent complications and help their decision process, decrease parents stress and encourage better co-operation. OBJECTIVE: To develop information system for patients with cleft lip-palate undergoing operation. MATERIAL AND METHOD: This is an action research divided into 3 phases. Phase 1 Situation review: in this phase we interview, nursing care observation, and review nursing documents about the information giving. Phase 2 Develop information system: focus groups, for discussion about what nurses can do to develop the system to give information to patients/parents. Phase 3 evaluation: by interviewing 61 parents using the structure questionnaire. RESULTS: 100 percent of patients/parents received information but some items were not received. Patients/parents satisfaction was 94.9 percent, no complications. CONCLUSION: The information system development provides optimal care for patients and family with cleft lip and palate, but needs to improve some techniques or tools to give more information and evaluate further the nursing outcome after.

The Development and Use of Evidence Summaries for Point of Care Information Systems: A Streamlined Rapid Review Approach.

BACKGROUND: A systematic review of evidence is the research method which underpins the traditional approach to evidence-based health care. As systematic reviews follow a rigorous methodology, they can take a substantial amount of time to complete ranging in duration from 6 months to 2 years. Rapid reviews have been proposed as a method to provide summaries of the literature in a more timely fashion. AIM: The aim of this paper is to outline our experience of developing evidence summaries in the context of a point of care resource as a contribution to the emerging field of rapid review methodologies. METHODS: Evidence summaries are defined as a synopsis that summarizes existing international evidence on healthcare interventions or activities. These summaries are based on structured searches of the literature and selected evidence-based healthcare databases. Following the search, all studies are assessed for internal validity using an abridged set of critical appraisal tools. Once developed, they undergo three levels of peer review by internal and external experts. RESULTS: As of November 2014, there are 2458 evidence summaries that have been created across a range of conditions to inform evidence-based healthcare practices. In addition, there is ongoing development of various new evidence summaries on a wide range of topics. Approximately 60-70 new evidence summaries are published every month, covering research in various medical specialty areas. All summaries are updated annually. LINKING EVIDENCE TO ACTION: Systematic reviews, although the ideal type of research to inform practice, often do not meet the needs of users at the point of care. This article describes the development framework for the creation of evidence summaries, a type of rapid review. Although evidence summaries may result in a less rigorous process of development, they can be useful for improving practice at the point of care.

Monitoring intervention coverage in the context of universal health coverage.

Monitoring universal health coverage (UHC) focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups-promotion/prevention, and treatment/care-as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the production of reliable, comprehensive, and timely health facility data. Please see later in the article for the Editors' Summary.

Know your market: use of online query tools to quantify trends in patient information-seeking behavior for varicose vein treatment.

PURPOSE: To analyze Internet search data to characterize the temporal and geographic interest of Internet users in the United States in varicose vein treatment. MATERIALS AND METHODS: From January 1, 2004, to September 1, 2012, the Google Trends tool was used to analyze query data for "varicose vein treatment" to identify individuals seeking treatment information for varicose veins. The term "varicose vein treatment" returned a search volume index (SVI), representing the search frequency relative to the total search volume during a specific time interval and region. Linear regression analysis and Kruskal-Wallis one-way analysis of variance were employed to characterize search results. RESULTS: Search traffic for varicose vein treatment increased by 520% over the 104-month study period. There was an annual mean increase of 28% (range, -18%-100%; standard deviation [SD], 35%), with a statistically significant linear increase in average yearly SVI over time (R(2) = 0.94, P < .0001). All years showed positive growth in mean SVI except for 2008 (18% decrease). There were statistically significant differences in SVI by month (Kruskal-Wallis, P < .0001) with significantly higher mean SVI compared with other months in May (190% increase; range, 26%-670%; SD, 15%) and June (209% increase; range, 35%-700%; SD, 20%). The southern United States showed significantly higher search traffic than all other regions (Tukey-Kramer, P < .00001). CONCLUSIONS: There have been significant increases in Internet search traffic related to varicose vein treatment in the past 8 years. Reflected in this trend is an annual peak in search traffic in the late spring months with an overall geographic bias toward southern states. Rigorous analysis of Internet search queries for medical procedures may prove useful to guide the efficient use of limited resources and marketing dollars.

An efficient biometric and password-based remote user authentication using smart card for Telecare Medical Information Systems in multi-server environment.

The medical organizations have introduced Telecare Medical Information System (TMIS) to provide a reliable facility by which a patient who is unable to go to a doctor in critical or urgent period, can communicate to a doctor through a medical server via internet from home. An authentication mechanism is needed in TMIS to hide the secret information of both parties, namely a server and a patient. Recent research includes patient's biometric information as well as password to design a remote user authentication scheme that enhances the security level. In a single server environment, one server is responsible for providing services to all the authorized remote patients. However, the problem arises if a patient wishes to access several branch servers, he/she needs to register to the branch servers individually. In 2014, Chuang and Chen proposed an remote user authentication scheme for multi-server environment. In this paper, we have shown that in their scheme, an non-register adversary can successfully logged-in into the system as a valid patient. To resist the weaknesses, we have proposed an authentication scheme for TMIS in multi-server environment where the patients can register to a root telecare server called registration center (RC) in one time to get services from all the telecare branch servers through their registered smart card. Security analysis and comparison shows that our proposed scheme provides better security with low computational and communication cost.

Three-factor anonymous authentication and key agreement scheme for Telecare Medicine Information Systems.

Nowadays, with comprehensive employment of the internet, healthcare delivery services is provided remotely by telecare medicine information systems (TMISs). A secure mechanism for authentication and key agreement is one of the most important security requirements for TMISs. Recently, Tan proposed a user anonymity preserving three-factor authentication scheme for TMIS. The present paper shows that Tan's scheme is vulnerable to replay attacks and Denial-of-Service attacks. In order to overcome these security flaws, a new and efficient three-factor anonymous authentication and key agreement scheme for TMIS is proposed. Security and performance analysis shows superiority of the proposed scheme in comparison with previously proposed schemes that are related to security of TMISs.

Mortality Associated with Priority Diseases in Flood-Affected Areas Using District Health Information System (DHIS2) During September-December 2022: Pakistan Experience.

OBJECTIVES: To quantify the burden of communicable diseases and characterize the most reported infections during public health emergency of floods in Pakistan. METHODS: The study's design is a descriptive trend analysis. The study utilized the disease data reported to District Health Information System (DHIS2) for the 12 most frequently reported priority diseases under the Integrated Disease Surveillance and Response (IDSR) system in Pakistan. RESULTS: In total, there were 1,532,963 suspected cases during August to December 2022 in flood-affected districts (n = 75) across Pakistan; Sindh Province reported the highest number of cases (n = 692,673) from 23 districts, followed by Khyber Pakhtunkhwa (KP) (n = 568,682) from 17 districts, Balochistan (n = 167,215) from 32 districts, and Punjab (n = 104,393) from 3 districts. High positivity was reported for malaria (79,622/201,901; 39.4%), followed by acute diarrhea (non-cholera) (23/62; 37.1%), hepatitis A and E (47/252; 18.7%), and dengue (603/3245; 18.6%). The crude mortality rate was 11.9 per 10 000 population (1824/1,532,963 [deaths/cases]). CONCLUSION: The study identified acute respiratory infection, acute diarrhea, malaria, and skin diseases as the most prevalent diseases. This suggests that preparedness efforts and interventions targeting these diseases should be prioritized in future flood response plans. The study highlights the importance of strengthening the IDSR as a Disease Early Warning System through the implementation of the DHIS2.

Pharmaceutical information systems and possible implementations of informed consent -- developing an heuristic.

BACKGROUND: Denmark has implemented a comprehensive, nationwide pharmaceutical information system, and this system has been evaluated by the Danish Council of Ethics. The system can be seen as an exemplar of a comprehensive health information system for clinical use. ANALYSIS: The paper analyses 1) how informed consent can be implemented in the system and how different implementations create different impacts on autonomy and control of information, and 2) arguments directed towards justifying not seeking informed consent in this context. RESULTS AND CONCLUSION: Based on the analysis a heuristic is provided which enables a ranking and estimation of the impact on autonomy and control of information of different options for consent to entry of data into the system and use of data from the system.The danger of routinisation of consent is identified.The Danish pharmaceutical information system raises issues in relation to autonomy and control of information, issues that will also occur in relation to other similar comprehensive health information systems. Some of these issues are well understood and their impact can be judged using the heuristic which is provided. More research is, however needed in relation to routinisation of consent.