Recurrence of Hypoglycemia in Hospitalized Adult Patients in Non-Critical Areas: An Opportunity to Improve Patient Care Using Electronic Health Records.

Electronic Health Records offer an opportunity to improve patient care (in terms of quality and/or safety) by making available patient health information stored in a single Clinical Data Repository. We aimed to estimate the frequency of hypoglycemic recurrences in hospitalized adult patients in non-critical areas. We designed a cross sectional study with hospitalizations between 2017 and 2018, which included patients with at least one hypoglycemia health record (defined as a value <70 mg/dL, either by capillary glycemic monitoring or serum measurement). Recurrence was defined as those who presented a second event, with at least 2 hours of difference. We included 1884 patients, and 573 presented recurrences, yielding a global prevalence of 30.41% (95%CI 28.34-32.54). Due to the high frequency, it is important to identify vulnerable populations, to implement preventive measures to assist clinicians for decision-making tasks, as a clinical decision support system.

Using Informatics Framework in Immunosuppressed or Transplanted Patients for a Preferential Care Route at the Emergency Department.

For immunosuppressed or transplanted patients, appropriate triage is a timely topic, especially in the Emergency Department (ED) of a high-volume referral center. We implemented a new Program called Rapid Clinical Care by Internal Medicine Specialists, as a preferential care route for these patients, which combines the proposed informatics framework in the field of total quality management in the healthcare units, as an example of digital technologies that can improve processes in the clinical routine. Our study aimed to describe waiting-time and attention-time in ED and to explore the effect on patients' clinical outcomes after discharge. Findings were: shortened waiting time (median of 8 minutes versus 21, p<0.001), improved ED on-call time (median of 2 hours compared to 4, p<0.001), and greater follow-up after discharge, measured as 1-week scheduled-visits rate (69% with 95%CI 63-75; compared to 43% with 95%CI 35-51; p<0.001).

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.

CDSS for Documenting Blood Glycemia Critical Values at the POC.

When a critical blood glucose value is detected, then it is necessary to inform, advice, communicate, act and document it in the patient's medical record. We sought to describe the development of an alert system for glycemia values at the point of care integrated with an EHR, both in desktop and mobile devices.

Autonomic nervous system activation during social cognition tasks in patients with schizophrenia and their unaffected relatives.

OBJECTIVE: The objective of the study was to determine whether patients with schizophrenia and their unaffected first-degree relatives have abnormal autonomic nervous system (ANS) responses to social cognition tasks. BACKGROUND: Social cognition impairments are significant in schizophrenia. ANS activity has been shown to be abnormal in schizophrenia patients, and some of the abnormalities seem to be shared by patients' unaffected relatives. METHOD: Heart rate variability (HRV) was measured at rest and during social cognition tasks, in patients with schizophrenia, their nonpsychotic first-degree relatives, and matched healthy controls (n=19 in each group). RESULTS: Social cognition tasks induced a shortening of the RR interval in unaffected relatives, but not in patients. Social cognition tasks generated decreases in high-frequency (indicating cardiac vagal activity) and low-frequency (reflecting predominantly sympathetic activity) HRV in patients. In relatives, the decrease occurred in the high-frequency component only. Low-frequency HRV was higher in patients during a theory of mind task than a control task. These changes were not observed in the controls. CONCLUSIONS: Social cognitive tasks induce a pattern of peripheral autonomic activity different from that seen in generic arousal responses, and this pattern is abnormal in schizophrenia patients. Autonomic abnormalities in unaffected first-degree relatives seem restricted to the parasympathetic division of the ANS.