Addressing psychiatric disorders and genetics: the meaningful use of comics for health information.

In the fields of healthcare and education, comics have shown considerable academic and teaching importance, with their combination of text and images. As a well-known character in comics, Batman allows us to discuss several relevant topics, from the outcomes in adulthood of experiencing parental death in childhood to genetic and epigenetic changes that may be factors of vulnerability to psychiatric disorders in adulthood. In this text, a narrative of Batman is developed, demonstrating the possibility of using it in an academic context and intending at paying greater attention to patients' history and the relationship between genetics and behaviour.

Combine parentally and university studies, a highly significant challenge / Combinar parentalidad y estudios universitarios, un reto altamente significativo

With the aim of interpreting the meaning of parenthood among nursing students who are also parents, a study was carried out with the qualitative paradigm, phenomenological approach, using the Spiegelberg method for the analysis of the information and the deep interview as a technique for gathering information. Five students were interviewed with whom the field got saturated. The participating external agents were three teachers of the nursing program and a mother of family, the information was validated through the triangulation of the data obtained from the subjects. Questions were registered and transcribed, and from the information emerged two categories: being parents and feelings. Subcategories were responsibility, beautiful experience, experience of experiences, inspiration, motivation, love, frustration, jealousy, transcendence and guilt. The meaning of being parents in nursing students is associated with the responsibility, the feelings and what they consider a life experience.

Con el objetivo de interpretar el significado de la paternidad entre los estudiantes de enfermería que también son padres, se realizó un estudio con el paradigma cualitativo, enfoque fenomenológico, utilizando el método de Spiegelberg para el análisis de la información y la entrevista profunda como una técnica para recopilar información. Se entrevistaron cinco estudiantes con quienes se saturó el campo. Los agentes externos participantes fueron tres profesores del programa de enfermería y una madre de familia, la información se validó a través de la triangulación de los datos obtenidos de los sujetos. Las preguntas fueron registradas y transcritas, y de la información surgieron dos categorías: ser padres y sentimientos. Las subcategorías fueron responsabilidad, hermosa experiencia, experiencia de experiencias, inspiración, motivación, amor, frustración, celos, trascendencia y culpa. El significado de ser padres en estudiantes de enfermería está asociado con la responsabilidad, los sentimientos y lo que consideran una experiencia de vida.

User-Centered Design Practices to Redesign a Nursing e-Chart in Line with the Nursing Process.

Regarding the user-centered design (UCD) practices carried out at Hospital Italiano of Buenos Aires, nursing e-chart user interface was redesigned in order to improve records' quality of nursing process based on an adapted Virginia Henderson theoretical model and patient safety standards to fulfil Joint Commission accreditation requirements. UCD practices were applied as standardized and recommended for electronic medical records usability evaluation. Implementation of these practices yielded a series of prototypes in 5 iterative cycles of incremental improvements to achieve goals of usability which were used and perceived as satisfactory by general care nurses. Nurses' involvement allowed balance between their needs and institution requirements.

Computerization of a Nursing Chart According to the Nursing Process.

The benefits associated with the computerization of clinical records are known since a long time ago. Documentation evolution from paper to electronic format aims to always improve communication, reduce errors and facilitate continuity of care. Ideally when improvements to nursing records are contemplated, they should consider the nurses needs, new functionality workflow impacts and correspondence with representation models of standardized data that are specific to their domains practices. The aim of this study was to describe the development and implementation of computerized nursing record at Hospital Italiano de Buenos Aires.

A sucata como avesso complementar da contemporaneidade / Scrap as the complementary reverse of contemporaneity / El material de desperdício como el reverso complementario de la contemporaneidad

Este artigo objetiva discutir os significados da sucata na contemporaneidade, apresentando o relato de uma experiência com sucata em oficina de criação espontânea, realizada em uma universidade, como parte de uma investigação sobre os sentidos atribuídos à sucata. Propõe-se, então, a sucata - cujo significado etimológico é objeto sem valor - e as relações que ela mantém, tanto no plano econômico quanto no plano das relações sociais, como objeto e, também, como método de investigação científica. Observamos que a sucata deixa de ser apenas um objeto sem valor para se tornar um meio, um caminho que abre possibilidades de leituras de mundo, de interferências no mundo, de desdobramentos, de vias de escape. Conclui-se, assim, que em toda sua complexidade, a sucata da história (história pessoal e social), pode proporcionar, por meio de sua característica maior - a falta de significado -, a possibilidade de ressignificação, tornando-se um modo, um método, às avessas, em negativo, do contemporâneo.

The main objective of this article is to discuss the meanings associated to refuse/scrap nowadays, presenting a report about an experience conducted in a university campus, exploring scrap workshop spontaneous creation, as part of an investigation into the meanings assigned to it. We focus on the concept of refuse/scrap - whose meaning is associated with worthless material- and the relationships it maintains, both on the economic level and in terms of social relations, and also as object and scientific research method. We can observe that scrap metal ceases to be just worthless object, to become a means and a path, which enables world readings, interference and escape routes in world developments. We conclude, therefore, that in all its complexity, scrap history (personal and social history), despite being considered worthless as its greatest feature, can provide - considering its lack of meaning - the possibility of reframing, becoming a method in reverse, as a negative, of the contemporary.

Este artículo objetiva discutir los significados de la chatarra en la contemporaneidad, presentando el relato de una experiencia con la chatarra en un taller de creación espontánea, realizada en una Universidad, como parte de una investigación sobre los sentidos atribuidos a la chatarra. De ahí, se propone la chatarra - cuyo significado etimológico es objeto sin valor - y las relaciones que ella mantiene, tanto en el plano económico como en los planos de relaciones sociales, como objeto y también como un método de investigación científica. Observamos que la chatarra deja de ser apenas un objeto sin valor para convertirse en un medio, un camino que abre posibilidades de lecturas de mundo, de interferencias en el mundo, de desdoblamientos, de despliegue. Se concluye, por lo tanto, que en toda su complejidad, la chatarra, chatarra de la historia (historia personal y social), puede proporcionar por medio de su mayor característica - la falta de significado - la posibilidad de resignificación, convirtiéndose en un método, al revés, en negativa, de lo contemporáneo.

Validating the Access to an Electronic Health Record: Classification and Content Analysis of Access Logs.

Electronic Health Records (EHRs) have made patient information widely available, allowing health professionals to provide better care. However, information confidentiality is an issue that continually needs to be taken into account. The objective of this study is to describe the implementation of rule-based access permissions to an EHR system. The rules that were implemented were based on a qualitative study. Every time users did not meet the specified requirements, they had to justify access through a pop up window with predetermined options, including a free text option ("other justification"). A secondary analysis of a deidentified database was performed. From a total of 20,540,708 hits on the electronic medical record database, 85% of accesses to the EHR system did not require justification. Content analysis of the "Other Justification" option allowed the identification of new types of access. At the time to justify, however, users may choose the faster or less clicks option to access to EHR, associating the justification of access to the EHR as a barrier.

Systems Architecture for a Nationwide Healthcare System.

From a national level to give Internet technology support, the Nationwide Integrated Healthcare System in Uruguay requires a model of Information Systems Architecture. This system has multiple healthcare providers (public and private), and a strong component of supplementary services. Thus, the data processing system should have an architecture that considers this fact, while integrating the central services provided by the Ministry of Public Health. The national electronic health record, as well as other related data processing systems, should be based on this architecture. The architecture model described here conceptualizes a federated framework of electronic health record systems, according to the IHE affinity model, HL7 standards, local standards on interoperability and security, as well as technical advice provided by AGESIC. It is the outcome of the research done by AGESIC and Systems Integration Laboratory (LINS) on the development and use of the e-Government Platform since 2008, as well as the research done by the team Salud.uy since 2013.

Electronic Dental Records System Adoption.

The use of Electronic Dental Records (EDRs) and management software has become more frequent, following the increase in prevelance of new technologies and computers in dental offices. The purpose of this study is to identify and evaluate the use of EDRs by the dental community in the São Paulo city area. A quantitative case study was performed using a survey on the phone. A total of 54 offices were contacted and only one declinedparticipation in this study. Only one office did not have a computer. EDRs were used in 28 offices and only four were paperless. The lack of studies in this area suggests the need for more usability and implementation studies on EDRs so that we can improve EDR adoption by the dental community.

Identification of Patient Safety Risks Associated with Electronic Health Records: A Software Quality Perspective.

Although Electronic Health Records (EHR) can offer benefits to the health care process, there is a growing body of evidence that these systems can also incur risks to patient safety when developed or used improperly. This work is a literature review to identify these risks from a software quality perspective. Therefore, the risks were classified based on the ISO/IEC 25010 software quality model. The risks identified were related mainly to the characteristics of "functional suitability" (i.e., software bugs) and "usability" (i.e., interface prone to user error). This work elucidates the fact that EHR quality problems can adversely affect patient safety, resulting in errors such as incorrect patient identification, incorrect calculation of medication dosages, and lack of access to patient data. Therefore, the risks presented here provide the basis for developers and EHR regulating bodies to pay attention to the quality aspects of these systems that can result in patient harm.

Validation of Minimum Data of Archetyped Telehealth Clinical Report for Monitoring Prenatal Care.

Studies on the validation of minimum data sets from international information standards have drawn the attention of the academic community to the identification of necessary requirements for the development of Electronic Health Records (EHRs). The primary motivation of such studies is the development of systems using archetypes. The aim of this study was to validate the minimum data set that should be used when constructing an archetyped EHR for prenatal care applications in telehealth. In order to achieve this, a data validation tool was built and used by nine expert obstetricians. The statistical analysis employed was the percentage of agreement and the content validity index. The study was conducted in three steps: 1) Literature review, 2)Instrument development, and 3) Validation of the minimum data set. Of the 179 evaluated pieces of data, 157 of them were validated to be included in the archetyped record of the first prenatal consultation, while 56 of them were allocated for the subsequent consultation record. The benefit of this research is the standardization (data validation for an archetyped system) of prenatal care, with the perspective of employing, both nationally and internationally, an archtyped telehealth system.

Mobile Health Applications, in the Absence of an Authentic Regulation, Does the Usability Score Correlate with a Better Medical Reliability?

Health-related mobile applications (apps) have been shown to improve the quality of health and patient care. Their use in clinical and health-related environments is becoming more considerable. The number of health-related apps available for download has considerably increased, while the regulatory position of this new industry is not well known. Despite this lack of regulation, measuring the usability score of these apps is not difficult. We compared two samples of twenty health-related applications each. One of the samples contained the apps with top-rated usability scores, and the other contained the apps with lowest-rated usability scores. We found that a good usability score correlates with a better medical reliability of the app's content (p<0.005). In the period in which a valid regulation is still lacking, calculation and attribution of usability scores to mobile applications could be used to identify apps with better medical quality. However, the usability score method ought to be rigorous and should not be rounded off with a simple five stars rating (as is the case in the classic app stores).

Patient Safety at Transitions of Care: Use of a Compulsory Electronic Reconciliation Tool in an Academic Hospital.

Medication errors are responsible for most inpatient adverse events. Medication reconciliation emerged as an effective strategy to decrease these problems, enhancing patient safety. Electronic health records with reconciliation tools could improve the process, but many aspects should be considered in order to reach expected outcomes. In this paper we analyzed how a compulsory, electronic reconciliation application was used at Hospital Italiano in Buenos Aires, through admission and discharge processes. We evaluated all medications that were reconciled during patient admission and discharge since its implementation, from February to November 2014. During that period, there were 78,714 reconciled medications regarding 37,741 admissions (2.08 reconciled medications per hospitalization), of 27,375 patients (2.88 medications per patient). At admission, 63% of medications were confirmed and the remaining were paused or deleted. At discharge, 41% of all medications were reconfirmed. In the creation of the best possible medication history, the use of an electronic reconciliation tool would clean overloaded lists, but at the same time medications could be erroneously deleted.

Usability Testing of PROCEnf-USP: A Clinical Decision Support System.

Decision support systems (DSSs) are recognized as important tools, capable of processing high volumes of data and increasing productivity. The usability of these tools affects their effectiveness. By evaluating the interactions between registered nurses (RNs) and the DSSs, this study explores how they impact RN decision-making. This study analyzed 24 months (2011-2012) of data collected in Brazil in two units of a large, public, urban hospital in São Paulo that uses a nurse documentation system with an embedded DSS based on NANDA-I. Using mixed effects logistic regression, this study analyzed the agreement between RNs and a DSS when selecting nursing diagnoses. Results suggest that the agreement is mediated by characteristics of the RNs (education and experience) as well as units and year of encounter. Surprisingly, disagreement between RN and DSS when selecting defining characteristics (DC) had positive effects on the odds of agreement on diagnoses. Our results suggest that DSSs support nurses' clinical decision making, but the nurse's clinical judgment is the mediating factor. More research is necessary.

Health Interoperability into Practice: Results of the Development of a Consent Form in a Pilot Project in a Health District in São Paulo, Brazil.

Interoperability of health information systems is a centerpiece of the "E-Health" Brazilian Ministry of Health strategy. It aims to solve at least partially the health information technology puzzle that we face today. This paper describes a health information exchange pilot project in a health district of the city of São Paulo. It discusses the results of the development of an informed consent form for health information exchange. This consent form showed excellent results, with median application time of 3 minutes and with 97.8% of patients feeling fully clarified. The patients' perception when faced with options of consent to share their data is also described.

Computerized provider order entry reduces length of stay in a community hospital.

OBJECTIVE: Does computerized provider order entry (CPOE) improve clinical, cost, and efficiency outcomes as quantified in shortened hospital length of stay (LOS)? Most prior studies were done in university settings with home-grown electronic records, and are now 20 years old. This study asked whether CPOE exerts a downward force on LOS in the current era of HITECH incentives, using a vendor product in a community hospital. METHODS: The methodology retrospectively evaluated correlation between CPOE and LOS on a perpatient, per-visit basis over 22 consecutive quarters, organized by discipline. All orders from all areas were eligible, except verbals, and medication orders in the emergency department which were not available via CPOE. These results were compared with quarterly case mix indices organized by discipline. Correlational and regression analyses were cross-checked to ensure validity of R-square coefficients, and data were smoothed for ease of display. Standard models were used to calculate the inflection point. RESULTS: Gains in CPOE adoption occurred iteratively house-wide, and in each discipline. LOS decreased in a sigmoid shaped curve. The inflection point shows that once CPOE adoption approaches 60%, further lowering of LOS accelerates. Overall there was a 20.2% reduction in LOS correlated with adoption of CPOE. Case mix index increased during the study period showing that reductions in LOS occurred despite increased patient complexity and resource utilization. CONCLUSIONS: There was a 20.2% reduction in LOS correlated with rising adoption of CPOE. CPOE contributes to improved clinical, cost, and efficiency outcomes as quantified in reduced LOS, over and above other processes introduced to lower LOS. CPOE enabled a reduction in LOS despite an increase in the case mix index during the time frame of this study.

Text classification performance: is the sample size the only factor to be considered?

The use of text mining and supervised machine learning algorithms on biomedical databases has become increasingly common. However, a question remains: How much data must be annotated to create a suitable training set for a machine learning classifier? In prior research with active learning in medical text classification, we found evidence that not only sample size but also some of the intrinsic characteristics of the texts being analyzed-such as the size of the vocabulary and the length of a document-may also influence the resulting classifier's performance. This study is an attempt to create a regression model to predict performance based on sample size and other text features. While the model needs to be trained on existing datasets, we believe it is feasible to predict performance without obtaining annotations from new datasets once the model is built.