A invenção de um setting on-line para atendimento psicológico remoto / The invention of an online environment for remote psychological care / La invención de un entorno en línea para la atención psicológica remota

Com o advento da covid-19, foi declarado estado de emergência de saúde pública e decretadas medidas de isolamento e distanciamento social para conter a propagação da doença. O Conselho Federal de Psicologia, considerando a importância do acolhimento seguro durante a pandemia, publicou a Resolução CFP nº 4/2020, permitindo que serviços psicológicos aconteçam de maneira remota. O presente estudo visa, através do Método da Cartografia, apresentar a construção de um setting on-line para intervenções grupais e os desafios na oferta de acolhimento e atendimento remoto. Foram ofertados grupos terapêuticos, por meio da plataforma Google Meet, para estudantes da Universidade Federal Rural do Rio de Janeiro. Um diário de bordo foi produzido para acompanhar as forças que atravessavam e constituíam o território e a experiência grupal remota. Compreendemos que o território-espaço-grupal-on-line era composto pelo espaço virtual em que nos reuníamos, pelos espaços individuais de cada integrante e pelas forças que os atravessavam. Observamos que nem sempre os participantes dispunham de um lugar privado, mas estiveram presentes no encontro com câmeras e áudios abertos e/ou fechados e/ou através do chat da videochamada. A participação no grupo funcionou como alternativa no momento de distanciamento social, sendo uma possibilidade para o atendimento psicológico em situações de dificuldade de encontros presenciais; entretanto, se mostrou dificultada em diversos momentos, pela falta de equipamentos adequados e instabilidade na internet, fatores que interferiram nas reuniões e impactaram na possibilidade de falar e escutar o que era desejado.(AU)

With the advent of COVID-19, a state of public health was declared, and measures of isolation and social distance to contain the spread of the disease was decreed. The Federal Council of Psychology, considering the importance of safe reception during the pandemic, published CFP Resolution No. 4/2020, allowing psychological services to happen remotely. This study narrates, via the Cartography Method, the experience of inventing an Online Setting for group reception. Therapeutic groups were offered, via Google Meet Platform, to students at the Federal Rural University of Rio de Janeiro. A logbook was produced to accompany the forces that crossed and constituted the territory and the remote group experience. We understand that the territoryspace-group-online was composed by the virtual-space that we gathered, by the individualspaces of each member and by the forces that crossed them. We observed that the participants did not always have a private place, but they were present at the meeting with open and/or closed cameras and audio and/or through the video call chat. Participation in the group worked as an alternative at the time of social distancing, being a possibility for psychological care in situations of difficulty in face-to-face meetings, however, it proved to be difficult at various times, due to the lack of adequate equipment and instability on the internet, factors that interfered in meetings and impacted the possibility of speaking and listening to what was desired.(AU)

La llegada de la COVID-19 produjo un estado de emergencia de salud pública, en el que se decretaron medidas de confinamiento y distanciamiento físico para contener la propagación de la enfermedad. El Consejo Federal de Psicología, considerando la importancia de la acogida segura durante la pandemia, publicó la Resolución CFP nº 4/2020, por la que se permite la atención psicológica remota. Este estudio tiene por objetivo presentar, mediante el método de la Cartografía, la elaboración de un escenario en línea para la intervención grupal y los desafíos en la oferta de acogida y atención remota. Grupos terapéuticos se ofrecieron, en la plataforma Google Meet, a estudiantes de la Universidad Federal Rural de Río de Janeiro. Se elaboró un diario para acompañar a las fuerzas que atravesaron y constituyeron el territorio y la experiencia remota del grupo. Entendemos que el territorio-espacio-grupo-en línea estaba compuesto por el espacio-virtual que reunimos, por los espacios individuales de cada integrante y por las fuerzas que los atravesaban. Observamos que los participantes no siempre tenían un lugar privado y que estaban presentes en la reunión con cámaras y audio abiertos y/o cerrados y/o por el chat de la videollamada. La participación en el grupo funcionó como una alternativa en el momento del distanciamiento físico y revela ser una posibilidad de atención psicológica en situaciones de dificultad en los encuentros presenciales, sin embargo, se mostró difícil en varios momentos, ya sea por la falta de medios adecuados o por inestabilidad en Internet, factores que interferían en las reuniones e impactaban en la posibilidad de hablar y escuchar lo que se deseaba.(AU)

Clasificación de Imágenes de Neumonía a causa de Covid-19 utilizando Transfer-Learning basado en Redes Convolucionales / Classification of Images of Pneumonia Due to Covid-19 Using TransferLearning, Based on Convolutional Networks

La Inteligencia Artificial ha ayudado a lidiar diferentes problemas relacionados con los datos masivos y a su vez con su tratamiento, diagnóstico y detección de enfermedades como la que actualmente nos preocupa, la Covid-19. El objetivo de esta investigación ha sido analizar y desarrollar la clasificación de imágenes de neumonía a causa de covid-19 para un diagnostico efectivo y óptimo. Se ha usado Transfer-Learning aplicando ResNet, DenseNet, Poling y Dense layer para la elaboración de los modelos de red propios Covid-UPeU y Covid-UPeU-TL, utilizando las plataformas Kaggle y Google colab, donde se realizaron 4 experimentos. El resultado con una mejor clasificación de imágenes se obtuvo en el experimento 4 prueba N°2 con el modelo Covid-UPeU-TL donde Acc.Train: 0.9664 y Acc.Test: 0.9851. Los modelos implementados han sido desarrollados con el propósito de tener una visión holística de los factores para la optimización en la clasificación de imágenes de neumonía a causa de COVID-19(AU)

Artificial Intelligence has helped to deal with different problems related to massive data in turn to the treatment, diagnosis and detection of diseases such as the one that currently has us in concern, Covid-19. The objective of this research has been to analyze and develop the classification of images of pneumonia due to covid-19 for an effective and optimal diagnosis. Transfer-Learning has been used applying ResNet, DenseNet, Poling and Dense layer for the elaboration of the own network models Covid-Upeu and Covid-UpeU-TL, using Kaggle and Google colab platforms, where 4 experiments have been carried out. The result with a better classification of images was obtained in experiment 4 test N ° 2 with the Covid-UPeU-TL model where Acc.Train: 0.9664 and Acc.Test: 0.9851. The implemented models have been developed with the purpose of having a holistic view of the factors for optimization in the classification of COVID-19 images(AU)

Intention to adopt Electronic Animal Movement Permit (e-GTA) systems in Rio Grande do Sul, Brazil / Intenção de adoção de Guia de Trânsito Animal Eletrônica (e-GTA) no Rio Grande do Sul, Brasil

Control of livestock and their movement has long been recognized as a crucial for the prevention and control of diseases. In Brazil, the control of livestock movement established in 1934. Since 1995 is regulated based on the Animal Movement Permit (GTA). Since then, the process has been improved and updated on its legal framework and strategies, including the use of emerging technological alternatives, which made possible the launching of the electronic Animal Movement Permit (e-GTA) in 2011. From a broader perspective, the e-GTA is inserted in a global context of the development of Information and Communication Technology (ICT) which since the early 1980s enabled governments worldwide to drive policies for the development of electronic government systems (e-government). After that, at a global level, there was an expansion and improvement of e-government services; however, discrepancies among countries persisted. Nonetheless, the levels of adoption of e-government by citizens have been lower than those expected by government authorities, which has attracted the attention of researchers in the area. In this context, studies of this nature that used theoretical antecedents related to the adoption of ICT have exposed peculiarities of the process of adoption of e-government, demanding research efforts directed to the structuring of specific models for this area. In Brazil, studies of this nature are still at an early stage, although government actions aimed at e-government date back to the 1990s. The objective of this article was to investigate, in an exploratory way, influence factors on the adoption intention of e-government related to animal health, having the e-GTA as the object of research. The conceptual framework was defined based upon the e-Government Adoption Model (GAM) For this objective, an online questionnaire oriented to intention to adopt e-GTA was applied to equine owners of Rio Grande do Sul not users of this system. Results indicated that respondents positively evaluated the quality of their computers and cellphones, as well as their efficacy to operate them, while quality of the internet connection was considered regular. In this context, the availability of computer and cellphone resources and computer self-efficacy did not influence the intention to adopt e-GTA. Moreover, aspects related to compatibility of e-GTA with users lifestyle have a positive association with the intention to adopt e-GTA. Also the study indicated that public information campaigns could contribute to the improvement of adoption of the e-GTA. Additionally, the authors suggested that further investigations considering other livestock sectors and variables, as well as the continuity of use after the adoption, could contribute to the expansion of the knowledge on this field.(AU)

O controle dos estoques e de movimentações de animais pecuários há muito tempo é reconhecido como um fator crucial para a prevenção e resposta para a introdução e disseminação de doenças animais ou zoonóticas. No Brasil, o controle de movimentação animal foi inicialmente estabelecido em 1934 e, desde 1995, é regulamentado com base na Guia de Trânsito Animal (GTA). Desde então, o processo foi aprimorado e atualizado em seu arcabouço legal e estratégias, inclusive no uso de alternativas tecnológicas emergentes, que possibilitaram o lançamento em 2011 da Guia de Trânsito Animal Eletrônica (e-GTA). Considerado desde uma perspectiva mais abrangente, o e-GTA está inserido em um contexto global de desenvolvimento da Tecnologia da Informação e Comunicação (TIC), que desde o início dos anos 80 permite que governos em todo o mundo conduzam políticas para o desenvolvimento de sistemas de governo eletrônico (governo eletrônico). Posteriormente, a disponibilidade do governo eletrônico tem estado em expansão de qualidade e de amplitude dos serviços oferecidos, embora este processo seja permeado por desigualdades entre os países. No entanto, os níveis de adoção do governo eletrônico pelos cidadãos têm sido inferiores aos esperados pelas autoridades governamentais, o que tem atraído a atenção dos pesquisadores da área. Nesse contexto, estudos dessa natureza, que utilizaram antecedentes teóricos relacionados à adoção das TIC expuseram idiossincrasias do processo de adoção do governo eletrônico, exigindo que esforços de pesquisa sejam direcionados à estruturação de modelos específicos para essa área. No Brasil, estudos dessa natureza ainda estão em estágio inicial, embora as ações governamentais direcionadas ao governo eletrônico datem dos anos 90. Dessa forma, o objetivo deste artigo foi investigar, de forma exploratória, fatores de influência na intenção de adoção do governo eletrônico relacionado à saúde animal, tendo o e-GTA como objeto de pesquisa. A estrutura conceitual foi definida com base no Modelo de Adoção de Governo Eletrônico (GAM). Para esse objetivo, um questionário online dirigido à intenção de adoção do e-GTA foi aplicado a proprietários de equinos do Rio Grande do Sul que não eram usuários deste sistema. Os resultados indicaram que os entrevistados avaliaram positivamente a qualidade de seus computadores e telefones celulares, bem como sua eficácia em operá-los, enquanto a qualidade da conexão de internet foi considerada regular. Nesse contexto, a disponibilidade de recursos informáticos e de celulares, bem como a capacidade de operação dos mesmos não influenciaram a intenção de adoção do e-GTA. Além disso, aspectos relacionados à compatibilidade do e-GTA com o estilo de vida do usuário têm uma associação positiva com a intenção de adoção do e-GTA. Além disso, o estudo indicou que as campanhas de informação pública poderiam contribuir para o incremento na adoção efetiva do e-GTA. Finalmente, o estudo identificou oportunidades para o desenvolvimento de investigações adicionais, considerando distintas variáveis, setores produtivos e sistemas de governo eletrônico dirigidos à saúde animal, o que poderia contribuir para a expansão do conhecimento nesta área.(AU)

Optimization and validation of patient-based real-time quality control procedure using moving average and average of normals with multi-rules for TT3, TT4, FT3, FT3, and TSH on three analyzers.

BACKGROUND: We have designed a patient-based real-time quality control (PBRTQC) procedure to detect analytical shifts and review analytical trends of measurement procedures. METHODS: All the nine months' patient results of total thyroxine (TT4), total triiodothyronine (TT3), free thyroxine (FT4), free triiodothyronine (FT3), and thyrotropin (TSH) measured by three identical analyzers were divided into three groups according to the source of inpatient patients, outpatient patients, and healthy people. The data in each group were truncated by optimized Box-Plot method and normalized by Box-Cox method if necessary. The z-score charts of internal quality control (IQC) samples' results and PBRTQC data were drawn by IQC levels and groups, respectively. The analytical shifts and analytical trends were detected by multi-rules of 2-2S rules and moving average rules. The performances of PBRTQC were compared with the BIQC in which IQC samples were measurand only once per day at the beginning of the analytical batch. Twelve quality control cases were listed to validate the performances. RESULTS: All the five analytes presented normal distributions when the parameter n of Box-Plot method was 1.2. The percentages of excluded data ranged from 2.9% to 11.6%. 31 and 14 rejections triggered in PBRTQC and BIQC, respectively. 96.8% of the shift rejections in PBRTQC were trend-related shifts and calibration-related shifts, while the proportion was 85.7% in BIQC but 78.6% of the shift rejections in TSH. 25.7% and 8.6% of 105 calibration events which caused analytical shifts were detected by PBRTQC and BIQC, respectively. However, the performance of PBRTQC was not well in TSH because of its large coefficient of variation. CONCLUSIONS: The optimized PBRTQC is high efficiency than BIQC in detecting analytical shifts, trends, and calibration events. The PBRTQC can be used as a low-cost supplementary procedure to IQC every day, especially at the end of the analytical batch on that day when the within-individual biological variation of analyte is not larger than its coefficient of variation in IQC. Further optimization and validation of PBRTQC are still needed.

MEDINAT: software educativo para la enseñanza de Medicina Natural y Tradicional / MEDINAT: educational software for teaching Herbal and Folk Medicine

RESUMEN Fundamento: la Medicina Natural y Tradicional es una especialidad de perfil amplio, con enfoque científico, único y holístico, que emplea métodos, técnicas y procedimientos para la promoción de salud, prevención de las enfermedades, diagnóstico, tratamiento y rehabilitación, con sistemas médicos basados en métodos tradicionales y naturales, ancestrales o modernos. Objetivo: diseñar un software educativo para el aprendizaje de la Medicina Natural y Tradicional en estudiantes de las ciencias médicas. Métodos: se realizó una investigación de desarrollo e innovación tecnológica durante el curso 2017-2018, en la Facultad de Medicina No.1 de Santiago de Cuba. Se emplearon métodos teóricos: histórico-lógico, análisis-síntesis y sistémico-estructural; empíricos para la recogida de la información, la valoración del producto por especialistas y usuarios y la estadística descriptiva. Resultados: el análisis documental facilitó la selección de los contenidos según los objetivos trazados para la confección del software; en su diseño se tuvieron en cuenta cuatro etapas; se seleccionó el Crheasoft versión 3.0 para su creación y se utilizó el Adobe Photoshop 10 para editar las imágenes. En su estructura contiene temario, mediateca, complementarios, ejercicios y glosario. Conclusiones: fue evaluado como Adecuado por los especialistas y de Bien por los usuarios según los aspectos técnicos, psicopedagógicos y comunicacionales, lo cual evidencia su calidad y pertinencia demostradas también en la efectividad del aprendizaje logrado con su aplicación.

ABSTRACT Background: Herbal and Folk Medicine is a wide profile specialty, with a scientific, unique and holistic approach, which uses methods, techniques and procedures for health promotion, disease prevention, diagnosis, treatment and rehabilitation, with medical based systems in folk and Herbal , ancestral or modern methods. Objective: to design educational software for learning Herbal and Folk Medicine in students of medical sciences. Methods: a research on technological development and innovation was carried out during the 2017-2018 academic year, at Santiago de Cuba Faculty of Medicine School1. Theoretical methods were used: historical-logical, analysis-synthesis and systemic-structural; empirical ones data collection, product evaluation by specialists and users and descriptive statistics. Results: the documentary analysis facilitated the selection of the contents according to the objectives set for the preparation of the software; four stages were taken into account in its design, Crheasoft version 3.0 was selected for its creation and Adobe Photoshop 10 was used to edit the images. In its structure it contains list of contents, media library, complementary exercises and glossary. Conclusions: it was evaluated as adequate by specialists and good by users according to the technical, psycho pedagogical and communicational aspects, which demonstrates its quality and relevance also demonstrated in the effectiveness of learning achieved with its application.

Informatização do processo de enfermagem na Atenção Primária à Saúde / Computerized nursing process in Brazilian Primary Health Care

A implementação e expansão do uso do Sistema e-SUS Atenção Básica com Prontuário Eletrônico do Cidadão (PEC), desencadeou discussões nos conselhos de enfermagem acerca do cumprimento da normativa do Conselho Federal de Enfermagem a respeito da Sistematização da Assistência de Enfermagem e a implementação do Processo de Enfermagem na Atenção Primária à Saúde (APS). Desta forma, o objetivo do estudo foi definir um modelo de informatização de Processo de Enfermagem adequado ao contexto da APS no Brasil. Para respondê-lo foi desenvolvida uma pesquisa avaliativa com proposta de intervenção, em três etapas complementares: a primeira etapa avaliou a versão atual do PEC, por meio de observação em unidades de saúde; a segunda propôs melhorias no sistema, utilizando um estudo metodológico; e a última etapa validou a proposta por método de consenso, centrada no processo de enfermagem e na resolução das fragilidades encontradas no uso do sistema, por meio da técnica de grupo nominal. Para construir o modelo usou-se a teoria de enfermagem completa, de Bárbara Barnum, sobre a tríade contexto, conteúdo e processo. Esta, estruturada pelo contexto da APS no Brasil, a Teoria de Necessidade Humanas Básicas de Wanda Horta, acomodada sobre a Classificação Internacional para a Prática de Enfermagem (CIPE), como conteúdo, e sustentando o processo, a estruturação por Necessidades Humanas e Sociais, em sintonia com o modelo de Registro Clínico Orientado por Problemas (RCOP). A proposta foi validada, por meio de protótipos de sistema, com uma taxa de 96,20%, por especialistas, profissionais de saúde, que atuam no campo de desenvolvimento de sistema com prontuário eletrônico na APS, enfermeiros da academia, com amplo conhecimento em processo de enfermagem na APS e terminologias padronizadas de enfermagem, bem como, enfermeiros da assistência, que usam prontuário eletrônico no dia-a-dia, nas cinco regiões do país. Os requisitos e recomendações apresentadas, permitem planejar um processo de desenvolvimento, ancorado na perspectiva de um modelo de desenvolvimento evolucionário, que atenda às necessidades de um sistema já em uso no Brasil. Ao mesmo tempo, lança um desafio sobre como fazer a gestão da mudança, permitindo ao enfermeiro explorar os novos recursos que potencializam o processo de enfermagem, sem ruptura com a cultura de uso do PEC, dentro de um desenho de capacidade bastante diverso da APS no Brasil. O estudo permitiu compreender que o processo de enfermagem não deve ser estruturado de forma isolada, característica que tem sido encontrada em outras propostas. Por outro lado, também fica claro que a ciência da enfermagem necessita ser aplicada com maior protagonismo no desenvolvimento de sistemas com prontuário eletrônico na APS. Ciência que traz as Necessidades Humanas e Sociais, na perspectiva holística do cuidado como eixo central, o qual se alinha perfeitamente às novas diretrizes da APS, colaborando para romper barreiras do modelo médico hegemônico. Este estudo aponta para um processo de desenvolvimento desafiador, demandando um grande projeto nacional, articulado pelas instituições responsáveis pela infoestrutura necessária para sustentar e concretizar a proposta do modelo de informatização do processo de enfermagem, inovador, validado para o contexto da APS no Brasil

The implementation and expansion of the use of the e-SUS Primary Care System with Electronic Medical Record (EMR), triggered discussions in nursing care about complying with the regulations of the Federal Board of Nursing with respect to the Nursing Care Systematization and the implementation of the Nursing Process at Primary Health Care (PHC). Therefore, the objective of the study was to define a computerized model for the Nursing Process / Consultation appropriate to the context of PHC in Brazil. To answer this question, an evaluative investigation was developed with a proposal for intervention, in three complementary stages: the first stage evaluating the current version of the EHR, through observation in health units; the second best proposal in the system, using a methodological study; and the last step to validate the proposal by consensus method, centered on the nursing process and on the resolution of the weaknesses found in the use of the system, using the nominal group technique. To build the model, Bárbara Barnum's complete nursing theory of was used, based on the context, content and processes. This is structured by the context of PHC in Brazil, the Wanda Horta's Theory of Basic Human Needs, on the International Classification for Nursing Practice (ICNP), as content and supporting the process, the structure by human and social needs, online with the Problem-Oriented Clinical Record (POCR) model. The proposal was validated, through prototypes of the system, with a 96.20% menu, by specialists, health professionals, who work in the field of systems development with EMR in PHC, nurse researchers, with wide knowledge in nursing process in PHC and standardized nursing terminology, as well as nursing assistants, who use EMR daily, in the five regions of the country. The requirements and recommendations presented, allow to plan a development process, based on the perspective of an evolutionary development model, which satisfies the needs of a system in use in Brazil. At the same time, it launches a challenge on how to manage change, which allows the nurse to explore new resources that improve the nursing process, without breaking with the culture of using the EMR, considering the variability of capacity in PHC in Brazil. This study allowed us to understand that the nursing process should not be structured in an isolated way, a characteristic that has been found in other proposals. On the other hand, it is also clear that the nursing science must apply with the greatest importance in the development of systems with EMR in PHC. Science that brings together human and social needs, in a holistic perspective of attention as a central theme, which aligns perfectly with the new PHC guidelines, collaborating to break the barriers of the hegemonic medical model. This study is part of a challenging development process, which requires a national project, articulated by the institutions responsible for the infostructure needed to support and materialize the proposal for the innovative model of computerized nursing process, validated for the PHC context in Brazil

Benefits of Blockchain Initiatives for Value-Based Care: Proposed Framework.

BACKGROUND: The potential of blockchain technology to achieve strategic goals, such as value-based care, is increasingly being recognized by both researchers and practitioners. However, current research and practices lack comprehensive approaches for evaluating the benefits of blockchain applications. OBJECTIVE: The goal of this study was to develop a framework for holistically assessing the performance of blockchain initiatives in providing value-based care by extending the existing balanced scorecard (BSC) evaluation framework. METHODS: Based on a review of the literature on value-based health care, blockchain technology, and methods for evaluating initiatives in disruptive technologies, we propose an extended BSC method for holistically evaluating blockchain applications in the provision of value-based health care. The proposed method extends the BSC framework, which has been extensively used to measure both financial and nonfinancial performance of organizations. The usefulness of our proposed framework is further demonstrated via a case study. RESULTS: We describe the extended BSC framework, which includes five perspectives (both financial and nonfinancial) from which to assess the appropriateness and performance of blockchain initiatives in the health care domain. CONCLUSIONS: The proposed framework moves us toward a holistic evaluation of both the financial and nonfinancial benefits of blockchain initiatives in the context of value-based care and its provision.

Epihack Sri Lanka: development of a mobile surveillance tool for dengue fever.

BACKGROUND: Dengue is a serious problem around the globe, with 3.9 billion people at risk of the disease. Sri Lanka has recently seen unprecedented rates of dengue with 4.3 times more cases than during the same period over the previous six years. The paper discusses the development of an integrated health systems framework, aided by mobile technology, to combat and contain dengue via a health hackathon in Sri Lanka. RESULTS: The framework addresses the key functions of surveillance, health communication and civic engagement through innovations including digitisation of hospital forms; digital aid to Public Health Inspectors (PHIs); data consolidation and analytics; education for construction workers, GPs, and schools; and educating the general public. CONCLUSIONS: We present the impact of the disease burden in tropical countries, such as Sri Lanka, current technological solutions, and the process of developing the mobile application modules developed via the health hackathon.

Disseminating health evidence summaries to increase evidence use in health care.

OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.

Hospital enterprise Architecture Framework (Study of Iranian University Hospital Organization).

BACKGROUNDS: Nowadays developing smart and fast services for patients and transforming hospitals to modern hospitals is considered a necessity. Living in the world inundated with information systems, designing services based on information technology entails a suitable architecture framework. OBJECTIVES: This paper aims to present a localized enterprise architecture framework for the Iranian university hospital. METHODS AND RESULTS: Using two dimensions of implementation and having appropriate characteristics, the best 17 enterprises frameworks were chosen. As part of this effort, five criteria were selected according to experts' inputs. According to these criteria, five frameworks which had the highest rank were chosen. Then 44 general characteristics were extracted from the existing 17 frameworks after careful studying. Then a questionnaire was written accordingly to distinguish the necessity of those characteristics using expert's opinions and Delphi method. The result showed eight important criteria. In the next step, using AHP method, TOGAF was chosen regarding having appropriate characteristics and the ability to be implemented among reference formats. In the next step, enterprise architecture framework was designed by TOGAF in a conceptual model and its layers. For determining architecture framework parts, a questionnaire with 145 questions was written based on literature review and expert's opinions. The results showed during localization of TOGAF for Iran, 111 of 145 parts were chosen and certified to be used in the hospital. CONCLUSION: The results showed that TOGAF could be suitable for use in the hospital. So, a localized Hospital Enterprise Architecture Modelling is developed by customizing TOGAF for an Iranian hospital at eight levels and 11 parts. This new model could be used to be performed in other Iranian hospitals.

Disseminating health evidence summaries to increase evidence use in health care

ABSTRACT OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.

Evaluating an Adjunctive Mobile App to Enhance Psychological Flexibility in Acceptance and Commitment Therapy.

The primary aims of this study were to evaluate the feasibility and potential efficacy of a novel adjunctive mobile app designed to enhance the acquisition, strengthening, and generalization of acceptance and commitment therapy (ACT) skills being taught in therapy. A sample of 14 depressed/anxious clients receiving ACT used the ACT Daily app for 2 weeks in a pre-post, open trial design. Participants reported a high degree of program satisfaction. Clients significantly improved over the 2-week period on depression and anxiety symptoms as well as a range of psychological inflexibility measures. Analyses of mobile app data indicated effects of ACT Daily skill coaching on in-the-moment measures of inflexibility and symptoms, with unique effects found for acceptance and mindfulness. Adjunctive ACT mobile apps appear promising in enhancing therapy effects on psychological inflexibility and outcomes. A tailored skill coaching approach like ACT Daily based on randomly prompted assessments may be especially promising.

Development and applications of the Veterans Health Administration's Stratification Tool for Opioid Risk Mitigation (STORM) to improve opioid safety and prevent overdose and suicide.

Concerns about opioid-related adverse events, including overdose, prompted the Veterans Health Administration (VHA) to launch an Opioid Safety Initiative and Overdose Education and Naloxone Distribution program. To mitigate risks associated with opioid prescribing, a holistic approach that takes into consideration both risk factors (e.g., dose, substance use disorders) and risk mitigation interventions (e.g., urine drug screening, psychosocial treatment) is needed. This article describes the Stratification Tool for Opioid Risk Mitigation (STORM), a tool developed in VHA that reflects this holistic approach and facilitates patient identification and monitoring. STORM prioritizes patients for review and intervention according to their modeled risk for overdose/suicide-related events and displays risk factors and risk mitigation interventions obtained from VHA electronic medical record (EMR)-data extracts. Patients' estimated risk is based on a predictive risk model developed using fiscal year 2010 (FY2010: 10/1/2009-9/30/2010) EMR-data extracts and mortality data among 1,135,601 VHA patients prescribed opioid analgesics to predict risk for an overdose/suicide-related event in FY2011 (2.1% experienced an event). Cross-validation was used to validate the model, with receiver operating characteristic curves for the training and test data sets performing well (>.80 area under the curve). The predictive risk model distinguished patients based on risk for overdose/suicide-related adverse events, allowing for identification of high-risk patients and enrichment of target populations of patients with greater safety concerns for proactive monitoring and application of risk mitigation interventions. Results suggest that clinical informatics can leverage EMR-extracted data to identify patients at-risk for overdose/suicide-related events and provide clinicians with actionable information to mitigate risk. (PsycINFO Database Record

Development of a web application for recording bacterial etiologic agents and their antimicrobial susceptibility to improve the treatment of urinary tract infections and monitor resistance to antibiotics.

OBJECTIVE: We describe the development of a web platform that provides an updated record of the etiology and antimicrobial susceptibility of the different microorganisms responsible for urinary tract infections. METHODS: The MicrobDinamyc system (Francisco Soria Melguizo, SA, Madrid, Spain) is employed for the management of information derived from the urine culture results. The web application database automatically gathers the results of urine cultures conducted in the laboratory. RESULTS: Results. The user can consult the distribution of bacterial etiologies and antimicrobial susceptibilities in the different clinical settings during a specific time window. CONCLUSIONS: Using susceptibility data obtained in previous studies and stored on the web platform, it is possible to deduce the clinical activity of a given antibiotic in a specific setting.

Beyond technology acceptance to effective technology use: a parsimonious and actionable model.

OBJECTIVE: To develop and test a parsimonious and actionable model of effective technology use (ETU). DESIGN: Cross-sectional survey of primary care providers (n = 53) in a large integrated health care organization that recently implemented new medication reconciliation technology. METHODS: Surveys assessed 5 technology-related perceptions (compatibility with work values, implementation climate, compatibility with work processes, perceived usefulness, and ease of use) and 1 outcome variable, ETU. ETU was measured as both consistency and quality of technology use. RESULTS: Compatibility with work values and implementation climate were found to have differential effects on consistency and quality of use. When implementation climate was strong, consistency of technology use was high. However, quality of technology use was high only when implementation climate was strong and values compatibility was high. This is an important finding and highlights the importance of users' workplace values as a key determinant of quality of use. CONCLUSIONS: To extend our effectiveness in implementing new health care information technology, we need parsimonious models that include actionable determinants of ETU and account for the differential effects of these determinants on the multiple dimensions of ETU.

European Health Information Initiative: first meeting of the Steering Group: Copenhagen, Denmark, 24–25 March 2015

The WHO European Health Information Initiative (EHII) Steering Group held its first formal meeting in Copenhagen, Denmark, on 24–25 March 2015. Launched in 2012 with start-up funding from the Ministry of Health, Welfare and Sport of the Netherlands, EHII is a multimember network committed to improving the health of the people of the WHO European Region by improving the information that underpins policy. This involves fostering international cooperation to exchange expertise, build capacity and harmonize data collection. Through these objectives, EHII contributes to integrating health information activities and developing a single integrated health information system for the Region. A number of countries and institutions, including an independent foundation, have contributed to specific EHII activities through funding and/or contributions in kind. The Steering Group received and discussed background information and updates, and reviewed and offered advice on EHII’s scope, terms of reference and action plan for 2015–2017.

Aligning health information technologies with effective service delivery models to improve chronic disease care.

OBJECTIVE: Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care, have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. METHOD: A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. RESULTS: Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. CONCLUSION: HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems.

Development and application of a web-based nutritional management program to improve dietary behaviors for the prevention of metabolic syndrome.

The purpose of this study was to develop a Web-based nutritional management program for the prevention of metabolic syndrome and to evaluate how the program affects health-related behaviors and the health status of office workers with metabolic syndrome risk factors. For the pilot test of the Web-based nutritional management program, 29 employees (19 males, 10 females) with more than one metabolic syndrome risk factor participated in the Web-based nutritional management program for 16 weeks. Participants visited the Web site more than two times per week and completed customized assessments of health status, smoking habits, alcohol consumption, dietary habits, food intake, ideal body weight, energy requirements, and exercise. Subjects had a significant decrease in body weight, waist circumference, body mass index (P < .01 in males, P < .05 in females), and body fat (P < .01 in males). The frequency of dietary habits such as eating snacks, eating out, and dining with others decreased, whereas the frequency of intake of foods such as whole grains, seaweed, fruit, and low-fat milk increased after intervention. After 16 weeks, program satisfaction was evaluated using a Web evaluation questionnaire, and most of the participants were highly satisfied with Web site components such as the loading speed, configuration, privacy, design, functionality, and contents.

Augmenting breath regulation using a mobile driven virtual reality therapy framework.

This paper presents a conceptual framework of a virtual reality therapy to assist individuals, especially lung cancer patients or those with breathing disorders to regulate their breath through real-time analysis of respiration movements using a smartphone. Virtual reality technology is an attractive means for medical simulations and treatment, particularly for patients with cancer. The theories, methodologies and approaches, and real-world dynamic contents for all the components of this virtual reality therapy (VRT) via a conceptual framework using the smartphone will be discussed. The architecture and technical aspects of the offshore platform of the virtual environment will also be presented.

An integrated healthcare information system for end-to-end standardized exchange and homogeneous management of digital ECG formats.

This paper investigates the application of the enterprise information system (EIS) paradigm to standardized cardiovascular condition monitoring. There are many specifications in cardiology, particularly in the ECG standardization arena. The existence of ECG formats, however, does not guarantee the implementation of homogeneous, standardized solutions for ECG management. In fact, hospital management services need to cope with various ECG formats and, moreover, several different visualization applications. This heterogeneity hampers the normalization of integrated, standardized healthcare information systems, hence the need for finding an appropriate combination of ECG formats and a suitable EIS-based software architecture that enables standardized exchange and homogeneous management of ECG formats. Determining such a combination is one objective of this paper. The second aim is to design and develop the integrated healthcare information system that satisfies the requirements posed by the previous determination. The ECG formats selected include ISO/IEEE11073, Standard Communications Protocol for Computer-Assisted Electrocardiography, and an ECG ontology. The EIS-enabling techniques and technologies selected include web services, simple object access protocol, extensible markup language, or business process execution language. Such a selection ensures the standardized exchange of ECGs within, or across, healthcare information systems while providing modularity and accessibility.