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1.
In Vivo ; 33(5): 1547-1551, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31471403

RESUMEN

An increasing trend in funding towards artificial intelligence (AI) research in medicine has re-animated huge expectations for future applications. Obstetrics and gynaecology remain highly litigious specialities, accounting for a large proportion of indemnity payments due to poor outcomes. Several challenges have to be faced in order to improve current clinical practice in both obstetrics and gynaecology. For instance, a complete understanding of fetal physiology and establishing accurately predictive antepartum and intrapartum monitoring are yet to be achieved. In gynaecology, the complexity of molecular biology results in a lack of understanding of gynaecological cancer, which also contributes to poor outcomes. In this review, we aim to describe some important applications of AI in obstetrics and gynaecology. We also discuss whether AI can lead to a deeper understanding of pathophysiological concepts in obstetrics and gynaecology, allowing delineation of some grey zones, leading to improved healthcare provision. We conclude that AI can be used as a promising tool in obstetrics and gynaecology, as an approach to resolve several longstanding challenges; AI may also be a means to augment knowledge and assist clinicians in decision-making in a variety of areas in obstetrics and gynaecology.


Asunto(s)
Inteligencia Artificial , Ginecología , Informática Médica , Obstetricia , Femenino , Ginecología/métodos , Ginecología/normas , Ginecología/tendencias , Humanos , Informática Médica/métodos , Informática Médica/normas , Informática Médica/tendencias , Obstetricia/métodos , Obstetricia/normas , Obstetricia/tendencias , Medicina de Precisión/métodos , Medicina de Precisión/normas
2.
Int J Med Inform ; 129: 430-437, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31445288

RESUMEN

OBJECTIVE: Electronic Health Records (EHRs) interventions hold the promise for enabling better healthcare. However, the implementation of EHR systems has been scarce in developing countries. The objective of this study is to investigate the state of EHRs implementation in Morocco; and draw insights for potential improvements. MATERIALS AND METHODS: University Medical Centers, known by locals in French as Centres Hospitalier Universitaires (CHU), are the largest and most advanced public healthcare centers in Morocco. A two-phase qualitative study was conducted in four out of the five CHUs. Phase One involved data collection through semi-structured interviews with 27 clinician champions, administrators, and medical directors. Phase Two included a brainstorming session during a health informatics conference held in Fes, Morocco. The data were analyzed using inductive analysis. RESULTS: We identified five main categories of challenges due to silo strategies: (1) EHRs selection and weak bargaining power, (2) identical errors repeated across silos, (3) a lack of interoperability standards, (4) insufficient human and financial, and (5) missed cooperation and collaboration opportunities. DISCUSSION: While identifying these silo challenges is an important milestone, proposing guidelines to address these challenges can bring Morocco and similar developing countries a step closer to improving healthcare through the use of health informatics and EHRs. Our recommendations for public healthcare organizations are threefold: (1) recognize the power of partnerships among all CHUs, (2) establish an e-health framework, and (3) seek national and international collaborations to drive and shape the eHealth agenda. Furthermore, we align our recommendations with the World Health Organization toolkit for an eHealth strategy to further benefit developing countries. CONCLUSION: This study identifies the challenges faced by the Moroccan EHRs implementation silo-ed strategy, and it proposes practical and fundamental guidelines to address these challenges and develop an interoperable and sustainable national eHealth system in Morocco and similar developing countries.


Asunto(s)
Registros Electrónicos de Salud , Prestación de Atención de Salud , Países en Desarrollo , Registros Electrónicos de Salud/organización & administración , Humanos , Informática Médica/normas , Marruecos , Investigación Cualitativa , Telemedicina , Organización Mundial de la Salud
3.
Prim Health Care Res Dev ; 20: e123, 2019 08 22.
Artículo en Inglés | MEDLINE | ID: mdl-31434596

RESUMEN

This study reports the first assessment of published comments in the family medicine literature using structured codes, which produced commentary annotations that will be the foundation of a knowledge base of appraisals of family medicine trials. Evidence appraisal occurs in a variety of formats and serves to shed light on the quality of research. However, scientific discourse generally and evidence appraisal in particular has not itself been analyzed for insights. A search strategy was devised to identify all journal comments indexed in PubMed linked to controlled intervention studies published in a recent 15-year period in major family medicine journals. A previously developed structured representation in the form of a list of appraisal concepts was used to formally annotate and categorize the journal comments through an iterative process. Trends in family medicine evidence appraisal were then analyzed. A total of 93 comments on studies from five journals over 15 years were included in the analysis. Two thirds of extracted appraisals were negative criticisms. All appraisals of measurement instruments were negative (100%). The participants baseline characteristics, the author discussions, and the design of the interventions were also criticized (respectively 91.7%, 84.6% and 83.3% negative). In contrast, appraisals of the scientific basis of the studies were positive (81.8%). The categories with the most appraisals were, most generally, those focused on the study design, and most specifically, those focused on the scientific basis. This study provides a new data-driven approach to review scientific discourse regarding the strengths and limitations of research within academic family medicine. This methodology can potentially generalize to other medical domains. Structured appraisal data generated here will enable future clinical, scientific, and policy decision-making and broader meta-research in family medicine.


Asunto(s)
Medicina Basada en la Evidencia/organización & administración , Medicina Familiar y Comunitaria/organización & administración , Informática Médica/estadística & datos numéricos , Informática Médica/normas , Publicaciones Periódicas como Asunto/estadística & datos numéricos , Publicaciones Periódicas como Asunto/normas , Medicina Basada en la Evidencia/estadística & datos numéricos , Medicina Familiar y Comunitaria/estadística & datos numéricos , Humanos , Revisión por Expertos
4.
Anesth Analg ; 129(3): 726-734, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31425213

RESUMEN

The convergence of multiple recent developments in health care information technology and monitoring devices has made possible the creation of remote patient surveillance systems that increase the timeliness and quality of patient care. More convenient, less invasive monitoring devices, including patches, wearables, and biosensors, now allow for continuous physiological data to be gleaned from patients in a variety of care settings across the perioperative experience. These data can be bound into a single data repository, creating so-called data lakes. The high volume and diversity of data in these repositories must be processed into standard formats that can be queried in real time. These data can then be used by sophisticated prediction algorithms currently under development, enabling the early recognition of patterns of clinical deterioration otherwise undetectable to humans. Improved predictions can reduce alarm fatigue. In addition, data are now automatically queriable on a real-time basis such that they can be fed back to clinicians in a time frame that allows for meaningful intervention. These advancements are key components of successful remote surveillance systems. Anesthesiologists have the opportunity to be at the forefront of remote surveillance in the care they provide in the operating room, postanesthesia care unit, and intensive care unit, while also expanding their scope to include high-risk preoperative and postoperative patients on the general care wards. These systems hold the promise of enabling anesthesiologists to detect and intervene upon changes in the clinical status of the patient before adverse events have occurred. Importantly, however, significant barriers still exist to the effective deployment of these technologies and their study in impacting patient outcomes. Studies demonstrating the impact of remote surveillance on patient outcomes are limited. Critical to the impact of the technology are strategies of implementation, including who should receive and respond to alerts and how they should respond. Moreover, the lack of cost-effectiveness data and the uncertainty of whether clinical activities surrounding these technologies will be financially reimbursed remain significant challenges to future scale and sustainability. This narrative review will discuss the evolving technical components of remote surveillance systems, the clinical use cases relevant to the anesthesiologist's practice, the existing evidence for their impact on patients, the barriers that exist to their effective implementation and study, and important considerations regarding sustainability and cost-effectiveness.


Asunto(s)
Anestesiología/métodos , Informática Médica/métodos , Calidad de la Atención de Salud , Tecnología de Sensores Remotos/métodos , Anestesiología/economía , Anestesiología/normas , Análisis Costo-Beneficio/métodos , Análisis Costo-Beneficio/normas , /normas , Humanos , Informática Médica/economía , Informática Médica/normas , Calidad de la Atención de Salud/economía , Calidad de la Atención de Salud/normas , Tecnología de Sensores Remotos/economía , Tecnología de Sensores Remotos/normas , Factores de Tiempo
5.
Home Healthc Now ; 37(4): 222-226, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31274585

RESUMEN

The use of Patient-Reported Outcome Measures (PROMs) to improve patient outcomes, communication, and shared decision-making is of significance to home healthcare. Clinicians have begun to integrate health information technology (HIT) enabled PROM platforms (such as tablets) into routine care to facilitate collection of PROMs. To evaluate the feasibility and suitability of incorporating PROMs into the overall workflow in home healthcare, and integrating data collected with electronic health records (EHRs), we engaged two home healthcare agencies as pilot sites over the course of 4 months. We provided tablets enabled with an app version of the validated Patient-Reported Outcomes Measurement Information System to collect patient data. This was followed by surveys, interviews, and observations on aspects of feasibility, which we analyzed using summary statistics and qualitative analysis. Results show that the implementation of the HIT-enabled PROMs in the home healthcare setting is suitable for workflow, without negatively impacting goals of care. Additionally, the tablets were considered user-friendly by both clinicians and patients. Key to the utility of HIT-enabled PROMs in home healthcare is the integration of the data collected with existing data systems, in order to facilitate quality and improve outcomes, the success of which can depend on EHR platform ownership and the related ability or access to modify EHRs.


Asunto(s)
Servicios de Atención de Salud a Domicilio , Medición de Resultados Informados por el Paciente , Evaluación de la Tecnología Biomédica/métodos , Adulto , Anciano , Anciano de 80 o más Años , Registros Electrónicos de Salud , Estudios de Factibilidad , Femenino , Humanos , Masculino , Informática Médica/métodos , Informática Médica/normas , Persona de Mediana Edad
6.
Rev Epidemiol Sante Publique ; 67(4): 213-221, 2019 Jul.
Artículo en Francés | MEDLINE | ID: mdl-31196581

RESUMEN

BACKGROUND: Since 2008, in France, hospital funding is determined by the nature of activities provided (activity-based funding). Quality control of hospital activity coding is essential to optimize hospital remuneration. There is a need for reliable tools to allocate human resources wisely in order to improve these controls. METHODS: The main objective of this study was to identify the determinants of time needed by medical information technicians to control hospital activity coding in a Regional Hospital Center. From March 2016 to the beginning of January 2017, medical information technicians reported the time they spent on each quality control, and the time they needed when they had to code the entire stay. Multiple linear regressions were performed to identify the determinants of quality control or coding duration. A split sample validation was used: model was created on one half of the sample and validated on the remaining half. RESULTS: Among the controls, 5431 were included in the analysis of determinants of control duration (2715 kept aside for model validation). Seven determinants have been identified (stay duration, level of complexity, month of control, type of control, medical information technician, rank of classing information, and major diagnostic category). The correlation coefficient between predicted and real control duration was 0.71 (P<10-4); 808 stays were included in the analysis of determinants of coding duration (404 kept aside for model validation). Two determinants have been identified. The correlation coefficient, between predicted and real coding duration, was 0.47 (P<10-3). We performed the same multiple regression, on 2017 activity data, to estimate the weight of each hospital activity pole, regarding quality control of hospital activity coding. CONCLUSION: We succeeded in modeling time needed for quality control of hospital stays. These results helped to estimate human resources required for quality control of each hospital pole. Nevertheless, the second analysis did not give satisfactory results: we failed in modeling time needed to code hospital stays.


Asunto(s)
Codificación Clínica , Medicina General , Cirugía General , Tiempo de Internación , Informática Médica , Obstetricia , Control de Calidad , Estudios de Casos y Controles , Codificación Clínica/organización & administración , Codificación Clínica/normas , Grupos Diagnósticos Relacionados/organización & administración , Grupos Diagnósticos Relacionados/normas , Registros Electrónicos de Salud/organización & administración , Registros Electrónicos de Salud/normas , Honorarios Médicos , Femenino , Francia , Medicina General/organización & administración , Medicina General/normas , Cirugía General/organización & administración , Cirugía General/normas , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Informática Médica/métodos , Informática Médica/organización & administración , Informática Médica/normas , Obstetricia/organización & administración , Obstetricia/normas , Indicadores de Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud , Programas Médicos Regionales/organización & administración , Programas Médicos Regionales/normas , Factores de Tiempo , Carga de Trabajo
7.
Comput Inform Nurs ; 37(8): 396-404, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31149911

RESUMEN

This study yielded a map of the alignment of American Association of Colleges of Nursing Graduate-Level Nursing Informatics Competencies with American Medical Informatics Association Health Informatics Core Competencies in an effort to understand graduate-level accreditation and certification opportunities in nursing informatics. Nursing Informatics Program Directors from the American Medical Informatics Association and a health informatics expert independently mapped the American Association of Colleges of Nursing competencies to the American Medical Informatics Association Health Informatics knowledge, skills, and attitudes. The Nursing Informatics Program Directors' map connected an average of 4.0 American Medical Informatics Association Core Competencies per American Association of Colleges of Nursing competency, whereas the health informatics expert's map connected an average of 5.0 American Medical Informatics Association Core Competencies per American Association of Colleges of Nursing competency. Agreement across the two maps ranged from 14% to 60% per American Association of Colleges of Nursing competency, revealing alignment between the two groups' competencies according to knowledge, skills, and attitudes. These findings suggest that graduates of master's degree programs in nursing, especially those specializing in nursing informatics, will likely be prepared to sit for the proposed Advanced Health Informatics Certification in addition to the American Nurses Credentialing Center bachelor's-level Informatics Nursing Certification. This preliminary map sets the stage for further in-depth mapping of nursing informatics curricula with American Medical Informatics Association Core Competencies and will enable interprofessional conversations around nursing informatics specialty program accreditation, nursing workforce preparation, and nursing informatics advanced certification. Nursing informaticists should examine their need for credentials as key contributors who will address critical health informatics needs.


Asunto(s)
Certificación/normas , Informática Médica/normas , Informática Aplicada a la Enfermería/normas , Competencia Profesional , American Nurses' Association , Curriculum , Educación de Postgrado en Enfermería , Conocimientos, Actitudes y Práctica en Salud , Humanos , Estados Unidos
8.
Hosp Top ; 97(3): 99-106, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31166151

RESUMEN

The objective of this study is to explore the relationship between hospitals Health Information Technology (HIT), and financial and quality performance. The study merged the 2017 Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System, American Hospital Association Annual Survey, and two CMS Hospital Compare datasets. A total of 3002 hospitals were analyzed using multivariate analysis. We found that hospitals with laboratory tracking systems reported better financial performance on five financial performance measures. Policymakers should consider developing policies that facilitate exploration and adoption of various hospital HIT capabilities that measurably improves hospital quality of care.


Asunto(s)
Técnicas de Laboratorio Clínico/métodos , Laboratorios/economía , Informática Médica/normas , Sistemas de Identificación de Pacientes/métodos , Técnicas de Laboratorio Clínico/economía , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Laboratorios/normas , Laboratorios/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Informática Médica/métodos , Medicare/estadística & datos numéricos , Sistemas de Identificación de Pacientes/economía , Sistemas de Identificación de Pacientes/normas , Indicadores de Calidad de la Atención de Salud , Análisis de Regresión , Estados Unidos
9.
BMC Med Res Methodol ; 19(1): 53, 2019 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-30871502

RESUMEN

BACKGROUND: The availability of clinical and therapeutic data drawn from medical records and administrative databases has entailed new opportunities for clinical and epidemiologic research. However, these databases present inherent limitations which may render them prone to new biases. We aimed to conduct a structured review of biases specific to observational clinical studies based on secondary databases, and to propose strategies for the mitigation of those biases. METHODS: Scoping review of the scientific literature published during the period 2000-2018 through an automated search of MEDLINE, EMBASE and Web of Science, supplemented with manually cross-checking of reference lists. We included opinion essays, methodological reviews, analyses or simulation studies, as well as letters to the editor or retractions, the principal objective of which was to highlight the existence of some type of bias in pharmacoepidemiologic studies using secondary databases. RESULTS: A total of 117 articles were included. An increasing trend in the number of publications concerning the potential limitations of secondary databases was observed over time and across medical research disciplines. Confounding was the most reported category of bias (63.2% of articles), followed by selection and measurement biases (47.0% and 46.2% respectively). Confounding by indication (32.5%), unmeasured/residual confounding (28.2%), outcome misclassification (28.2%) and "immortal time" bias (25.6%) were the subcategories most frequently mentioned. CONCLUSIONS: Suboptimal use of secondary databases in pharmacoepidemiologic studies has introduced biases in the studies, which may have led to erroneous conclusions. Methods to mitigate biases are available and must be considered in the design, analysis and interpretation phases of studies using these data sources.


Asunto(s)
Investigación Biomédica/estadística & datos numéricos , Bases de Datos Factuales/estadística & datos numéricos , Prestación de Atención de Salud/estadística & datos numéricos , Almacenamiento y Recuperación de la Información/estadística & datos numéricos , Farmacoepidemiología/estadística & datos numéricos , Sesgo , Investigación Biomédica/métodos , Investigación Biomédica/normas , Prestación de Atención de Salud/normas , Política de Salud , Servicios de Salud/normas , Servicios de Salud/estadística & datos numéricos , Humanos , Almacenamiento y Recuperación de la Información/métodos , Almacenamiento y Recuperación de la Información/normas , Informática Médica/métodos , Informática Médica/normas , Informática Médica/estadística & datos numéricos , Farmacoepidemiología/métodos
10.
PLoS One ; 14(3): e0213688, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30921341

RESUMEN

Qiu et al. made a security analysis about the protocols of Chaudhry et al. and Kumari et al. in 2018, and they pointed out that there are many security weaknesses in the protocols. To improve the security, Qiu et al. proposed an advanced authentication scheme for Session Initiation Protocol on the basis of the previous protocols and claimed that their own protocol was very secure and practical. However, we demonstrate that the protocol of Qiu et al. has a serious mistake which causes their protocol cannot be executed normally. Beyond that, we also find out that their protocol cannot withstand insider attack and denial service attack. In order to remove these weaknesses, we propose an efficient provably secure mutual authentication scheme. Furthermore, our scheme provides security analysis with the help of Burrows-Abadi-Needham (BAN) logic. Compared with their protocol, ours has greater security and better performance.


Asunto(s)
Cognición , Seguridad Computacional , Sistemas de Computación , Confidencialidad , Programas Informáticos , Algoritmos , Humanos , Sistemas de Información , Lógica , Informática Médica/normas , Lenguajes de Programación , Telemedicina
11.
Rev Bras Enferm ; 72(1): 19-26, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30916263

RESUMEN

OBJECTIVE: To evaluate the Primary Health Care attributes of Fortaleza city, Ceará State. METHOD: Evaluative study carried out at 97 Primary Health Care Units, from August 2015 to June 2016. 451 professionals from the Family Health Strategy participated in the study. We used the Primary Care Assessment Tool - Brazil, which evaluates the attributes, assigning scores on a scale of zero to ten. We adopted as a cut-off point, to consider high Primary Care score, attributes with a value of 6.60 or higher. RESULTS: Among the eight attributes evaluated the First Contact Access and the Coordination - Information System were the ones that obtained the lowest and highest scores, (2.98) and (7.82), respectively. The Overall Score, calculated by means of a mean of the attributes, was 6.34. CONCLUSION: The Primary Care evaluated had a low score, showing the need to discuss mechanisms to boost the attributes that obtained low scores.


Asunto(s)
Gobierno Local , Atención Primaria de Salud/normas , Adulto , Anciano , Brasil , Distribución de Chi-Cuadrado , Continuidad de la Atención al Paciente/normas , Continuidad de la Atención al Paciente/estadística & datos numéricos , Estudios Transversales , Escolaridad , Servicios de Planificación Familiar/normas , Servicios de Planificación Familiar/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/normas , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Humanos , Masculino , Informática Médica/normas , Informática Médica/estadística & datos numéricos , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Religión , Estadísticas no Paramétricas
12.
BMC Res Notes ; 12(1): 42, 2019 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-30658682

RESUMEN

OBJECTIVE: Misspellings in clinical free text present challenges to natural language processing. With an objective to identify misspellings and their corrections, we developed a prototype spelling analysis method that implements Word2Vec, Levenshtein edit distance constraints, a lexical resource, and corpus term frequencies. We used the prototype method to process two different corpora, surgical pathology reports, and emergency department progress and visit notes, extracted from Veterans Health Administration resources. We evaluated performance by measuring positive predictive value and performing an error analysis of false positive output, using four classifications. We also performed an analysis of spelling errors in each corpus, using common error classifications. RESULTS: In this small-scale study utilizing a total of 76,786 clinical notes, the prototype method achieved positive predictive values of 0.9057 and 0.8979, respectively, for the surgical pathology reports, and emergency department progress and visit notes, in identifying and correcting misspelled words. False positives varied by corpus. Spelling error types were similar among the two corpora, however, the authors of emergency department progress and visit notes made over four times as many errors. Overall, the results of this study suggest that this method could also perform sufficiently in identifying misspellings in other clinical document types.


Asunto(s)
Diccionarios como Asunto , Informática Médica/métodos , Procesamiento de Lenguaje Natural , Vocabulario Controlado , Algoritmos , Humanos , Lenguaje , Informática Médica/normas , Informática Médica/estadística & datos numéricos , Sistemas de Registros Médicos Computarizados/normas , Sistemas de Registros Médicos Computarizados/estadística & datos numéricos , Patología Quirúrgica/métodos , Reproducibilidad de los Resultados , Informe de Investigación/normas , Unified Medical Language System/normas , Unified Medical Language System/estadística & datos numéricos
13.
Radiology ; 291(1): 112-118, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30694156

RESUMEN

Purpose To evaluate readability of websites that are commonly accessed for information on breast lesions requiring surgery. Materials and Methods An internet search using three malignant and eight nonmalignant breast lesions that traditionally require lumpectomy or excisional biopsy as search terms was conducted to identify websites commonly accessed for patient information on breast lesions requiring surgery. Nine websites with information on breast diagnoses were identified based on search engine results for each breast lesion queried. Available patient-directed information was downloaded for each lesion from each website on May 15, 2018. Grade-level readability of downloaded content for each lesion was then determined by using generalized estimating equations, with observations nested within readability metrics from each website. Readability of associated terms breast biopsy, breast cancer, and breast surgery was also evaluated with the same method. Results were compared with American Medical Association (AMA) recommended readability parameters (sixth-grade reading level). All interval estimates were calculated for 95% confidence. Results Average grade level readability score of health information on breast lesions requiring surgery was 11.7, which exceeded the AMA parameters. Information on Wikipedia was written at the highest reading level (grade level readability score, 14.2), while information on the National Institutes of Health website ( http://cancer.gov ) was written at the lowest reading level (grade level readability score, 9.7). Educational materials on malignant breast lesions (grade level readability score, 12.3) were written at a higher reading level than were those on nonmalignant breast lesions (grade level readability score,11.4). Information on the terms breast biopsy (grade level readability score, 10.9), breast cancer (grade level readability score, 10.6), and breast surgery (grade level readability score, 11.1) were all written above a sixth-grade reading level. Conclusion Readability of current online resources on breast biopsy lesions traditionally requiring surgery may be too complex for the general public to comprehend, leading to misinformation and confusion. © RSNA, 2019 See also the editorial by Haygood in this issue.


Asunto(s)
Neoplasias de la Mama/cirugía , Comprensión , Internet/normas , Educación del Paciente como Asunto/normas , Biopsia , Femenino , Humanos , Mamografía , Informática Médica/normas , Educación del Paciente como Asunto/métodos , Terminología como Asunto
15.
IEEE/ACM Trans Comput Biol Bioinform ; 16(4): 1342-1348, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30059313

RESUMEN

The capacity to link records associated with the same individual across data sets is a key challenge for data-driven research. The challenge is exacerbated by the potential inclusion of both genomic and clinical data in data sets that may span multiple legal jurisdictions, and by the need to enable re-identification in limited circumstances. Privacy-Preserving Record Linkage (PPRL) methods address these challenges. In 2016, the Interdisciplinary Committee of the International Rare Diseases Research Consortium (IRDiRC) launched a task team to explore approaches to PPRL. The task team is a collaboration with the Global Alliance for Genomics and Health (GA4GH) Regulatory and Ethics and Data Security Work Streams, and aims to prepare policy and technology standards to enable highly reliable linking of records associated with the same individual without disclosing their identity except under conditions in which the use of the data has led to information of importance to the individual's safety or health, and applicable law allows or requires the return of results. The PPRL Task Force has examined the ethico-legal requirements, constraints, and implications of PPRL, and has applied this knowledge to the exploration of technology methods and approaches to PPRL. This paper reports and justifies the findings and recommendations thus far.


Asunto(s)
Seguridad Computacional , Confidencialidad , Genómica , Informática Médica/métodos , Macrodatos , Bases de Datos Factuales , Europa (Continente) , Ligamiento Genético , Genoma Humano , Humanos , Comunicación Interdisciplinaria , Informática Médica/normas , Enfermedades Raras/genética , Estados Unidos
16.
Drug Saf ; 42(1): 13-25, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30117051

RESUMEN

INTRODUCTION: The risk of dose errors is high in paediatric inpatient settings. Computerized provider order entry (CPOE) systems with clinical decision support (CDS) may assist in reducing the risk of dosing errors. Although a frequent type of medication error, the prevalence of dose errors is not well described. Dosing error rates in hospitals with or without CPOE have not been compared. OBJECTIVE: Our aim was to conduct a systematic review assessing the prevalence and impact of dose errors in paediatric wards with and without CPOE and/or CDS. METHODS: We systematically searched five databases to identify studies published between January 2000 and December 2017 that assessed dose error rates by medication chart audit or direct observation. RESULTS: We identified 39 studies, nine of which involved paediatric wards using CPOE with or without CDS. Studies of paediatric wards using paper medication charts reported approximately 8-25% of patients experiencing a dose error, and approximately 2-6% of medication orders and approximately 3-8% of dose administrations contained a dose error, with estimates varying by ward type. The nine studies of paediatric wards using CPOE reported approximately 22% of patients experiencing a dose error, and approximately 1-6% of medication orders and approximately 3-8% of dose administrations contained a dose error. Few studies provided data for individual wards. The severity and prevalence of harm associated with dose errors was rarely assessed and showed inconsistent results. CONCLUSIONS: Dose errors occur in approximately 1 in 20 medication orders. Hospitals using CPOE with or without CDS had a lower rate of dose errors compared with those using paper charts. However, few pre/post studies have been conducted and none reported a significant reduction in dose error rates associated with the introduction of CPOE. Future research employing controlled designs is needed to determine the true impact of CPOE on dosing errors among children, and any associated patient harm.


Asunto(s)
Hospitales/tendencias , Informática Médica/tendencias , Errores de Medicación/tendencias , Sistemas de Medicación en Hospital/tendencias , Pediatría/tendencias , Niño , Hospitales/normas , Humanos , Informática Médica/normas , Sistemas de Entrada de Órdenes Médicas/normas , Sistemas de Entrada de Órdenes Médicas/tendencias , Errores de Medicación/prevención & control , Sistemas de Medicación en Hospital/normas , Pediatría/normas , Prevalencia
17.
BMJ Open ; 8(12): e022885, 2018 12 22.
Artículo en Inglés | MEDLINE | ID: mdl-30580265

RESUMEN

INTRODUCTION: eHealth is critically important to build strong health systems, and accelerate the achievement of sustainable development goals, particularly universal health coverage. To support and strengthen the health system, the eHealth architecture needs to be formulated and established prior to the implementation and development of any national eHealth applications and services. The aim of this study is to design and validate a standard questionnaire to assess the current status of national eHealth architecture (NEHA) components. METHODS AND ANALYSIS: This study will use a mixed-methods design consisting of four phases: (1) item generation through review of evidences and experts' opinions, (2) face and content validity of the questionnaire, (3) determination of a range of possible scenarios for each item included in the questionnaire and (4) evaluation of reliability. This questionnaire is expected to generate critical and important information about the status of NEHA components that will be useful for monitoring, formulating, developing, implementing and evaluating NEHA. Our paper will contribute, we envisage, to establishment of a socio-technical basis on which governments and other relevant sectors can compare the policy interventions that boost the availability and utilisation of eHealth services within their settings. ETHICS AND DISSEMINATION: The Ethics Committee for Research at the Tehran University of Medical Sciences approved the study protocol. We will obtain informed consent from each participant and collect data anonymously to maintain confidentiality. The translation of the findings into future policy planning will include the production of a series of peer-reviewed articles, presentation of the findings at relevant eHealth conferences and preparation of policy reports to the international organisations aiming to strengthen national capacity for better-informed eHealth architecture.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Política de Salud/tendencias , Informática Médica/tendencias , Encuestas y Cuestionarios , Telemedicina/organización & administración , Femenino , Predicción , Humanos , Difusión de la Información , Irán , Masculino , Informática Médica/normas , Formulación de Políticas
19.
Health Aff (Millwood) ; 37(11): 1736-1743, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30395508

RESUMEN

The Institute of Medicine's To Err Is Human, published in 1999, represented a watershed moment for the US health care system. The report dramatically raised the profile of patient safety and stimulated dedicated research funding to this essential aspect of patient care. Highly effective interventions have since been developed and adopted for hospital-acquired infections and medication safety, although the impact of these interventions varies because of their inconsistent implementation and practice. Progress in addressing other hospital-acquired adverse events has been variable. In the past two decades additional areas of safety risk have been identified and targeted for intervention, such as outpatient care, diagnostic errors, and the use of health information technology. In sum, the frequency of preventable harm remains high, and new scientific and policy approaches to address both prior and emerging risk areas are imperative. With the increasing availability of electronic data, investments must now be made in developing and testing methods to routinely and continuously measure the frequency and types of patient harm and even predict risk of harm for specific patients. This progress could lead us from a Bronze Age of rudimentary tool development to a Golden Era of vast improvement in patient safety.


Asunto(s)
Errores Diagnósticos/estadística & datos numéricos , Prioridades en Salud , Errores Médicos/prevención & control , Informática Médica/normas , Seguridad del Paciente/normas , Errores Diagnósticos/efectos adversos , Humanos , Errores de Medicación/prevención & control , Mejoramiento de la Calidad
20.
Int J Med Inform ; 120: 31-41, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30409344

RESUMEN

INTRODUCTION: Unpaid informal caregivers of adult care recipients, including persons with dementia, experience multiple unmet information needs and information management challenges. OBJECTIVES: To understand the current personal health information management (PHIM) practices in informal caregiving for adults with and without dementia. METHODS: Semi-structured interviews were performed with ten informal caregivers-half of whom were caring for persons with dementia-and four formal caregivers at an adult day service. Interviews centered on a paper-based tool distributed by the day service, the CARE Kit, permitting an artifacts analysis of the tools used by participants for PHIM. Qualitative thematic analysis was applied to interview data. RESULTS: Caregivers' PHIM practices aimed to support daily care management and decision-making on behalf of care recipients, through: 1) information acquisition and integration across multiple sources and records; 2) information maintenance, updating, and use over time; and 3) information sharing and communication with healthcare professionals and other family caregivers. Participants reported advantages and challenges of their PHIM practices and tools, including fitting PHIM into their daily lives, managing PHIM-related cognitive workload, the functionality of PHIM tools, and the dynamic, longitudinal nature of PHIM. CONCLUSION: The study produced a number of implications for caregiver health information management information technology (CHIM IT), based on findings about the nature of caregivers' practices for managing information for adult care recipients. We present CHIM IT requirements related to privacy and security, customization and flexibility, ease of use, credibility and sensitivity, situation awareness, information integration, delegation and shared use, updating and maintenance, archiving and versioning, communication, agency and information access, and validation.


Asunto(s)
Cuidadores/psicología , Demencia/enfermería , Gestión de la Información en Salud/normas , Informática Médica/normas , Pautas de la Práctica en Enfermería/normas , Pautas de la Práctica en Medicina/normas , Acceso a la Información , Adulto , Anciano , Artefactos , Comunicación , Estudios Transversales , Demencia/terapia , Femenino , Humanos , Persona de Mediana Edad
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