Electronic prescription systems in Greece: a large-scale survey of healthcare professionals' perceptions.

BACKGROUND: The national e-prescription system in Greece is one of the most important achievements in the e-health sector. Healthcare professionals' feedback is essential to ensure the introduced system tends to their needs and reduces their everyday workload. The number of surveys collecting the users' views is limited, while the existing studies include only a small number of participants. METHODS: In this study, healthcare professionals' perceptions on e-prescription are explored. For this, a questionnaire was distributed online, containing closed- and open-ended questions aiming to address strengths and identify drawbacks in e-prescription. Answers were collected from primary health care physicians, specialized medical doctors and pharmacists. RESULTS: In total, 430 answers were collected (129 from primary health care physicians, 164 responses from specialized medical doctors and 137 pharmacists). Analysis of the collected answers reveals that the views of the three groups of healthcare professionals mostly converge. The positive impact e-prescribing systems have on the overall prescribing procedure in preventing errors and providing automation is commented. Among gaps identified and proposed improvements, health care professionals note the need for access to information on adverse drug reactions, side effects, drug-to-drug interactions and allergies. Flexible interaction with Therapeutic Prescription Protocols is desired to ameliorate monitoring and decision-making, while drug dosing features, and simplified procedures for copying, repeating, canceling a prescription, are perceived as useful to incorporate. CONCLUSIONS: Collecting healthcare professionals' feedback is important, as their views can be transcribed to system requirements, to further promote e-prescribing and improve the provided health care services by facilitating decision making through safer and more efficient e-prescription. Introduction of the identified improvements can simplify the everyday workflow of healthcare professionals. To the best of our knowledge, a survey with more than 400 answered questionnaires on the use of e-prescription systems by healthcare professionals has never been conducted in Greece before.

Evaluation of an electronic prescription platform: Clinicians' feedback on three distinct services aiming to facilitate clinical decision and safer e-prescription.

BACKGROUND: Health Care Professionals (HCPs) are the main end-users of digital clinical tools such as electronic prescription systems. For this reason, it is of high importance to include HCPs throughout the design, development and evaluation of a newly introduced system to ensure its usefulness, as well as confirm that it tends to their needs and can be integrated in their everyday clinical practice. METHODS: In the context of the PrescIT project, an electronic prescription platform with three services was developed (i.e., Prescription Check, Prescription Suggestion, Therapeutic Prescription Monitoring). To allow an iterative process of discovery through user feedback, design and implementation, a two-phase evaluation was carried out, with the participation of HCPs from three hospitals in Northern Greece. The two-phase evaluation included presentations of the platform, followed by think-aloud sessions, individual platform testing and the collection of qualitative as well as quantitative feedback, through standard questionnaires (e.g., SUS, PSSUQ). RESULTS: Twenty one HCPs (8 in the first, 18 in the second phase, and five present in both) participated in the two-phase evaluation. HCPs comprised clinicians varying in their specialty and one pharmacist. Clinicians' feedback during the first evaluation phase already deemed usability as "excellent" (with SUS scores ranging from 75 to 95/100, showing a mean value of 86.6 and SD of 9.2) but also provided additional user requirements, which further shaped and improved the services. In the second evaluation phase, clinicians explored the system's usability, and identified the services' strengths and weaknesses. Clinicians perceived the platform as useful, as it provides information on potential adverse drug reactions, drug-to-drug interactions and suggests medications that are compatible with patients' comorbidities and current medication. CONCLUSIONS: The developed PrescIT platform aims to increase overall safety and effectiveness of healthcare services. Therefore, including clinicians in a two-phase evaluation confirmed that the introduced system is useful, tends to the users' needs, does not create fatigue and can be integrated in their everyday clinical practice to support clinical decision and e-prescribing.

Assessing the cognitive decline of people in the spectrum of AD by monitoring their activities of daily living in an IoT-enabled smart home environment: a cross-sectional pilot study.

Introduction: Assessing functional decline related to activities of daily living (ADLs) is deemed significant for the early diagnosis of dementia. As current assessment methods for ADLs often lack the ability to capture subtle changes, technology-based approaches are perceived as advantageous. Specifically, digital biomarkers are emerging, offering a promising avenue for research, as they allow unobtrusive and objective monitoring. Methods: A study was conducted with the involvement of 36 participants assigned to three known groups (Healthy Controls, participants with Subjective Cognitive Decline and participants with Mild Cognitive Impairment). Participants visited the CERTH-IT Smart Home, an environment that simulates a fully functional residence, and were asked to follow a protocol describing different ADL Tasks (namely Task 1 - Meal, Task 2 - Beverage and Task 3 - Snack Preparation). By utilizing data from fixed in-home sensors installed in the Smart Home, the identification of the performed Tasks and their derived features was explored through the developed CARL platform. Furthermore, differences between groups were investigated. Finally, overall feasibility and study satisfaction were evaluated. Results: The composition of the ADLs was attainable, and differentiation among the HC group compared to the SCD and the MCI groups considering the feature "Activity Duration" in Task 1 - Meal Preparation was possible, while no difference could be noted between the SCD and the MCI groups. Discussion: This ecologically valid study was determined as feasible, with participants expressing positive feedback. The findings additionally reinforce the interest and need to include people in preclinical stages of dementia in research to further evolve and develop clinically relevant digital biomarkers.

A Semantic Framework to Detect Problems in Activities of Daily Living Monitored through Smart Home Sensors.

Activities of daily living (ADLs) are fundamental routine tasks that the majority of physically and mentally healthy people can independently execute. In this paper, we present a semantic framework for detecting problems in ADLs execution, monitored through smart home sensors. In the context of this work, we conducted a pilot study, gathering raw data from various sensors and devices installed in a smart home environment. The proposed framework combines multiple Semantic Web technologies (i.e., ontology, RDF, triplestore) to handle and transform these raw data into meaningful representations, forming a knowledge graph. Subsequently, SPARQL queries are used to define and construct explicit rules to detect problematic behaviors in ADL execution, a procedure that leads to generating new implicit knowledge. Finally, all available results are visualized in a clinician dashboard. The proposed framework can monitor the deterioration of ADLs performance for people across the dementia spectrum by offering a comprehensive way for clinicians to describe problematic behaviors in the everyday life of an individual.

Eliciting brain waves of people with cognitive impairment during meditation exercises using portable electroencephalography in a smart-home environment: a pilot study.

Objectives: Meditation imparts relaxation and constitutes an important non-pharmacological intervention for people with cognitive impairment. Moreover, EEG has been widely used as a tool for detecting brain changes even at the early stages of Alzheimer's Disease (AD). The current study investigates the effect of meditation practices on the human brain across the AD spectrum by using a novel portable EEG headband in a smart-home environment. Methods: Forty (40) people (13 Healthy Controls-HC, 14 with Subjective Cognitive Decline-SCD and 13 with Mild Cognitive Impairment-MCI) participated practicing Mindfulness Based Stress Reduction (Session 2-MBSR) and a novel adaptation of the Kirtan Kriya meditation to the Greek culture setting (Session 3-KK), while a Resting State (RS) condition was undertaken at baseline and follow-up (Session 1-RS Baseline and Session 4-RS Follow-Up). The signals were recorded by using the Muse EEG device and brain waves were computed (alpha, theta, gamma, and beta). Results: Analysis was conducted on four-electrodes (AF7, AF8, TP9, and TP10). Statistical analysis included the Kruskal-Wallis (KW) nonparametric analysis of variance. The results revealed that both states of MBSR and KK lead to a marked difference in the brain's activation patterns across people at different cognitive states. Wilcoxon Signed-ranks test indicated for HC that theta waves at TP9, TP10 and AF7, AF8 in Session 3-KK were statistically significantly reduced compared to Session 1-RS Z = -2.271, p = 0.023, Z = -3.110, p = 0.002 and Z = -2.341, p = 0.019, Z = -2.132, p = 0.033, respectively. Conclusion: The results showed the potential of the parameters used between the various groups (HC, SCD, and MCI) as well as between the two meditation sessions (MBSR and KK) in discriminating early cognitive decline and brain alterations in a smart-home environment without medical support.

Use of Real-World Data to Support Adverse Drug Reactions Prevention During ePrescription.

Adverse Drug Reactions (ADRs) are a crucial public health issue due to the significant health and monetary burden that they can impose. Real-World Data (RWD), e.g., Electronic Health Records, claims data, etc., can support the identification of potentially unknown ADRs and thus, they could provide raw data to mine ADR prevention rules. The PrescIT project aims to create a Clinical Decision Support System (CDSS) for ADR prevention during ePrescription and uses OMOP-CDM as the main data model to mine ADR prevention rules, based on the software stack provided by the OHDSI initiative. This paper presents the deployment of OMOP-CDM infrastructure using the MIMIC-III as a testbed.

The PrescIT Knowledge Graph: Supporting ePrescription to Prevent Adverse Drug Reactions.

Adverse Drug Reactions (ADRs) are an important public health issue as they can impose significant health and monetary burdens. This paper presents the engineering and use case of a Knowledge Graph, supporting the prevention of ADRs as part of a Clinical Decision Support System (CDSS) developed in the context of the PrescIT project. The presented PrescIT Knowledge Graph is built upon Semantic Web technologies namely the Resource Description Framework (RDF), and integrates widely relevant data sources and ontologies, i.e., DrugBank, SemMedDB, OpenPVSignal Knowledge Graph and DINTO, resulting in a lightweight and self-contained data source for evidence-based ADRs identification.

Discovery of steroidal lactam conjugates of POPAM-NH2 with potent anticancer activity.

Aim: Steroidal prodrugs of nitrogen mustards such as estramustine and prednimustine have proven effective anticancer agents in clinical use since the 1970s. In this work, we aimed to develop steroidal prodrugs of the novel nitrogen mustard POPAM-NH2. POPAM-NH2 is a melphalan analogue that was coupled with three different steroidal lactams. Methodology: The new conjugates were preclinically tested for anticancer activity against nine human and one rodent cancer experimental models, in vitro and in vivo. Results & conclusion: All the steroidal alkylators showed high antitumor activity, in vitro and in vivo, in the experimental systems tested. Moreover, these hybrid compounds showed by far superior anticancer activity compared with the alkylating agents, melphalan and POPAM-NH2.