Mind the clinical-analytic gap: Electronic health records and COVID-19 pandemic response.

Data quality is essential to the success of the most simple and the most complex analysis. In the context of the COVID-19 pandemic, large-scale data sharing across the US and around the world has played an important role in public health responses to the pandemic and has been crucial to understanding and predicting its likely course. In California, hospitals have been required to report a large volume of daily data related to COVID-19. In order to meet this need, electronic health records (EHRs) have played an important role, but the challenges of reporting high-quality data in real-time from EHR data sources have not been explored. We describe some of the challenges of utilizing EHR data for this purpose from the perspective of a large, integrated, mixed-payer health system in northern California, US. We emphasize some of the inadequacies inherent to EHR data using several specific examples, and explore the clinical-analytic gap that forms the basis for some of these inadequacies. We highlight the need for data and analytics to be incorporated into the early stages of clinical crisis planning in order to utilize EHR data to full advantage. We further propose that lessons learned from the COVID-19 pandemic can result in the formation of collaborative teams joining clinical operations, informatics, data analytics, and research, ultimately resulting in improved data quality to support effective crisis response.

Cuidados paliativos nas mídias sociais: revisão integrativa de literatura / Palliative care in social media: integrative literature review / Atención paliativa en medios sociales: revisión integrativa de la literatura

Este artigo traz o estudo realizado com o objetivo de identificar as publicações sobre como os cuidados paliativos são abordados nas mídias sociais. Trata-se de uma revisão integrativa de literatura, com pesquisa de artigos nas bases Medical Literature Analysis and Retrieval System Online (Medline), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) e Scientific Eletronic Library Online (SciELO), em português, inglês e espanhol. Foram selecionados quinze artigos que atendiam aos critérios de seleção propostos, e são aqui apresentados por meio da construção de um quadro sinóptico, contendo título do estudo, periódico, ano de publicação e abordagem dos cuidados paliativos nas mídias sociais. Os resultados dos estudos demonstram que os cuidados paliativos necessitam ser melhor difundidos nas mídias sociais. Entretanto, tal evolução deve ocorrer com cautela, de modo a evitar riscos de comprometer a qualidade das informações e a respeitar questões éticas que envolvem pacientes e profissionais de saúde. Cabe destacar o papel do enfermeiro em ações de educação em saúde relacionadas com cuidados paliativos.

The study presented in this article aims to identify publications which reveal how palliative care is approached on social media. It is an integrative literature review, using search of articles in the bases Medical Literature Analysis and Retrieval System Online (Medline), Latin American and Caribbean Health Sciences Literature (Lilacs) and Scientific Electronic Library Online (SciELO), in Portuguese, English and Spanish languages. Fifteen articles that met the proposed selection criteria were selected, and they are presented here through the construction of a synoptic table, containing the title of the study, the journal in which it was published, its publication date and the specific approaches to palliative care in social media. The results of the studies demonstrate that the palliative care needs to be better disseminated on social media. However, caution should be taken while such dissemination occuring, in order to prevent risks damaging the quality of information and to follow ethical issues involving patients and health professionals. The role of nurses in health education actions regarding the palliative care should be highlighted.

El estudio presentado en este artículo tiene el objetivo de identificar publicaciones sobre cómo se aborda el cuidado paliativo en las redes sociales. Es una revisión literaria integrativa, haciendo una búsqueda de artículos en las bases del Medical Literature Analysis and Retrieval System Online (Medline), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs) y Scientific Eletronic Library Online (SciELO), en portugués, inglés y español. Se seleccionaron quince artículos que cumplían los criterios de selección propuestos, y ellos son presentados aquí a través de la construcción de un cuadro sinóptico, que contiene el título del estudio, la revista en la cual ha sido publicado, el año de publicación y el abordaje de los cuidados paliativos en las redes sociales. Los resultados de los estudios demuestran que los cuidados paliativos deben ser mejor difundidos en las redes sociales. Sin embargo, dicha difusión debe ocurrir con precaución para evitar riesgos de perjudicar la calidad de la información y para cumplir las cuestiones éticas que involucran pacientes y profesionales de la salud. El papel de los enfermeros y de las enfermeras en las acciones de educación en salud relacionadas con cuidados paliativos debe ser destacado.

COVID-19 and 'immune boosting' on the internet: a content analysis of Google search results.

OBJECTIVE: The spread of misinformation has accompanied the coronavirus pandemic, including topics such as immune boosting to prevent COVID-19. This study explores how immune boosting is portrayed on the internet during the COVID-19 pandemic. DESIGN: Content analysis. METHODS: We compiled a dataset of 227 webpages from Google searches in Canada and the USA using the phrase 'boost immunity' AND 'coronavirus' on 1 April 2020. We coded webpages for typology and portrayal of immune boosting and supplements. We recorded mentions of microbiome, whether the webpage was selling or advertising an immune boosting product or service, and suggested strategies for boosting immunity. RESULTS: No significant differences were found between webpages that appeared in the searches in Canada and the USA. The most common types of webpages were from news (40.5%) and commercial (24.7%) websites. The concept of immune boosting was portrayed as beneficial for avoiding COVID-19 in 85.5% of webpages and supplements were portrayed as beneficial in 40% of the webpages, but commercial sites were more likely to have these portrayals. The top immune boosting strategies were vitamin C (34.8%), diet (34.4%), sleep (34.4%), exercise (30.8%) and zinc (26.9%). Less than 10% of the webpages provide any critique of the concept of immune boosting. CONCLUSIONS: Pairing evidence-based advice for maintaining one's health (eg, healthy diet, exercise, sleep) with the phrase immune boosting and strategies lacking in evidence may inadvertently help to legitimise the concept, making it a powerful marketing tool. Results demonstrate how the spread of misinformation is complex and often more subtle than blatant fraudulent claims.

YouTube for information about side effects of biologic therapy: A social media analysis.

OBJECTIVE: Biologic therapies are one of the most significant breakthroughs in the treatment of rheumatic diseases, although there is still some uncertainty surrounding long-term patient safety. Recently, a growing number of patients browse the Internet as a source of health-related information. We aimed to assess the quality of information available on YouTube videos regarding the side effects of biologic therapy. METHODS: We used the keywords "biologic therapy side effects," "biologic therapy risks," "biologic therapy safety," "biologic agents side effects," "biologic agents risks," and "biologic agents safety." Also, the generic and commercial names of biologic agents were searched on YouTube in May 2020. The quality and reliability of the videos was assessed according to the global quality score (GQS), DISCERN score. Video Power Index (VPI) used to assess both the view and the like ratios of the videos. RESULTS: Seventy-five videos were evaluated. According to the GQS, 31 videos (40.3%) were of high quality, 18 videos (23.4%) were of intermediate quality, and 28 videos (36.4%) were of low quality. The GQS was significantly positively correlated with the DISCERN score (P < .001). VPI scores were not correlated with DISCERN (P = .268) and GQS scores (P = .411). CONCLUSION: YouTube videos on the side effects of biologic therapy are informative for patients and physicians. High-quality videos are more reliable but may not be as popular as expected.

Knowledge transmission patterns at the border: ethnobotany of Hutsuls living in the Carpathian Mountains of Bukovina (SW Ukraine and NE Romania).

BACKGROUND: Cross-border research is a novel and important tool for detecting variability of ecological knowledge. This is especially evident in regions recently divided and annexed to different political regimes. Therefore, we conducted a study among Hutsuls, a cultural and linguistic minority group living in Northern and Southern Bukovina (Ukraine and Romania, respectively). Indeed, in the 1940s, a border was created: Northern Bukovina was annexed by the USSR while Southern Bukovina remained part of the Kingdom of Romania. In this research, we aim to document uses of plants for food and medicinal preparations, discussing the different dynamics of Local Ecological Knowledge (LEK) transmission among Hutsuls living in Ukraine and Romania. METHODS: Field research was conducted using convenience and snowball sampling techniques to recruit 31 Hutsuls in Ukraine and 30 in Romania for participation in semi-structured interviews regarding the use of plants for medicinal and food preparation purposes and the sources of such knowledge. RESULTS: The interviews revealed that, despite a common cultural and linguistic background, ethnobotanical knowledge transmission occurs in different ways on each side of the border. Family is a primary source of ethnobotanical knowledge transmission on both sides of the border; however, in Romania, knowledge from other sources is very limited, whereas in Ukraine interviewees reported several other sources including books, magazines, newspapers, the Internet and television. This is especially evident when analysing the wild plants used for medicinal purposes as we found 53 taxa that were common to both, 47 used only in Ukraine and 11 used only in Romania. While Romanian Hutsuls used almost exclusively locally available plants, Ukrainian Hutsuls often reported novel plants such as Aloe vera, Aronia melanocarpa and Elaeagnus rhamnoides. Knowledge related to these plants was transferred by sources of knowledge other than oral transmission among members of the same family. Therefore, this may imply hybridization of the local body of knowledge with foreign elements originating in the Soviet context which has enriched the corpus of ethnobotanical knowledge held by Ukrainian Hutsuls. CONCLUSIONS: While ethnobotanical knowledge among Romanian Hutsuls is mainly traditional and vertically transmitted, among Ukrainian Hutsuls there is a considerable proportion of LEK that is transmitted from other (written and visual) sources of knowledge. This cross-border research reveals that despite a common cultural background, socio-political scenarios have impacted Hutsul ethnobotanical knowledge and its transmission patterns.

[The shared medical record, a digital health record for all]. / Le dossier médical partagé, un carnet de santé numérique pour tous.

In July 2016, the National Health Insurance re-launched the shared medical record, a tool for sharing information between health professionals and patients. Its use has been growing among doctors for more than a year now, and more healthcare institutions are rolling it out.

Preserving osteopathic antiquity through historical pamphlets and postcards.

During the late nineteenth and early twentieth centuries, osteopathic information was circulated by way of pamphlets and postcards. Several osteopathic historical pamphlets and postcards from the D'Angelo Library collection have been researched and digitized in order to preserve these osteopathic artifacts and highlight their historical significance for the current profession.

Internet of Things and Artificial Intelligence in Healthcare During COVID-19 Pandemic-A South American Perspective.

The shudders of the COVID-19 pandemic have projected newer challenges in the healthcare domain across the world. In South American scenario, severe issues and difficulties have been noticed in areas like patient consultations, remote monitoring, medical resources, healthcare personnel etc. This work is aimed at providing a holistic view to the digital healthcare during the times of COVID-19 pandemic in South America. It includes different initiatives like mobile apps, web-platforms and intelligent analyses toward early detection and overall healthcare management. In addition to discussing briefly the key issues toward extensive implementation of eHealth paradigms, this work also sheds light on some key aspects of Artificial Intelligence and the Internet of Things along their potential applications like clinical decision support systems and predictive risk modeling, especially in the direction of combating the emergent challenges due to the COVID-19 pandemic.

Development of a nutritional documentation tool: a Delphi study.

In daily clinical practice, the smooth, timely and comprehensive transfer of information between care settings is important and reflects a cornerstone of high-quality patient care. The integration of nutritional information in the medical information transfer is currently not included in an evidence-based approach. It was, therefore, the aim of this study to develop a nutritional documentation tool (NDoc) on the basis of evidence and test it for its usability in daily clinical practice. Based on the results of a literature review, the authors collected core content using a modified Delphi survey from experts across Europe and included the information collected in a structured, NDoc. The subsequently developed tool included thirty items and was tested for its usability on a daily basis among primary care physicians and clinical physicians. The new NDoc can be introduced for use in any computer-based hospital information system regionally and adapted for worldwide use.

Information and communication in the emergency department.

BACKGROUND: Effective communication between healthcare providers and patients represents an important caveat in healthcare, both nationally and internationally. Providing information to patients about their care and condition can be challenging, particularly in demanding, time-pressured environments such as the Emergency Department (ED). Understanding the process of communication and information between patients and staff in the ED is essential to ensuring patients are satisfied with their treatment and care. AIM: This study aimed to develop a holistic understanding of the informational and communicational requirements of patients and staff in the ED. METHODS: Action Research involving patient qualitative interviews and a staff focus group were used. RESULTS: Fifteen patient and family interviews identified four main themes associated with information and communication in the ED. Six ED staff participated in the focus group, which identified three emergent themes echoing some findings from the patient qualitative interviews. DISCUSSION: Meaningful and informative interactions between patients and healthcare providers are an imperative and pragmatic component of a positive patient experience. Establishing communicative procedures that are practical, functional and reflective of the service can improve communications between patients and staff and have implications for practice on a local, national and international level.

[Online information system for -phytotherapy in animals]. / Online-Informationssystem für die Phytotherapie bei Tieren.

INTRODUCTION: Phytotherapy becomes increasingly popular in veterinary medicine. To fully exploit the therapeutic potential of medicinal plants and ensure their safe use, knowledge about the effective plant parts and preparations is required. Improper use and overdosage of medicinal plants can be toxic. With www.phytoarznei.ch, we provide an online decision support aid that allows for the retrieval of currently available information on medicinal plants and their use in domestic animals. This decision support system is based on the available literature in the field, which after critical evaluation has been incorporated into a structured database. For each medicinal plant or drug, we have listed therapeutic indications, different application types, organoleptic properties, plant ingredients, pharmacological effects, dosages, duration of treatment, toxicity, legal frame for use in livestock and relevance for doping. A user-friendly access to all data is achieved by means of two search programs, either by entering the plant name or name of the drug in a search field or by selecting the desired animal species and therapeutic application from respective drop-down lists. This database on medicinal plant applications in animals is linked to the poisonous plant database of the University of Zurich and, for marketed preparations, to the Swiss compendium of veterinary medicinal products as well as to an index of related veterinary products.

INTRODUCTION: En médecine vétérinaire aussi, la phytothérapie devient de plus en plus populaire. Exploiter le potentiel thérapeutique des plantes médicinales et assurer leur utilisation en toute sécurité nécessite toutefois une connaissance particulière des parties de plantes ou des préparations efficaces. Une utilisation inappropriée et un surdosage de plantes médicinales peuvent être toxiques. C'est pourquoi nous avons créé un outil de prise de décision en ligne, www.phytoarznei.ch, qui permet un accès rapide aux connaissances actuelles sur les plantes médicinales et leur utilisation sur les animaux. Ce système d'information est basé sur la littérature spécialisée disponible qui a été incorporée, après une évaluation critique, dans une base de données structurée. Les indications thérapeutiques, les modes d'applications, les propriétés organoleptiques, les composants, les effets pharmacologiques, doses, la durée du traitement, la toxicité, les réglementations juridiques chez les animaux de rente ainsi que la pertinence en matière de dopage sont répertoriés pour chaque plante médicinale ou médicament à base de plantes. Deux programmes de recherche fournissent un accès convivial, soit par la saisie du nom de la plante, du nom du médicament ou des ingrédients de la plante dans une zone de recherche, soit en sélectionnant les espèces d'animaux souhaitées ainsi que l'utilisation thérapeutique dans des menus déroulants correspondants. Cette base de données des plantes médicinales est liée avec base de plantes toxiques de l'Université de Zurich et, si des produits finis correspondants sont disponibles, au Compendium des médicaments vétérinaires suisse ainsi qu'à un répertoire de produits vétérinaires.

[Consumer behavior toward functional foods. The role of authentic information]. / Az egészségvédo élelmiszerekkel kapcsolatos fogyasztói magatartás. A hiteles tájékoztatás szerepe.

Nowadays, we are witnessing a spectacular improvement in health consciousness of advanced societies. Due to the transformation of consumer behaviour, the proportion of health-conscious consumers who make well-informed and independent decisions increases steadily. In parallel, health-promoting foods are gaining more ground in the markets. Regarding the health effects, primarily cardiovascular prevention, bacterial flora modification, weight reduction as well as energy and vitamin supplementation are in focus in Hungary. Practically, any food type can be enriched with functional attributes; however, in addition to technical difficulties, the main challenge for food manufacturers is to persuade consumers to try out their products and use them continuously. In addition to research, development and innovation, consumer awareness and continuous knowledge expansion are also key factors for the success of functional foods. Consequently, strengthening the collaboration between functional food manufacturers and health professionals and researchers would be particularly beneficial, since their interrelationships might have a significant impact on the development and acceptance of novel functional foods. Orv Hetil. 2018; 159(30): 1221-1225.

Mobile Applications for Women's Health and Midwifery Care: A Pocket Reference for the 21st Century.

Midwives and other women's health care providers are charged with providing high-quality care to women based on the most current available evidence. Quick, reliable, and accurate access to evidence-based information is essential. Numerous smartphone and mobile device applications (apps) are available to assist clinicians in providing care for women. This article discusses clinical reference apps, including those for evidence-based care guidelines, women's health care, pharmacologic reference, laboratory and diagnostic guides, as well as apps for information storage and management, electronic health records, and client education. Midwives and other clinicians are encouraged to thoughtfully integrate mobile apps into their clinical practices to improve client outcomes and clinician and client satisfaction. Although the thousands of health care apps that are available may seem daunting, this article highlights key apps that may help clinicians improve their care of women. By adding one app at a time, midwives and other women's health care providers can successfully integrate mobile apps into clinical practice.

Is Cancer Information Exchanged on Social Media Scientifically Accurate?

Cancer patients and their caregivers are increasingly using social media as a platform to share cancer experiences, connect with support, and exchange cancer-related information. Yet, little is known about the nature and scientific accuracy of cancer-related information exchanged on social media. We conducted a content analysis of 12 months of data from 18 publically available Facebook Pages hosted by parents of children with acute lymphoblastic leukemia (N = 15,852 posts) and extracted all exchanges of medically-oriented cancer information. We systematically coded for themes in the nature of cancer-related information exchanged on personal Facebook Pages and two oncology experts independently evaluated the scientific accuracy of each post. Of the 15,852 total posts, 171 posts contained medically-oriented cancer information. The most frequent type of cancer information exchanged was information related to treatment protocols and health services use (35%) followed by information related to side effects and late effects (26%), medication (16%), medical caregiving strategies (13%), alternative and complementary therapies (8%), and other (2%). Overall, 67% of all cancer information exchanged was deemed medically/scientifically accurate, 19% was not medically/scientifically accurate, and 14% described unproven treatment modalities. These findings highlight the potential utility of social media as a cancer-related resource, but also indicate that providers should focus on recommending reliable, evidence-based sources to patients and caregivers.