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2.
JMIR Public Health Surveill ; 6(2): e18873, 2020 04 14.
Artículo en Inglés | MEDLINE | ID: mdl-32248145

RESUMEN

Previous epidemic management research proves the importance of city-level information, but also highlights limited expertise in urban data applications during a pandemic outbreak. In this paper, we provide an overview of city-level information, in combination with analytical and operational capacity, that define urban intelligence for supporting response to disease outbreaks. We present five components (movement, facilities, people, information, and engagement) that have been previously investigated but remain siloed to successfully orchestrate an integrated pandemic response. Reflecting on the coronavirus disease (COVID-19) outbreak that was first identified in Wuhan, China, we discuss the opportunities, technical challenges, and foreseeable controversies for deploying urban intelligence during a pandemic. Finally, we emphasize the urgency of building urban intelligence through cross-disciplinary research and collaborative practice on a global scale.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Coronavirus , Ciencia de los Datos , Neumonía Viral/epidemiología , Informática en Salud Pública , Salud Pública , Población Urbana , Inteligencia Artificial , Betacoronavirus , China/epidemiología , Brotes de Enfermedades , Humanos , Informática Médica , Pandemias
3.
Appl Clin Inform ; 11(2): 265-275, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32268390

RESUMEN

BACKGROUND: UW Medicine was one of the first health systems to encounter and treat COVID-19 patients in the United States, starting in late February 2020. OBJECTIVE: Here we describe the rapid rollout of capabilities by UW Medicine Information Technology Services (ITS) to support our clinical response to the COVID-19 pandemic and provide recommendations for health systems to urgently consider, as they plan their own response to this and potentially other future pandemics. METHODS: Our recommendations include establishing a hospital incident command structure that includes tight integration with IT, creating automated dashboards for incident command, optimizing emergency communication to staff and patients, and preparing human resources, security, other policies, and equipment to support the transition of all nonessential staff to telework.We describe how UW Medicine quickly expanded telemedicine capabilities to include most primary care providers and increasing numbers of specialty providers. We look at how we managed expedited change control processes to quickly update electronic health records (EHR) with new COVID-19 laboratory and clinical workflows. We also examine the integration of new technology such as tele-intensive care (ICU) equipment and improved integration with teleconferencing software into our EHR. To support the rapid preparation for COVID-19 at other health systems, we include samples of the UW Medicine's COVID-19 order set, COVID-19 documentation template, dashboard metric categories, and a list of the top 10 things your health care IT organization can do now to prepare. CONCLUSION: The COVID-19 response requires new and expedited ways of approaching ITS support to clinical needs. UW Medicine ITS leadership hope that by quickly sharing our nimble response to clinical and operational requests, we can help other systems prepare to respond to this public health emergency.


Asunto(s)
Infecciones por Coronavirus , Prestación de Atención de Salud/organización & administración , Tecnología de la Información , Informática Médica , Pandemias , Neumonía Viral , Betacoronavirus , Comunicación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/terapia , Sistemas de Apoyo a Decisiones Clínicas , Registros Electrónicos de Salud , Sistemas Prepagos de Salud , Humanos , Noroeste de Estados Unidos , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Neumonía Viral/terapia , Salud Pública , Telemedicina , Flujo de Trabajo
4.
Semin Oncol ; 47(1): 56-64, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32229032

RESUMEN

Pediatric cancer is a rare disease with a low annual incidence, which presents a significant challenge in being able to collect enough data to fuel clinical discoveries. Big data registry trials hold promise to advance the study of pediatric cancers by allowing for the combination of traditional randomized controlled trials with the power of larger cohort sizes. The emergence of big data resources and data-sharing initiatives are becoming transformative for pediatric cancer diagnosis and treatment. This review discusses the uses of big data in pediatric cancer, existing pediatric cancer registry initiatives and research, the challenges in harmonizing these data to improve accessibility for study, and building pediatric data commons and other important future endeavors.


Asunto(s)
Macrodatos , Oncología Médica/estadística & datos numéricos , Neoplasias/epidemiología , Pediatría/estadística & datos numéricos , Factores de Edad , Niño , Bases de Datos Factuales , Humanos , Difusión de la Información , Informática Médica/métodos , Oncología Médica/tendencias , Neoplasias/diagnóstico , Neoplasias/etiología , Neoplasias/terapia , Pediatría/tendencias , Vigilancia en Salud Pública , Sistema de Registros , Investigación , Supervivencia
6.
Medicina (B Aires) ; 80 Suppl 2: 31-36, 2020.
Artículo en Español | MEDLINE | ID: mdl-32150710

RESUMEN

It has been observed that the stratification of Autism Spectrum Disorders (ASD) generated by the current scales is not effective for the personalization of early treatments. The clinical evaluation of ASD requires its consideration as a continuum of deficits, and there is a need to identify biologically significant parameters (biomarkers) that have the power to automatically characterize each individual at different stages of neurological development. The emerging field of computational psychiatry (CP) attempts to meet the needs of precision diagnosis by developing powerful computational and mathematical techniques. A growing scientific activity proposes the use of implicit measures based on biosignals for the classification of ASD. Virtual reality (VR) technologies have demonstrated potential for ASD interventions, but most of the work has used virtual reality for the learning / objective of interventions. Very few studies have used biological signals for recording and detailed analysis of behavioral responses that can be used to monitor or produce changes over time. In this paper the concept of behavioral biomarkers based on VR or VRBB is introduced. VRBB will allow the classification of ASD using a paradigm of computational psychiatry based on implicit brain processes measured through psychophysiological signals and the behavior of subjects exposed to complex replicas of social conditions using virtual reality interfaces.


Asunto(s)
Inteligencia Artificial , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/terapia , Biomarcadores , Terapia de Exposición Mediante Realidad Virtual/métodos , Trastorno del Espectro Autista/fisiopatología , Humanos , Informática Médica/métodos , Psiquiatría/métodos
7.
PLoS One ; 15(2): e0220754, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32027661

RESUMEN

INTRODUCTION: Adverse drug reactions have been linked with HLA alleles in different studies. These HLA proteins play an essential role in the adaptive immune response for the presentation of self and non-self peptides. Anti-thyroid drugs methimazole and propylthiouracil have been associated with drug induced agranulocytosis (severe lower white blood cell count) in patients with B*27:05, B*38:02 and DRB1*08:03 alleles in different populations: Taiwanese, Vietnamese, Han Chinese and Caucasian. METHODS: In this study, informatics methods were used to investigate if any sequence or structural similarities exist between the two associated HLA-B alleles, compared with a set of "control" alleles assumed not be associated, which could help explain the molecular basis of the adverse drug reaction. We demonstrated using MHC Motif Viewer and MHCcluster that the two alleles do not have a propensity to bind similar peptides, and thus at a gross level the structure of the antigen presentation region of the two alleles are not similar. We also performed multiple sequence alignment to identify polymorphisms shared by the risk but not by the control alleles and molecular docking to compare the predicted binding poses of the drug-allele combinations. RESULTS: Two residues, Cys67 and Thr80, were identified from the multiple sequence alignments to be unique to these risk alleles alone. The molecular docking showed the poses of the risk alleles to favour the F-pocket of the peptide binding groove, close to the Thr80 residue, with the control alleles generally favouring a different pocket. The data are thus suggestive that Thr80 may be a critical residue in HLA-mediated anti-thyroid drug induced agranulocytosis, and thus can guide future research and risk assessment.


Asunto(s)
Agranulocitosis/inducido químicamente , Alelos , Antitiroideos/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Antígenos HLA-B/genética , Informática Médica/métodos , Inmunidad Adaptativa , Agranulocitosis/etnología , Secuencia de Aminoácidos , Grupo de Ascendencia Continental Asiática , Sitios de Unión , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etnología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/genética , Grupo de Ascendencia Continental Europea , Predisposición Genética a la Enfermedad , Humanos , Metimazol/efectos adversos , Propiltiouracilo/efectos adversos , Unión Proteica
8.
PLoS One ; 15(2): e0228632, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32053653

RESUMEN

OBJECTIVE: Some patients who are given opioids for pain could develop opioid use disorder. If it was possible to identify patients who are at a higher risk of opioid use disorder, then clinicians could spend more time educating these patients about the risks. We develop and validate a model to predict a person's future risk of opioid use disorder at the point before being dispensed their first opioid. METHODS: A cohort study patient-level prediction using four US claims databases with target populations ranging between 343,552 and 384,424 patients. The outcome was recorded diagnosis of opioid abuse, dependency or unspecified drug abuse as a proxy for opioid use disorder from 1 day until 365 days after the first opioid is dispensed. We trained a regularized logistic regression using candidate predictors consisting of demographics and any conditions, drugs, procedures or visits prior to the first opioid. We then selected the top predictors and created a simple 8 variable score model. RESULTS: We estimated the percentage of new users of opioids with reported opioid use disorder within a year to range between 0.04%-0.26% across US claims data. We developed an 8 variable Calculator of Risk for Opioid Use Disorder (CROUD) score, derived from the prediction models to stratify patients into higher and lower risk groups. The 8 baseline variables were age 15-29, medical history of substance abuse, mood disorder, anxiety disorder, low back pain, renal impairment, painful neuropathy and recent ER visit. 1.8% of people were in the high risk group for opioid use disorder and had a score > = 23 with the model obtaining a sensitivity of 13%, specificity of 98% and PPV of 1.14% for predicting opioid use disorder. CONCLUSIONS: CROUD could be used by clinicians to obtain personalized risk scores. CROUD could be used to further educate those at higher risk and to personalize new opioid dispensing guidelines such as urine testing. Due to the high false positive rate, it should not be used for contraindication or to restrict utilization.


Asunto(s)
Recolección de Datos/métodos , Informática Médica/métodos , Trastornos Relacionados con Opioides/epidemiología , Adolescente , Adulto , Anciano , Algoritmos , Analgésicos Opioides/uso terapéutico , Área Bajo la Curva , Dolor Crónico/tratamiento farmacológico , Estudios de Cohortes , Prescripciones de Medicamentos , Femenino , Humanos , Masculino , Anamnesis , Persona de Mediana Edad , Trastornos Relacionados con Opioides/diagnóstico , Dolor , Enfermedades del Sistema Nervioso Periférico , Análisis de Regresión , Medición de Riesgo , Factores de Riesgo , Encuestas y Cuestionarios , Estados Unidos , Adulto Joven
11.
Otolaryngol Head Neck Surg ; 162(1): 26-32, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31910124

RESUMEN

This plain language summary explains nosebleeds, also known as epistaxis (pronounced ep-ih-stak-sis), to patients. The summary applies to any individual aged 3 years and older with a nosebleed or history of nosebleed who needs medical treatment or wants medical advice. It is based on the 2020 "Clinical Practice Guideline: Nosebleed (Epistaxis)." This guideline uses research to advise doctors and other health care providers on the diagnosis, treatment, and prevention of nosebleeds. The guideline includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to help patients ask questions and make decisions in their own care.


Asunto(s)
Comprensión , Epistaxis/terapia , Lenguaje , Educación del Paciente como Asunto/métodos , Guías de Práctica Clínica como Asunto , Niño , Preescolar , Epistaxis/diagnóstico , Femenino , Humanos , Difusión de la Información , Masculino , Informática Médica/métodos , Estados Unidos
12.
Br J Radiol ; 93(1109): 20190574, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-31971816

RESUMEN

Healthcare is increasingly and routinely generating large volumes of data from different sources, which are difficult to handle and integrate. Confidence in data can be established through the knowledge that the data are validated, well-curated and with minimal bias or errors. As the National Measurement Institute of the UK, the National Physical Laboratory (NPL) is running an interdisciplinary project on digital health data curation. The project addresses one of the key challenges of the UK's Measurement Strategy, to provide confidence in the intelligent and effective use of data. A workshop was organised by NPL in which important stakeholders from NHS, industry and academia outlined the current and future challenges in healthcare data curation. This paper summarises the findings of the workshop and outlines NPL's views on how a metrological approach to the curation of healthcare data sets could help solve some of the important and emerging challenges of utilising healthcare data.


Asunto(s)
Recolección de Datos/métodos , Informática Médica/métodos , Proyectos de Investigación/normas , Recolección de Datos/normas , Difusión de Innovaciones , Humanos , Informática Médica/normas , Metadatos/normas , Telemedicina/métodos , Telemedicina/normas , Reino Unido
13.
PLoS One ; 15(1): e0227377, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31945775

RESUMEN

AIM: To estimate the economic burden of common health problems associated with pregnancy and childbirth, such as incontinence, mental health problems, or gestational diabetes, excluding acute complications of labour or birth, or severe acute adverse maternal outcomes. METHODS: Searches for relevant studies were carried out to November 2019 in Medline, Embase, CINAHL, PsycINFO and EconLit databases. After initial screening, all results were reviewed for inclusion by two authors. An adapted version of a previously developed checklist for cost-of-illness studies was used for quality appraisal. All costs were converted to 2018 Euro using national consumer price indices and purchasing power parity conversion factors. RESULTS: Thirty-eight relevant studies were identified, some of which reported incremental costs for more than one health problem (16 gestational diabetes, 13 overweight/obesity, 8 mental health, 4 hypertensive disorders, 2 nausea and vomiting, 2 epilepsy, 1 intimate partner violence). A high level of heterogeneity was observed in both the methods used, and the incremental cost estimates obtained for each morbidity. Average incremental costs tended to be higher in studies that modelled a hypothetical cohort of women using data from a range of sources (compared to analyses of primary data), and in studies set in the United States. No studies that examined the economic burden of some common pregnancy-related morbidities, such as incontinence, pelvic girdle pain, or sexual health problems, were identified. CONCLUSION: Our findings indicate that maternal morbidity is associated with significant costs to health systems and society, but large gaps remain in the evidence base for the economic burden of some common health problems associated with pregnancy and childbirth. More research is needed to examine the economic burden of a range of common maternal health problems, and future research should adopt consistent methodological approaches to ensure comparability of results.


Asunto(s)
Costo de Enfermedad , Complicaciones del Embarazo/economía , Femenino , Humanos , Informática Médica , Embarazo
14.
Artículo en Alemán | MEDLINE | ID: mdl-31950231

RESUMEN

The discussion of digital health technologies, in particular medical and health apps, is currently dominated by a focus on their potential to reach large parts of the population for the dissemination of evidence-based health promotion and prevention content. However, potentially unintended consequences, side effects, and negative effects of digital health technologies are rarely discussed in public health.In this paper, via a narrative literature review, we propose a perspective on unintended consequences and side-effects of digital health technologies on multiple hierarchical levels of a socio-ecological model of health. Unintended consequences and side-effects of digital health technologies can be identified on an individual level, a level of social relationships, and a health services level.We propose a broader conceptualization of unintended consequences and side-effects of digital health technology together with a more thorough documentation of such effects using multiple levels in a socio-ecological approach. This would build a cumulative evidence base of unintended effects and shift the focus from development-centered discussion of risks and challenges to a comprehensive conception of side effects and undesirable effects of digital health technologies. The proposed division into three effect levels may be helpful here.


Asunto(s)
Promoción de la Salud , Informática Médica , Salud Pública , Alemania , Humanos
17.
Arthritis Care Res (Hoboken) ; 72(2): 166-175, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31566905

RESUMEN

OBJECTIVE: Despite strong recommendations for routine measurement of rheumatoid arthritis (RA) disease activity and associated treatment changes to attain remission/low disease activity, the measurement tools that clinicians use to evaluate RA patients' disease activity and frequency of treatment change have not been well characterized. Therefore, we evaluated different measurement tools that physicians used to assess RA disease activity and associated RA treatment changes. METHODS: Using data from the Rheumatology Informatics System for Effectiveness (RISE) registry from January 2016 through June 2017, and using the following criteria: age ≥18 years, diagnosis of RA (International Classification of Diseases, Ninth and Tenth Revision, codes), ≥2 RISE visits, and ≥1 RA disease activity measure scored in 2016, we classified eligible patients' drug use at the index visit as monotherapy or combination therapy with conventional synthetic (cs) and biologic disease-modifying antirheumatic drugs (bDMARDs). Outcomes include change in treatment over 12 months. Mixed models identified factors associated with treatment change. RESULTS: Among 50,996 eligible patients, 27,274 had longitudinal data. The most commonly used measures were RAPID3 (78.9%) and the Clinical Disease Activity Index (CDAI) (34.2%). The frequency of treatment change during follow-up was relatively low (35.6-54.6%), even for patients with moderate/high disease activity according to RAPID3 or CDAI scores. Older patients (age ≥75 years; adjusted odds ratio [ORadj ] 0.63 [95% confidence interval (95% CI) 0.50-0.78]) and those already receiving combination therapy with csDMARDs (ORadj 0.45 [95% CI 0.33-0.61]) or combination therapy with bDMARDs (ORadj 0.30 [95% CI 0.24-0.38]) were less likely to change RA treatment even after multivariable adjustment. CONCLUSION: Using the American College of Rheumatology's national RISE registry, one- to two-thirds of RA patients failed to change their treatment, even when experiencing moderate/high disease activity. Multimodal interventions directed at both patients and providers are needed to encourage shared decision-making, goal-directed care, and to overcome barriers to treatment escalation.


Asunto(s)
Antirreumáticos/administración & dosificación , Artritis Reumatoide/tratamiento farmacológico , Progresión de la Enfermedad , Informática Médica/tendencias , Sistema de Registros , Reumatología/tendencias , Anciano , Artritis Reumatoide/epidemiología , Estudios de Cohortes , Registros Electrónicos de Salud/tendencias , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Estados Unidos/epidemiología
19.
Nurs Educ Perspect ; 41(1): E3-E7, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31860501

RESUMEN

AIM: The aim of this literature review was to determine the state of the science related to clinical informatics competencies of registered nurses and to determine best practices in educational strategies for both nursing students and faculty. BACKGROUND: Continued emphasis on the provision of evidence-based patient care has implications for requisite informatics-focused competencies to be threaded throughout all levels of nursing educational programs. METHOD: Whittemore and Knalf's five-step integrative review process guided this research. An extensive search yielded 69 publications for critical appraisal. RESULTS: Results suggest nursing educational programs do not adhere to standardized criteria for teaching nursing informatics competencies. Another identified literature gap was the scarcity of research related to informatics training requirements for nurse educators. CONCLUSION: Findings support the need for continued research to provide clear direction about the expected clinical informatics competencies of graduate nurses and what training faculty need to facilitate student learning.


Asunto(s)
Informática Médica , Enfermeras y Enfermeros , Informática Aplicada a la Enfermería , Estudiantes de Enfermería , Competencia Clínica , Docentes de Enfermería , Humanos
20.
Int J Med Inform ; 133: 103937, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31739223

RESUMEN

INTRODUCTION: Population health programs are increasingly reliant on Health Information Technology (HIT). Program HIT architecture description is a necessary step prior to evaluation. Several sociotechnical frameworks have been used previously with HIT programs. The Informatics Stack is a novel framework that provides a thorough description of HIT program architecture. The Emergency Department Return Visit Quality Program (EDRVQP) is a population-level continuous quality improvement (QI) program connecting EDs across Ontario. The objectives of the study were to utilize the Informatics Stack to provide a description of the EDRVQP HIT architecture and to delineate population health program factors that are enablers or barriers. MATERIALS AND METHODS: The Informatics Stack was used to describe the HIT architecture. A qualitative study was completed with semi-structured interviews of key informants across stakeholder organizations. Emergency departments were selected randomly. Purposive sampling identified key informants. Interviews were conducted until saturation. An inductive qualitative analysis using grounded theory was completed. A literature review of peer-reviewed background literature, and stakeholder organization reports was also conducted. RESULTS: 23 business actors from 15 organizations were interviewed. The EDRVQP architecture description is presented across the Informatics Stack levels. The levels from most comprehensive to most basic are world, organization, perspectives/roles, goals/functions, workflow/behaviour/adoption, information systems, modules, data/information/knowledge/wisdom/algorithms, and technology. Enabling factors were the high rate of electronic health record adoption, legislative mandate for data collection, use of functional data standards, implementation flexibility, leveraging validated algorithms, and leveraging existing local health networks. Barriers were privacy legislation and a high turn-around time. DISCUSSION: The Informatics Stack provides a robust approach to thoroughly describe the HIT architecture of population health programs prior to program replication. The EDRVQP is a population health program that illustrates the pragmatic use of continuous QI methodology across a population (provincial) level.


Asunto(s)
Servicio de Urgencia en Hospital , Mejoramiento de la Calidad , Recolección de Datos , Registros Electrónicos de Salud , Informática Médica , Investigación Cualitativa
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