Impact of COVID-19 on Neurosurgery in Brazil's Health System: The Reality of a Developing Country Affected by the Pandemic.

BACKGROUND: The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery protocols to provide ongoing care for patients while ensuring the safety of health care workers. In Brazil, the rapid spread of the disease led to new challenges in the health system. Neurooncology practice was one of the most affected by the pandemic due to restricted elective procedures and new triage protocols. We aim to characterize the impact of the pandemic on neurosurgery in Brazil. METHODS: We analyzed 112 different types of neurosurgical procedures, with special detail in 11 neurooncology procedures, listed in the Brazilian Hospital Information System records in the DATASUS database between February and July 2019 and the same period in 2020. Linear regression and paired t-test analyses were performed and considered statistically significant at P < 0.05. RESULTS: There was an overall decrease of 21.5% (28,858 cases) in all neurosurgical procedures, impacting patients needing elective procedures (-42.46%) more than emergency surgery (-5.93%). Neurooncology procedures decreased by 14.89%. Nonetheless, the mortality rate during hospitalization increased by 21.26%. Linear regression analysis in hospitalizations (Slope = 0.9912 ± 0.07431; CI [95%] = 0.8231-1.159) and total cost (Slope = 1.03 ± 0.03501; CI [95%] = 0.9511-1.109) in the 11 different types of neurooncology procedures showed a P < 0.0001. The mean cost per type of procedure showed an 11.59% increase (P = 0.0172) between 2019 and 2020. CONCLUSIONS: The COVID-19 pandemic has increased mortality, decreased hospitalizations, and therefore decreased overall costs, despite increased costs per procedure for a variety of neurosurgical procedures. Our study serves as a stark example of the effect of the pandemic on neurosurgical care in settings of limited resources and access to care.

Health Information System's Responses to COVID-19 Pandemic in China: A National Cross-sectional Study.

OBJECTIVE: After the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Chinese hospitals and health information technology (HIT) vendors collaborated to provide comprehensive information technology support for pandemic prevention and control. This study aims to describe the responses from the health information systems (HIS) to the COVID-19 pandemic and provide empirical evidence in the application of emerging health technologies in China. METHODS: This observational descriptive study utilized a nationally representative, cross-sectional survey of hospitals in China (N = 1,014) from 30 provincial administrative regions across the country. Participants include hospital managers, hospital information workers, and health care providers. RESULTS: Among all the responses, the most popular interventions and applications include expert question-and-answer sessions and science popularization (61.74%) in online medical consultation, online appointment registration (58.97%) in online medical service, and remote consultation (75.15%) in telehealth service. A total of 63.71% of the participating hospitals expanded their fever clinics during the pandemic, 15.38% hospitals used new or upgraded mobile ward rounds systems, and 44.68% hospitals applied online self-service systems. Challenges and barriers include protecting network information security (57.00%) since some hospitals experienced cybersecurity incidents. 71.79% participants hope to shorten wait time and optimize the treatment process. Health care workers experienced increased amount of work during the pandemic, while hospital information departments did not experience significant changes in their workload. CONCLUSION: In the process of fighting against the COVID-19, hospitals have widely used traditional and emerging novel HITs. These technologies have strengthened the capacity of prevention and control of the pandemic and provided comprehensive information technology support while also improving accessibility and efficiency of health care delivery.

Baja implantación de la teledermatología / Low teledermatology implantation

Las nuevas tecnologías están cambiando nuestras vidas a nivel individual y como sociedad. Su aplicación en la medicina está transformando nuestra práctica médica dándole una nueva dimensión y planteando nuevos retos tanto a profesionales como a las organizaciones. La aplicación de las nuevas tecnologías a las ciencias de la salud define la telemedicina. En el siguiente trabajo se hace una introducción del inicio de la aplicación de la telemedicina y las nuevas tecnologías a través de la búsqueda en las principales bases de datos: Pubmed, Cochrane y Uptodate con los términos de telemedicina, nuevas tecnologías y teledermatología. OBJETIVOS: Conocer el estado actual de la telemedicina y una de sus principales aplicaciones en el campo de la dermatología, la teledermatología, conocer su grado de implantación, así como sus ventajas y desventajas. Estudio de la implantación del Dercam (proyecto de teledermatología en CLM). MÉTODO: Estudio descriptivo de todas las teleconsultas recibidas a través del sistema Dercam, desde marzo 2016 hasta mayo de 2017 en la GAI del Albacete, se recogieron datos sobre los distintos Centros de Salud implicados, las distintas patologías consultadas, tiempo de respuesta, seguimiento por atención primaria o especializada. Coincidencia diagnóstica, seguridad diagnóstica y calidad de la foto. RESULTADO: Se recibieron un total de 370 teleconsultas (TC) en el sistema Dercam, respecto a un total de 10.903 consultas por vía normal, al Servicio de Dermatología. El mayor número de TC derivadas fueron del centro de salud de Iniesta. El grupo de TC más frecuente fue la patología inflamatoria con un 25,14% seguida de las lesiones pigmentadas benignas con un 24,05%. La mayoría de las altas se registran en el grupo de patología del folículo piloso (66,67%), infecciosa (57,50%) e inflamatoria con un 45,16%. El tiempo de respuesta en la mitad de los casos entre uno y tres días. la coincidencia diagnóstica es del 58,54%, con una seguridad alta en los diagnósticos virtuales realizados por especializada y en la mayoría de las fotos valoradas con calidad media. CONCLUSIONES: El sistema Dercam en la GAI de Albacete se encuentra todavía en una fase incipiente de implantación. Sería importante valorar en que patologías es más rentable su uso para obtener una mayor rentabilidad, todo ello a través de protocolos estructurados implicando a todos los profesionales

New technologies are changing our lives at the individual level and as a society. Its application in medicine is transforming our medical practice by giving it a new dimension and posing new challenges for both professionals and organizations. The application of new technologies to health sciences defines telemedicine. In the following work an introduction is made of the beginning of the application of telemedicine and new technologies through the search in the main databases: Pubmed, Cochrane and Uptodate with the terms of telemedicine, new technologies and teledermatology. OBJECTIVES: To know the current state of telemedicine and one of its main applications in the field of dermatology, teledermatology, to know its degree of implantation, as well as its advantages and disadvantages. Study of the implementation of Dercam (teledermatology project in CLM). METHOD: Descriptive study of all teleconsultations received through the Dercam system, from March 2016 to May 2017 in the GAI of Albacete, data were collected on the different Health Centers involved, the different pathologies consulted, response time, follow-up by primary or specialized care. Diagnostic match, diagnostic security and photo quality. RESULT: A total of 370 teleconsultations (TC) were received in the Dercam system, with respect to a total of 10,903 consultations by normal route, to the Dermatology Service. The highest number of CT derived were from the Iniesta health center. The most frequent group of CT was inflammatory pathology with 25.14% followed by benign pigmented lesions with 24.05%. Most of the discharges are registered in the group of pathology of the hair follicle (66.67%), infectious (57.50%) and inflammatory with 45.16%. The response time in half of the cases between one and three days. The diagnostic coincidence is 58.54%, with a high security in the virtual diagnoses made by specialized and in the majority of the photos valued with medium quality. CONCLUSIONS: The Dercam system in the GAI of Albacete is still in an incipient phase of implementation. It would be important to assess in which pathologies its use is more profitable to obtain a greater profitability, all through structured protocols involving all professionals

Perceptions and Experiences of Hospital Nurses During Transition to an Electronic Handover Informatics System.

An effective patient transfer, or handover, among healthcare professionals can help prevent communication-related medical errors, and a reliable electronic handover informatics system can standardize the handoff process. Adapting to a new handover system may cause stress for nurses. This descriptive qualitative study aimed to explore the perceptions and transition experiences of hospital nurses in adopting and adapting to a new handover informatics system. Thirty-eight nurses at a medical center in Taiwan participated in the study from December 2016 to January 2017. The researcher conducted five focus group interviews and analyzed all responses using content analysis. Results showed three major themes: "Perceptions of challenges and barriers related to the transition to a new handover informatics system," "Perceptions of benefits and strategies to the transition to a new handover informatics system," and "Suggestions for successful implementation of a new handover informatics system." Five subthemes emerged from the first theme, and six subthemes emerged from the second theme. The results of this study could enhance our understanding of nurses' perceptions and experiences with transition to a new handover informatics system and could provide a reference for hospitals to develop individualized strategies to facilitate the implementation of a handover informatics system.

Respiratory medicine in Iraq - from the primitive to the advanced.

Healthcare in Iraq has seen significant decline over the past few decades. Political instability coupled with austerity due to conflict and war has become a major obstacle in the transition needed to restore acceptable healthcare standards. Respiratory medicine had remained under developed despite the potential benefit it could offer to many people suffering diseases of high prevalence. A dedicated team of experts carried out a feasibility study to create a specialist respiratory centre, ThiQar lung diseases (TQLD). Equipped with advanced diagnostic equipment, a paperless hospital information system and staff trained by specialists from the UK, the centre has reduced a significant healthcare gap. It now serves a large population catchment area and has helped offer people an alternative to seeking healthcare abroad.

Preferencias sobre normas de acompañamiento en el Servicio de Urgencias Hospitalario / Preferences regarding accompanying rules at the Hospital Emergency Unit

OBJETIVO: conocer la opinión de los acompañantes de los pacientes y de profesionales implicados en la atención respecto a las preferencias sobre la visita y acompañamiento en el Servicio de Urgencias Hospitalario. MÉTODO: estudio descriptivo transversal, que se llevó a cabo en el Servicio de Urgencias del Hospital San Eloy, en Barakaldo (Bizkaia). Los sujetos de estudio fueron los acompañantes del paciente que acudía a urgencias del hospital y los profesionales que trabajaban en el servicio. Se diseñó una encuesta para acompañantes con 13 ítems y otra para profesionales con nueve ítems. Se realizó análisis descriptivo. RESULTADOS: participaron 48 profesionales y 150 acompañantes. Acompañantes: mujeres (70,67%), la relación con el paciente fue hija/o (40,67%). Profesionales: médico adjunto (31,25%) y enfermera (27,08%), experiencia en urgencias superior a 10 años (50%). El 42,7% de los sujetos percibió la información como buena, estando un 88,7% muy satisfecho. La opción de presenciar procedimientos de urgencias fue evaluada como buena en un 42,7%. La participación en el cuidado se valoró como buena en el 42% de los casos, eligiéndose la estancia intermitente como mejor opción de visita (77,1%). La mayoría de los profesionales encuestados afirmó que la presencia familiar condicionaba su forma de trabajar. CONCLUSIONES: los acompañantes desean estar con el enfermo el mayor tiempo posible, están dispuestos a colaborar en el cuidado, respetan el trabajo profesional y aceptan abandonar la zona asistencial cuando se les solicita. Están satisfechos con el trato, aunque aprecian déficit de información. En general, apoyan la existencia de normas que regulen las visitas. El profesional valora positivamente dichas normas y la idea de colaboración por parte del acompañante

OBJECTIVE: to understand the opinion by persons accompanying patients and professionals involved in care regarding their preferences on visits and accompanying at the Hospital Emergency Unit. METHOD: a descriptive cross-sectional study, conducted at the Emergency Unit of the Hospital San Eloy, in Barakaldo (Bizkaia). The study subjects were those persons accompanying patients attending the Hospital Emergency Unit, and those professionals working in said unit. A survey with 13 items was designed for accompanying persons, and another survey with 9 items for professionals. A descriptive analysis was conducted. RESULTS: the study included 48 professionals and 150 accompanying persons; of these, 70.67% were women, and patients were their parents (40,67%). In the group of professionals: hospital specialists (31.25%) and nurses (27.08%), with > 10-year experience in the ER (50%). There was a perception of information as Good by 42.7% of the subjects, and 88.7% were Very Satisfied. The option of being present during Emergency procedures was evaluated as Good by 42.7% of participants; involvement in care was considered Good in 42% of cases, and Intermittent Stay was selected as the best option for visits (77.1%). The majority of professionals taking part in the survey stated that the presence of relatives had an impact on the way they worked. CONCLUSIONS: accompanying persons wish to stay with the patient as long as possible, they are willing to collaborate in care, they respect professional work, and accept leaving the care area when requested. They are satisfied with the way they are treated, though they notice there is lack of information. Overall, they support the implementation of rules regulating visits. Professionals have a positive evaluation of rules and of the idea of collaboration by accompanying persons

Anesthesia Information Management Systems.

Anesthesia information management systems (AIMS) have evolved from simple, automated intraoperative record keepers in a select few institutions to widely adopted, sophisticated hardware and software solutions that are integrated into a hospital's electronic health record system and used to manage and document a patient's entire perioperative experience. AIMS implementations have resulted in numerous billing, research, and clinical benefits, yet there remain challenges and areas of potential improvement to AIMS utilization. This article provides an overview of the history of AIMS, the components and features of AIMS, and the benefits and challenges associated with implementing and using AIMS. As AIMS continue to proliferate and data are increasingly shared across multi-institutional collaborations, visual analytics and advanced analytics techniques such as machine learning may be applied to AIMS data to reap even more benefits.

Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: a before and after study.

BACKGROUND: Hospital discharge summaries are a key communication tool ensuring continuity of care between primary and secondary care. Incomplete or untimely communication of information increases risk of hospital readmission and associated complications. The aim of this study was to evaluate whether the introduction of a new electronic discharge system (NewEDS) was associated with improvements in the completeness and timeliness of discharge information, in Nottingham University Hospitals NHS Trust, England. METHODS: A before and after longitudinal study design was used. Data were collected using the gold standard auditing tool from the Royal College of Physicians (RCP). This tool contains a checklist of 57 items grouped into seven categories, 28 of which are classified as mandatory by RCP. Percentage completeness (out of the 28 mandatory items) was considered to be the primary outcome measure. Data from 773 patients discharged directly from the acute medical unit over eight-week long time periods (four before and four after the change to the NewEDS) from August 2010 to May 2012 were extracted and evaluated. Results were summarised by effect size on completeness before and after changeover to NewEDS respectively. The primary outcome variable was represented with percentage of completeness score and a non-parametric technique was used to compare pre-NewEDS and post-NewEDS scores. RESULTS: The changeover to the NewEDS resulted in an increased completeness of discharge summaries from 60.7% to 75.0% (p < 0.001) and the proportion of summaries created under 24 h from discharge increased significantly from 78.0% to 93.0% (p < 0.001). Furthermore, five of the seven grouped checklist categories also showed significant improvements in levels of completeness (p < 0.001), although there were reduced levels of completeness for three items (p < 0.001). CONCLUSION: The introduction of a NewEDS was associated with a significant improvement in the completeness and timeliness of hospital discharge communication.

Visualising emergency department capacity in an 'Emergency Department Capacity Clock': A novel tool to assess and communicate overcrowding and access block.

Hospital-wide engagement is required to alleviate the problem of ED crowding and its associated adverse effects. To this end, the article describes a novel visualisation termed 'the ED Capacity Clock', which can be formatted using business intelligence software. This radial diagram represents ED capacity and its consumption in a format that can be understood intuitively and at a glance. The ED Capacity Clock is designed to promote common understanding and discussion between relevant hospital services and also acts as an auditing tool to monitor processes implemented to alleviate ED crowding.

Hospital Characteristics are Associated With Readiness to Attain Stage 2 Meaningful Use of Electronic Health Records.

PURPOSE: To examine the difference between rural and urban hospitals as to their overall level of readiness for stage 2 meaningful use of electronic health records (EHRs) and to identify other key factors that affect their readiness for stage 2 meaningful use. METHODS: A conceptual framework based on the theory of organizational readiness for change was used in a cross-sectional multivariate analysis using 2,083 samples drawn from the HIMSS Analytics survey conducted with US hospitals in 2013. FINDINGS: Rural hospitals were less likely to be ready for stage 2 meaningful use compared to urban hospitals in the United States (OR = 0.49) in our final model. Hospitals' past experience with an information exchange initiative, staff size in the information system department, and the Chief Information Officer (CIO)'s responsibility for health information management were identified as the most critical organizational contextual factors that were associated with hospitals' readiness for stage 2. Rural hospitals lag behind urban hospitals in EHR adoption, which will hinder the interoperability of EHRs among providers across the nation. The identification of critical factors that relate to the adoption of EHR systems provides insights into possible organizational change efforts that can help hospitals to succeed in attaining meaningful use requirements. CONCLUSION: Rural hospitals have increasingly limited resources, which have resulted in a struggle for these facilities to attain meaningful use. Given increasing closures among rural hospitals, it is all the more important that EHR development focus on advancing rural hospital quality of care and linkages with patients and other organizations supporting the care of their patients.

2016 MOST WIRED.

This year's IT survey shows that hospitals are aggressively fighting cyber crime and looking for ways to use data to help in the transition to value-based care. Find out who made the 2016 lists of Most Wired, Most Advanced, Most Improved and Most Wired-Small and Rural.

The Rise of Ransomware.

As more cyber criminals make records-for-ransom demands, physicians need to be more vigilant than ever against attacks, tightening digital security and taking other precautions.

Improving pediatric liquid medication labeling of the hospital information system in Malaysia: qualitative analysis of pharmacists' perceptions

Background: Inadequacies of drug labeling have been frequently reported among Malaysian healthcare institutes, in which the Hospital Information System (HIS) is used. Objective: To identify potential areas to improve the existing labels used for pediatric liquid medications. Methods: This study was qualitative in nature, whereby focus group discussions (FGDs), face-to-face interviews (FTFIs), and onsite observation were used for data collection. Pharmacists stationed at three units (outpatient, inpatient and clinical pharmacy) of a tertiary hospital were targeted. Both FGDs and FTFIs were facilitated using a semi-structured interview guide, video-recorded and transcribed verbatim. All transcripts were thematically analyzed using content analysis approach. Results: Thirteen pharmacists participated in FGDs, while five were approached for FTFIs. Data analysis resulted in four major themes: format of labels, presentation of medication instructions, insufficiency of information, and the need for external aids and education. Participants unanimously agreed on the need for enlarging font sizes of key information. Suggestions were made to use more specific instructions for administration times and pictograms to illustrate important directions. The absence of information about storage, stability and handling of liquid medications was also highlighted. While discussion mainly focused on improving drug labeling, participants consistently stressed the need for an instruction sheet and pharmacist-based, one-to-one education regarding medication instructions. Conclusion: This study provides important insights into critical shortcomings in current labeling practice, underlying the need for developing a new label that incorporates a new format, additional information and pictograms for pediatric liquid medications (AU)

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Big data en sanidad en España: la oportunidad de una estrategia nacional / Big data in health in Spain: now is the time for a national strategy

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Peligros del uso de los big data en la investigación en salud pública y en epidemiología / Risks of the use of big data in research in public health and epidemiology

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Anatomy of an Extensible Open Source PACS.

The conception and deployment of cost effective Picture Archiving and Communication Systems (PACS) is a concern for small to medium medical imaging facilities, research environments, and developing countries' healthcare institutions. Financial constraints and the specificity of these scenarios contribute to a low adoption rate of PACS in those environments. Furthermore, with the advent of ubiquitous computing and new initiatives to improve healthcare information technologies and data sharing, such as IHE and XDS-i, a PACS must adapt quickly to changes. This paper describes Dicoogle, a software framework that enables developers and researchers to quickly prototype and deploy new functionality taking advantage of the embedded Digital Imaging and Communications in Medicine (DICOM) services. This full-fledged implementation of a PACS archive is very amenable to extension due to its plugin-based architecture and out-of-the-box functionality, which enables the exploration of large DICOM datasets and associated metadata. These characteristics make the proposed solution very interesting for prototyping, experimentation, and bridging functionality with deployed applications. Besides being an advanced mechanism for data discovery and retrieval based on DICOM object indexing, it enables the detection of inconsistencies in an institution's data and processes. Several use cases have benefited from this approach such as radiation dosage monitoring, Content-Based Image Retrieval (CBIR), and the use of the framework as support for classes targeting software engineering for clinical contexts.