A Path Towards Inclusion: Transdisciplinary Experience for the Inclusion of Self-Perceived Gender in an Information System.

In Argentina, since 2012 the Gender Identity Law guarantees that people who identify as transgender must be called by their chosen name, among other things. Transgender patients are usually not represented in information systems, whether electronic or not. This can place them in situations of vulnerability and discrimination. With that in mind, an interdisciplinary team was formed to take address the problems of this population regarding to the information systems of Hospital Italiano de Buenos Aires. The aim of this study is to spread the experience of the transdisciplinary team on the Electronic Health Record's modification and other associated applications to achieve include the self-perceived gender identity and the chosen name of those people who modified their gender.

A Path to Inclusion: Design and Prototype of Transgender Identity in an Electronic Health Record.

With the purpose of reducing discrimination on gender, the Department of Health Informatics of the Hospital Italiano de Buenos Aires (HIBA) developed changes in its Patient Master Index to register chosen name and self-perceived gender identity. To improve the visualization of information related to the identity of each person to provide comprehensive quality care, it was decided to modify the impact of this information on the EHR. For this, prototypes were developed with changes in the patient identification module and then user-tests were carried out.

Adverse Drug Event Reporting Rates After the Implementation of an EHR Integrated Reporting System.

Under-reporting of adverse drug events (ADEs) is a common issue across healthcare systems, and lack of integration with clinical workflow and systems are among the leading causes of this problem. We sought to describe the development of an ADEs reporting system within an EHR that represents user needs and captures relevant data. We compared periods before and after the implementation, and describe the corresponding reporting rates.

Implementation of an Inpatient Portal Integrated to an EHR: First Stage Evaluation.

Technology has led to the communication of the hospitalized patient and their family with clinical knowledge. The objective of this study is to describe the rate of use of the Inpatient Personal Health Record of Hospital Italiano de Buenos Aires. A cross-sectional study was conducted between May and September of 2018. The rate of use was 2.10% (95% CI 1.89-2.32). The most used functionalities were analyzed. New strategies are needed to improve the rate of use.

Estudo longitudinal do eixo hipófise-tireóide durante a gravidez / Longitudinal study of pituitary-thyroid axis in pregnancy

A tireóide sofre importantes modificações durante a gravidez. Visando mostrar as modificações no eixo hipófise-tireóide ao longo deste período, estudamos a função tireoidiana de 587 mulheres, com dosagens de TSH, T4 livre, anti-TPO, betahCG no 1°. trimestre e TSH, T4 livre e anti-TPO no 2°. e 3°. trimestres. Observamos aumento progressivo do TSH no 2°. (média: 2,14mU/L) e 3°. (média: 2,76mU/L) trimestres, em relação ao 1°. (média: 1,39mU/L). No grupo com TSH abaixo do valor de referência (0,4mU/L) no 1°. trimestre, a média de bhCG foi de 129.200UI/L, enquanto no grupo que apresentou níveis normais de TSH, a média foi de 34.200UI/L. Observamos, também, uma ligeira diminuição do T4 livre no 2°. e 3°. trimestres em relação ao 1°. (médias: 1°: 1,15; 2°: 0,99; 3°: 0,94ng/dl). A presença de anti-TPO positivo ocorreu em 13,9 por cento das mulheres. Não foram observadas alterações significativas nos valores médios de TSH e T4 livres naquelas com ou sem auto-imunidade. Entretanto, proporções significativamente maiores de gestantes apresentaram valores hormonais fora da faixa da normalidade em todos os trimestres da gestação. Concluímos que a função tireoidiana é afetada pela gravidez, com tendência ao declínio durante seu progresso, sendo este fenômeno mais marcante no grupo de gestantes anti-TPO positivas.

[Longitudinal study of pituitary-thyroid axis in pregnancy]. / Estudo longitudinal do eixo hipófise-tireóide durante a gravidez.

The thyroid undergoes important changes during pregnancy. In order to evaluate changes of the hypophyseal-thyroid axis during this period we studied the thyroid function in 587 pregnants by determining serum TSH, free T4, TPO antibodies and betahCG in the 1st trimester and serum TSH, free T4 and TPOAb in to 2nd and 3rd. We observed a progressive rise in average serum TSH in the 2nd (2.14 mU/L) and 3rd (2.96 mU/L) trimesters when compared to the 1st (1.39 mU/L). Serum TSH values in the 1st trimester were inversely correlated with betahCG levels in as much as TSH levels below 0.4 mU/L corresponded to average betahCG levels of 129,000 UI/L whereas these were 34,200 UI/L in the normal TSH group. A slight decrease in free T4 levels was also observed in the 2nd and 3rd trimesters (averages 1st: 1.15; 2nd: 0.99; 3rd: 0.94 ng/dl). Thyroid autoimmunity defined as positive TPOAb occurred in 13.9% of our patients during pregnancy. No significant differences in TSH and free T4 medium values were found between patients with positive TPOAb and those without. However, a significantly higher proportion of pregnants had abnormal hormonal values throughout the trimesters. We conclude that thyroid function is affected by pregnancy with a tendency for decline as it progresses, a feature more easily observed in positive TPOAb group.