State of the fight against informal market of medicines in Togo: approaches and limitations.

The extent of medicines sales and consumption in the informal market in Togo raises many ethical and public health issues. In order to report on the situation of public action in the fight against this practice, we conducted a qualitative survey from 15 to 25 February 2016 in the commune of Lomé and in the Maritime Region among the actors of control system and resource people in the general population. This was supplemented by an analysis of Togo's pharmaceutical and health policy documents and a literature review on the illicit drug market issues relating to public health, political science, the social sciences applied to health. In spite of the existence of national and international tools, household poverty, cultural self-medication, ignorance of the population concerning the health risks of informal market medicines, weak political commitment, weakness regulation and enforcement, corruption, constitute obstacles to the success of actions to combat this practice.

On Contributing to the Progress of Medical Informatics as Publisher.

May 1st, 2017, will mark Dieter Bergemann's 80th birthday. As Chief Executive Officer and Owner of Schattauer Publishers from 1983 to 2016, the biomedical and health informatics community owes him a great debt of gratitude. The past and present editors of Methods of Information in Medicine, the IMIA Yearbook of Medical Informatics, and Applied Clinical Informatics want to honour and thank Dieter Bergemann by providing a brief biography that emphasizes his contributions, by reviewing his critical role as an exceptionally supportive publisher for Schattauer's three biomedical and health informatics periodicals, and by sharing some personal anecdotes. Over the past 40 years, Dieter Bergemann has been an influential, if behind-the-scenes, driving force in biomedical and health informatics publications, helping to ensure success in the dissemination of our field's research and practice.

Digital health and the need to develop centers of expertise in sub-Saharan Africa : two examples in Mali and Cameroon.

It is generally agreed today that digital technology provides a lever for improving access to health care, care processes, and public health planning and activities such as education and prevention. Its use in countries that have reached a given level of development has taken place in a somewhat fragmented manner that raises important interoperability problems and sometimes makes synergy impossible between the different projects of digital health. This may be linked to several factors, principally the lack of a global vision of digital health, and inadequate methodological knowledge that prevents the development and implementation of this vision. The countries of Africa should be able to profit from these errors from the beginnings of digital health, by moving toward systemic approaches, known standards, and tools appropriate to the realities on the ground. The aim of this work is to present the methodological approaches as well as the principal results of two relatively new centers of expertise in Mali and Cameroon intended to cultivate this vision of digital governance in the domain of health and to train professionals to implement the projects. Both centers were created due to initiatives of organizations of civil society. The center in Mali developed toward an economic interest group and then to collaboration with healthcare and university organizations. The same process is underway at the Cameroon center. The principal results from these centers can be enumerated under different aspects linked to research, development, training, and implementation of digital health tools. They have produced dozens of scientific publications, doctoral dissertations, theses, and papers focused especially on subjects such as the medicoeconomic evaluation tools of e-health and health information technology systems. In light of these results, we can conclude that these two centers of expertise have well and truly been established. Their role may be decisive in the local training of participants, the culture of good governance of digital health projects, the development of operational strategies, and the implementation of projects.

The delegation of tasks in the era of e-health to support community interventions in maternal and child health: lessons learned from the PACT-Denbaya project.

The PACT-Denbaya project (Program for community access to telemedicine for families) aimed to help improve the health of mothers and child in rural communities through the delegation of obstetric-gynecologic and pediatric tasks, supported by teleconsultations. This operational research took place in 6 community health centers in the Dioïla health district in Mali. Our method was based of the delegation of tasks, supported by teleconsultations. Experts in pediatrics and obstetrics/gynecology provided a week-long training program to general practitioners and midwives, in the management of the most common problems in the field and in the use of the "Bogou" teleconsultation and "Dudal" tele-education platforms to ensure exchanges and follow-up. Overall, 17 healthcare providers, that is, general practitioners, nurse-obstetricians, and midwives participated in sessions to strengthen gynecology-obstetric and pediatric capacity in the field. The evaluation of knowledge and of the indicators compared with the baseline of 8359 pregnancies and 1991 documented deliveries and of user satisfaction showed that this type of service resulted in decreased maternal and child mortality. In view of these results, we can deduce that the delegation of tasks, when it is supported by telehealth, encounters no resistance from the specialists and contributes to the significant improvement of maternal and infant health in remote areas. A long-term impact study is necessary to reinforce these results.

Discussion of "Combining Health Data Uses to Ignite Health System Learning".

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Combining Health Data Uses to Ignite Health System Learning" written by John D. Ainsworth and Iain E. Buchan [1]. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the paper of Ainsworth and Buchan. In subsequent issues the discussion can continue through letters to the editor. With these comments on the paper "Combining Health Data Uses to Ignite Health System Learning", written by John D. Ainsworth and Iain E. Buchan [1], the journal seeks to stimulate a broad discussion on new ways for combining data sources for the reuse of health data in order to identify new opportunities for health system learning. An international group of experts has been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper.

[KidsETransplant--a serious game for children with liver disease or liver transplant]. / KidsETransplant--un serious game pour les enfants greffés ou malades du foie.

In Switzerland all children's liver transplants are centralized at the University Hospitals of Geneva (HUG) since 1989. Approximately 150 children have received transplants since then, and their survival rate is higher than 90%--one of the highest in Europe. Maximizing the chances of long-term success requires that patients comply with follow-up treatment, something which mandates a sound understanding of their medical condition. The KidsETransplant project aims to help the child--and his family--to understand better his state of health. To this end, our tool offers secured, unrestricted access to the patient's medical record, with a view to both increase patient autonomy and improve communication with healthcare professionals. This paper describes KidsETransplant, as well as its implemented evaluation process.

[Telemedicine in your suitcase: useful tools for the traveler]. / De la télémédecine dans vos valises: des outils utiles pour le voyageur.

In our digital age, telemedicine becomes, under various forms, a useful companion for the traveler, providing access to up-to-date information about health and security risks, remote consultation of specialists to ascertain a diagnosis of select an appropriate treatment, connection to similar patients in order to obtain contextualized advice, biomedical sensors and other monitoring and diagnostic portable tools, as well as transportable electronic health records enabling continuity of care and mobility. Commercial telemedicine services are being developed specifically for travelers, most of which are using mobile phones as the main device, which thus becomes a real telestethoscope.

Discussion of "Biomedical informatics: we are what we publish".

This article is part of a For-Discussion-Section of Methods of Information in Medicine about the paper "Biomedical Informatics: We Are What We Publish", written by Peter L. Elkin, Steven H. Brown, and Graham Wright. It is introduced by an editorial. This article contains the combined commentaries invited to independently comment on the Elkin et al. paper. In subsequent issues the discussion can continue through letters to the editor.

Trustworthy reuse of health data: a transnational perspective.

BACKGROUND: The widespread adoption of electronic health records (EHRs) is accelerating the collection of sensitive clinical data. The availability of these data raises privacy concerns, yet sharing the data is essential for public health, longitudinal patient care, and clinical research. METHOD: Following previous work in the United States [1,2], the International Medical Informatics Association convened the 2012 European Summit on Trustworthy Reuse of Health Data. Over 100 delegates representing national governments, academia, patient groups, industry, and the European Commission participated. In all, 21 countries were represented. The agenda was designed to solicit a wide range of perspectives on trustworthy reuse of health data from the participants. RESULTS AND CONCLUSIONS: Delegates agreed that the "government" should provide oversight, that the reuse should be "fully regulated," and that the patient should be "fully informed." One important reflection was that doing nothing will have negative implications across the European Union (EU). First, continued fragmented parallel non-standards-based developments in multiple sectors entail a substantial duplication of costs and human effort. Second, a failure to work jointly across the stakeholders on common policy frameworks will forego a crucial opportunity to boost key EU markets (pharmaceuticals, health technology and devices, and eHealth solutions) and counter global competition. Finally, and crucially, the lack of harmonized policy across EU nations for trustworthy reuse of health data risks patient safety. The productive dialog, initiated with multiple stakeholders from government, academia, and industry, will have to continue, in order to address the many remaining issues outlined in this white paper.

Nanoinformatics: developing new computing applications for nanomedicine.

Nanoinformatics has recently emerged to address the need of computing applications at the nano level. In this regard, the authors have participated in various initiatives to identify its concepts, foundations and challenges. While nanomaterials open up the possibility for developing new devices in many industrial and scientific areas, they also offer breakthrough perspectives for the prevention, diagnosis and treatment of diseases. In this paper, we analyze the different aspects of nanoinformatics and suggest five research topics to help catalyze new research and development in the area, particularly focused on nanomedicine. We also encompass the use of informatics to further the biological and clinical applications of basic research in nanoscience and nanotechnology, and the related concept of an extended "nanotype" to coalesce information related to nanoparticles. We suggest how nanoinformatics could accelerate developments in nanomedicine, similarly to what happened with the Human Genome and other -omics projects, on issues like exchanging modeling and simulation methods and tools, linking toxicity information to clinical and personal databases or developing new approaches for scientific ontologies, among many others.

Personal health informatics. Editorial.

OBJECTIVES: To provide an editorial introduction to the 2012 IMIA Yearbook of Medical Informatics with an overview of its contents and contributors. METHODS: A brief overview of the main theme, and an outline of the purposes, contents, format, and acknowledgment of contributions for the 2012 IMIA Yearbook. RESULTS: This 2012 issue of the IMIA Yearbook highlights important developments in personal health informatics, impacting the activities in research, education and practice in this interdisciplinary field. There has been steady progress towards introducing individualization or personalization into informatics systems by taking advantage of the increasing amounts of personal information that is relevant to medical decisions and application in clinical practice. At the same time, there are serious issues about the limits of existing systems being able to effectively personalize information within both practical and ethical constraints so critical to the practice of medicine. Recent literature bearing on these questions includes the selected papers published during the past 12 months, and articles reported by IMIA Working Groups on these topics. CONCLUSION: Surveys of the main research sub-fields in biomedical informatics in the Yearbook provide an overview of progress and current challenges across the spectrum of the discipline, focusing on the challenges and opportunities involved in personal health informatics.

Serious games in health care: a survey.

OBJECTIVE: to present an overview of existing serious games in healthcare designed for patients, and the evaluation of their effects. Such games, aiming to help patients better understand their condition or treatment, to foster healthy behaviors, or even to participate in therapies, are expected to grow in parallel with the importance of the videogaming industry. METHODS: references were searched in Medline and through recursive browsing of their citations. RESULTS: 21 papers were identified and analyzed. Serious games are used to increase knowledge and control, foster preventive behaviors, or can be used in therapies. Their positive effects on improved patient understanding, adherence, and engagement, although documented mostly in preliminary studies, calls for the development and more thorough evaluation of these tools.

Confluence of disciplines in health informatics: an international perspective.

OBJECTIVE: To discuss international aspects as they relate to the convergence of disciplines in health informatics. METHOD: A group of international experts was invited at a symposium to present and discuss their perspectives on this topic. These have been collated in a single manuscript. RESULTS AND CONCLUSIONS: Significant challenges, as well as opportunities, appear when cumulating the intrinsic multidisciplinary nature of health informatics interventions with the diversity of contexts at the global level, in particular when considered in the perspective of a confluence, i.e., the mixing of different waters and their merging into a new, stronger entity. Health informatics experts reflect on key issues such as collaborative software development and distributed knowledge sourcing, social media and mobile technologies, the evolutions of the discipline from an historical perspective, as well as examples of challenges for implementing ubiquitous healthcare or for supporting disaster situations when infrastructures get disrupted.

Can ICTs contribute to the efficiency and provide equitable access to the health care system in Sub-Saharan Africa? The Mali experience.

OBJECTIVE: The aim of this study is to demonstrate from actual projects that ICT can contribute to the balance of health systems in developing countries and to equitable access to human resources and quality health care service. Our study is focused on two essential elements which are: i) Capacity building and support of health professionals, especially those in isolated areas using telemedicine tools; ii) Strengthening of hospital information systems by taking advantage of full potential offered by open-source software. METHODS: Our research was performed on the activities carried out in Mali and in part through the RAFT (Réseau en Afrique Francophone pour la Télémédecine) Network. We focused mainly on the activities of e-learning, telemedicine, and hospital information systems. These include the use of platforms that work with low Internet connection bandwidth. With regard to information systems, our strategy is mainly focused on the improvement and implementation of open-source tools. RESULTS: Several telemedicine application projects were reviewed including continuing online medical education and the support of isolated health professionals through the usage of innovative tools. This review covers the RAFT project for continuing medical education in French-speaking Africa, the tele-radiology project in Mali, the "EQUI-ResHuS" project for equal access to health over ICT in Mali, The "Pact-e.Santé" project for community health workers in Mali. We also detailed a large-scale experience of an open-source hospital information system implemented in Mali: "Cinz@n". CONCLUSION: We report on successful experiences in the field of telemedicine and on the evaluation by the end-users of the Cinz@n project, a pilot hospital information system in Mali. These reflect the potential of healthcare-ICT for Sub-Saharan African countries.

Medical decision support systems in Africa.

OBJECTIVE: To present an overview of the current state of computer-based medical decision support systems in Africa in the areas of public health, patient care, and consumer support. METHODS: Scientific and gray literature reviews complemented by expert interviews. RESULTS: Various domains of decision support are developed and deployed in Sub-Saharan Africa: public health information systems, clinical decision-support systems, and patient-centred decision-support systems. CONCLUSIONS: Until recently, most of these systems have been deployed by international organizations without a real ownership policy entrusted to the African stakeholders. Many of these endeavours have remained or ceased at the experimentation stage. The multiplicity of organizations has led to the deployment of fragmented systems causing serious interoperability problems. In addition to basic infrastructures, these studies also highlight the importance of good organization, training and support, as key to the success and sustainability of these decision support systems.

Clinical data mining: a review.

OBJECTIVE: Clinical data mining is the application of data mining techniques using clinical data. We review the literature in order to provide a general overview by identifying the status-of-practice and the challenges ahead. METHODS: The nine data mining steps proposed by Fayyad in 1996 [4] were used as the main themes of the review. MEDLINE was used as primary source and 84 papers were retained based on our inclusion criteria. RESULTS: Clinical data mining has three objectives: understanding the clinical data, assist healthcare professionals, and develop a data analysis methodology suitable for medical data. Classification is the most frequently used data mining function with a predominance of the implementation of Bayesian classifiers, neural networks, and SVMs (Support Vector Machines). A myriad of quantitative performance measures were proposed with a predominance of accuracy, sensitivity, specificity, and ROC curves. The latter are usually associated with qualitative evaluation. CONCLUSION: Clinical data mining respects its commitment to extracting new and previously unknown knowledge from clinical databases. More efforts are still needed to obtain a wider acceptance from the healthcare professionals and for generalization of the knowledge and reproducibility of its extraction process: better description of variables, systematic report of algorithm parameters including the method to obtain them, use of easy-to-understand models and comparisons of the efficiency of clinical data mining with traditional statistical analyses. More and more data will be available for data miners and they have to develop new methodologies and infrastructures to analyze the increasingly complex medical data.

From ambient assisted living to global information management: IMIA-referencing publications in 2008.

OBJECTIVE: To give an overview of publications directly referencing the International Medical Informatics Association (IMIA) in 2008. METHOD: Systematic search for references to IMIA over the two official IMIA journals, and reports of the recent IMIA General Assembly and Board meetings, using PubMed/Medline, supplemented by searches with Google Scholar and Google Books. RESULTS: Beyond the IMIA Yearbook 2008, 38 IMIA-referencing publications were found by these searches, encompassing a broad range of topics, ranging from ambient assisted living technologies in home environments to global information management methodologies. CONCLUSIONS: In 2008 IMIA-referencing publications found through both medical and general search engines were predominantly in journals. In years where IMIA's world congress on medical informatics, Medinfo take place, it could be expected that the Medinfo proceedings will also play an important role in referencing IMIA explicitly.