Funcionamiento afectivo-motivacional de pacientes prediabéticos y diabéticos / Affective-motivational functioning in prediabetic and diabetic patients

Fundamento: El funcionamiento afectivo-motivacional influye en el control de las enfermedades crónicas y en la actitud que asumen los enfermos ante la enfermedad. Objetivo: Caracterizar las particularidades afectivo-motivacionales que diferencian la regulación del comportamiento en pacientes prediabéticos y diabéticos crónicos. Metodología: Se utilizó un paradigma mixto de investigación, con diseño exploratorio secuencial. La muestra quedó conformada por un total de 20 sujetos, distribuidos en dos grupos: uno integrado por pacientes prediabéticos y el otro por pacientes diabéticos. Se aplicó el RAMDI (S), la escala Dembo - Rubinstein, el test de completamiento de frases, la técnica de la composición. Resultados: Se revelaron diferencias afectivo-motivacionales entre ambos grupos, expresadas en la concientización o no de la enfermedad y la consecuente regulación del comportamiento. Predominó una tendencia a la sobrevaloración en la variable salud, en los pacientes prediabéticos y subvaloración en los pacientes diabéticos. Conclusiones: Los sujetos prediabéticos no se reconocen como enfermos, no valoran los riesgos que contraen con su condición y no se comprometen con un cambio de estilo de vida. El grupo de pacientes diabéticos se caracterizó por expresar conciencia de la enfermedad, compromiso afectivo y elaboración personal, como procesos que facilitan la regulación de su comportamiento.

Background: Affective-motivational functioning affects the control over chronic diseases and the attitudes that patients assume towards the disease. Objective: To characterize the affective-motivational specificities that distinguish behavioral adaptations in prediabetic and chronic diabetic patients. Methods: A mixed research paradigm was applied, with a sequential exploratory design. The sample was composed by a total number of 20 patients, distributed in two groups: one composed by prediabetic patients and the other by diabetic ones. The RAMDI (S), the Dembo-Rubinstein Scale, and the Sentence Completion Test were applied, the Composition Technique. Results: Affective-motivational differences between the two groups were detected, manifested in the consciousness or not of the disease and consequent behavior regulation. A tendency to overestimate the health variable prediabetic patients and underestimate diabetic patients prevailed. Conclusions: Prediabetic patients do not recognize themselves as sick, do not value the risks they take with their status and do not engage in a lifestyle change. The diabetic patient group was characterized by expressing disease self-consciousness, affective compromise and personal development, as the processes that facilitate the adjustment of their behavior.

Atuação da terapia ocupacional no treino de atividade de vida diária com pacientes acometidos pela COVID-19 em enfermarias de um hospital universitário / Occupational Therapy intervention in the training of activities of daily living with patients affected by COVID-19 in inpatient units of a university hospital

Resumo Introdução A Covid-19 acarreta comprometimentos multissistêmicos, ocasionando prejuízos funcionais, principalmente voltados às Atividades de Vida Diária (AVDs), sendo imprescindível a atuação do terapeuta ocupacional no processo de reabilitação. Objetivo Analisar a proporção de treino de AVDs e as principais atividades treinadas com pacientes com Covid-19. Método Trata-se de um estudo documental realizado em um hospital universitário da região sudeste do Brasil. Foram analisados registros da terapia ocupacional em prontuário eletrônico de pacientes internados em enfermarias de Covid-19, entre junho de 2020 e janeiro de 2021. Resultados A prevalência de atendimentos terapêuticos ocupacionais foi de 53,1%. Os pacientes atendidos estavam restritos ao leito, com maior dependência para as AVDs e mais tempo de hospitalização. Foram realizados 413 atendimentos no total, sendo que a média por paciente foi de três, o mínimo de um e o máximo de 15. A proporção do treino de AVDs foi de 76,9%. As AVDs mais treinadas foram alimentação (96,8%), higiene pessoal (93,9%) e mobilidade funcional (59,8%). Conclusão O desenvolvimento deste estudo promoveu a discussão da análise multidimensional cuidadosa, realizada por terapeutas ocupacionais para efetuar o treino de AVDs com pacientes diagnosticados com Covid-19, internados em enfermarias. Ademais, trouxe resultados importantes relacionados ao perfil dos pacientes atendidos, às proporções das intervenções voltadas ao treino de AVDs e aos elementos que nortearam essa prática.

Abstract Introduction COVID-19 causes multisystemic compromises, resulting in functional impairments, mainly related to the Activities of Daily Living (ADLs). Therefore, the occupational therapist is one of the professionals needed to favor the rehabilitation process. Objective To analyze the proportion of ADLs training and the main activities that were trained with patients with COVID-19. Method This is a documental study developed in a teaching hospital in the southeast region of Brazil. Occupational therapy records were analyzed in electronic medical records of patients admitted to COVID-19 infirmaries between June 2020 and January 2021. Results The prevalence of occupational therapy attendances was 53.1%. The patients who were prioritized were those restricted to bed, with worse functionality and longer hospital stay. In all, 413 attendances were performed; the average per patient was three, the minimum was one, and the maximum was 15. The proportion of ADLs training was 76.9%. The most trained activities in the infirmaries by the occupational therapy team were feeding (96.8%), personal hygiene (93.9%), and functional mobility (59.8%). Conclusion The development of this study promoted the discussion of the careful multidimensional analysis performed by occupational therapists to carry out ADLs training with patients diagnosed with Covid-19 hospitalized in wards. Furthermore, it brought important results related to the profile of the patients seen, the proportions of interventions aimed at ADLs training and the elements that guided this practice.

Fatores associados ao registro da alimentação infantil e intercorrências clínicas na Caderneta da Criança / Factors associated with the registration of infant feeding and clinical complications in the Children's Handbook

RESUMO Este artigo teve como objetivo analisar os fatores associados ao registro da alimentação infantil e intercorrências clínicas na caderneta de crianças menores de 3 anos, residentes em João Pessoa, Paraíba, Brasil. Trata-se de um estudo transversal, realizado com 424 cadernetas de crianças menores de 3 anos, cadastradas em Unidades de Saúde da Família de João Pessoa, Paraíba. Os dados foram coletados no período de maio a novembro de 2019 e analisados a partir da estatística descritiva e inferencial, com os testes Quiquadrado e Exato de Fisher. Constatou-se que apenas 1,9% das cadernetas analisadas apresentavam dados relacionados com a alimentação e que 0,9% tinha registrado algum dado acerca das intercorrências clínicas da criança. Ademais, as características sociodemográficas dos responsáveis/cuidadores e das crianças não apresentaram associação estatística significativa com os registros da alimentação e das intercorrências clínicas na Caderneta da Criança. Conclui-se que é precário o registro sobre alimentação infantil e intercorrências clínicas na Caderneta da Criança. Esta realidade representa uma lacuna à continuidade do cuidado à criança e poderá prejudicar os esforços para a redução da morbimortalidade infantil.

ABSTRACT This article aims to analyze the factors associated with the registration of infant feeding and clinical complications in the handbook of children under three years of age living in João Pessoa, Paraíba, Brazil. This is a cross-sectional study, carried out with 424 handbooks of children under three years old registered in Family Health Units in João Pessoa, Paraíba. Data were collected from May to November 2019 and were analyzed using descriptive and inferential statistics, using Chi-square and Fisher's Exact tests. In this investigation, it was found that only 1.9% of the handbooks analyzed had data related to food and 0.9% had recorded some data about the child's clinical complications. Furthermore, the sociodemographic characteristics of those guardians/caregivers and the children did not present a statistically significant association with the records of food and clinical complications in the Child's Handbook. It is concluded that the record on infant feeding and clinical complications in the Child's Handbook is precarious. This reality represents a gap in the continuity of child care and may hamper efforts to reduce child morbidity and mortality.

Barriers and facilitators to the use of personal information documents in health and social care settings for people living with dementia: A thematic synthesis and mapping to the COM-B framework.

INTRODUCTION: People living with dementia experience communication difficulties. Personal information documents, or healthcare passports, enable communication of information essential for the care of a person with dementia. Despite the potential for providing person-centred care, personal information documents are not ubiquitously used. The Capability Opportunity Motivation-Behaviour (COM-B) model can be used to understand factors determining individuals' behaviours. OBJECTIVES: This study aimed to identify the barriers to and facilitators of the use of healthcare passports for people living with dementia through a systematic review methodology. METHODS: A systematic search of six electronic databases was undertaken. Grey literature was searched using three databases. All study types reporting barriers to or facilitators of the use of personal information documents in the care of adults living with dementia in high-income countries were included. Study quality was assessed using the NICE Quality Appraisal Checklist. Thematic synthesis was used to develop descriptive themes, which were subsequently mapped to the COM-B framework. RESULTS: Nineteen papers were included. Themes included training, awareness, embedding the process in norms and appreciating the value of the personal information documents. A broad range of barriers and facilitators was identified within each COM-B domain. CONCLUSION: This framework provides a starting point for evidence-informed initiatives to improve the use of personal information documents in the care of people with dementia. PATIENT AND PUBLIC CONTRIBUTION: This is a review of studies and did not involve patients or the public. Review results will guide evaluation of a local personal information document, which will be designed with input from the Dementia Champions Network (includes carers and other stakeholders).

Percepção e utilização da Caderneta da Criança por profissionais e mães: uma abordagem interacionista / Perception and use of the Child's Health Handbook by professionals and mothers: an interactionist approach

RESUMO Objetivo compreender a percepção dos profissionais de saúde e das mães sobre a Caderneta da Criança. Métodos estudo qualitativo, desenvolvido em Unidades de Saúde da Família, com 25 profissionais e 11 mães de crianças menores de três anos por meio de entrevista semiestruturada. O material empírico foi submetido à Análise Temática Indutiva e interpretado à luz do Interacionismo Simbólico. Resultados a Caderneta da Criança foi percebida como ferramenta multiprofissional e intersetorial que possibilita a continuidade do cuidado, norteia a conduta do profissional e o cuidado à criança pela família. Contudo, ainda foi vista como cartão de vacinação. Quanto à utilização, foram mencionadas fragilidades durante a visita domiciliar e nos registros dos profissionais. Além disso, as mães a utilizavam apenas quando levavam a criança ao serviço de saúde. Conclusão os profissionais e as mães apresentaram opiniões distintas sobre a Caderneta da Criança. Alguns a perceberam como uma extensão do prontuário e outros como ferramenta similar ao cartão da criança, sendo utilizada por profissionais específicos e em momentos pontuais. Contribuições para a prática os dados revelam significados e percepções da equipe de saúde e mães sobre a Caderneta da Criança e sua utilização, trazendo contribuições para o conhecimento científico sobre o tema.

ABSTRACT Objective to understand the perception of health professionals and mothers about the Children's Handbook. Methods qualitative study, developed in Family Health Units, with 25 professionals and 11 mothers of children under three years old by means of semi-structured interviews. The empirical material was submitted to Inductive Thematic Analysis and interpreted in the light of Symbolic Interactionism. Results Child Health Handbook was seen as a multi-professional and intersectoral tool that allows continuity of care, guides the professional's conduct and the care of the child's family. However, it was still seen as a vaccination card. As for use, weaknesses were mentioned during home visits and in professionals' records. In addition, mothers only used it when they took the child to the health service. Conclusion professionals and mothers presented distinct opinions about the Child Health Notebook. Some considered it as an extension of the medical record and others as a tool like the child's card, being used by specific professionals and at specific times. Contributions to practice the data reveal meanings and perceptions of the health team and mothers about the Child's Health Handbook and its use, bringing contributions to the scientific knowledge on the subject.

Situação vacinal de crianças cadastradas em equipes de saúde da família / Vaccine situation of children registered in family health teams / Situación de vacunas de niños matriculados en los equipos de salud familiar

Objetivo: analisar a situação vacinal de crianças menores de três anos, cadastradas em Equipes de Saúde da Família. Método: estudo transversal, realizado em Unidades de Saúde da Família de João Pessoa, Paraíba, Brasil, com 424 cadernetas de crianças menores de três anos. Os dados foram coletados entre maio e novembro de 2019, com o auxílio de um instrumento elaborado conforme Caderneta da Criança, e analisados por estatística descritiva e inferencial. Resultados: 295 (69,6%) cadernetas estavam atualizadas conforme idade da criança, com maior porcentagem de atraso 58 (40%) nas cadernetas de crianças entre 12 e 23 meses. As vacinas mais registradas foram BCG e Hepatite B. Crianças do sexo masculino e entre 12 e 23 meses apresentaram associação significante com atualização vacinal. Conclusão: a cobertura vacinal está abaixo do recomendado, sendo necessárias campanhas de orientação a população para melhor adesão as vacinas e busca ativa de crianças com atraso vacinal.

Objective: to analyze the vaccination status of children under three years old, registered in Family Health Teams. Method: cross-sectional study carried out in Family Health Units in João Pessoa, Paraíba, Brazil, with 424 booklets for children under three years of age. Data were collected between May and November 2019, with the help of an instrument prepared according to the Child Handbook, and analyzed using descriptive and inferential statistics. Results: 295 (69,6%) booklets were updated according to the child's age, with a higher percentage of delay 58 (40%) in the booklets of children between 12 and 23 months. The most registered vaccines were BCG and Hepatitis B. Male children aged between 12 and 23 months showed a significant association with vaccination update. Conclusion: vaccination coverage is below what is recommended, and campaigns are needed to guide the population for better adherence to vaccines and an active search for children with delayed vaccinations.

Objetivo: analizar el estado de vacunación de los niños menores de tres años, registrados en los Equipos de Salud de la Familia. Método: estudio transversal realizado en Unidades de Salud de la Familia en João Pessoa, Paraíba, Brasil, con 424 folletos para niños menores de tres años. Los datos fueron recolectados entre mayo y noviembre de 2019, con la ayuda de un instrumento elaborado según el Manual del Niño, y analizados mediante estadística descriptiva e inferencial. Resultados: 295 (69,6%) cuadernillos se actualizaron según la edad del niño, con mayor porcentaje de atraso 58 (40%) en los cuadernillos de niños entre 12 y 23 meses. Las vacunas más registradas fueron BCG y Hepatitis B. Los niños varones de entre 12 y 23 meses mostraron una asociación significativa con la actualización de la vacunación. Conclusión: la cobertura de vacunación está por debajo de lo recomendado, y se necesitan campañas que orienten a la población para una mejor adherencia a las vacunas y una búsqueda activa de niños con vacunación tardía.

Uso da caderneta de saúde da criança no acompanhamento do crescimento ­ uma revisão de escopo / Use of the child health booklet in growth monitoring ­ a scoping review

O Ministério da Saúde prevê a disponibilização da Caderneta de Saúde da Criança (CSC) desde 2005 a todas as crianças nascidas no Brasil. Trata-se de uma ferramenta centralizadora para a atenção integral da saúde na infância e, portanto, de um instrumento valioso para o acompanhamento do crescimento das crianças. O registro correto e completo das informações é requisito básico para que a CSC cumpra seu papel estratégico. Elegemos a revisão de escopo com o objetivo de discutir os estudos primários que analisaram quantitativamente o preenchimento dos dados sobre crescimento na CSC. A pesquisa foi realizada nas bases de dados MEDLINE, LILACS, SciELO e na Biblioteca Virtual em Saúde usando os descritores "Saúde da criança"e "Registros de saúde pessoal" (em inglês, "Child Health" e "Health Records, Personal"). Além disso, foi usada a palavra-chave "Caderneta de Saúde da Criança. Foram identificados 191 trabalhos, sendo 15 artigos elegíveis para esta revisão. Os estudos observaram registro insatisfatório dos dados sobre o crescimento na CSC. O preenchimento dos gráficos de peso por idade variou entre 8,9% e 96,3%, por exemplo, revelando fragilidade no uso desse instrumento e necessidade de melhora dos registros no acompanhamento do crescimento das crianças.

The Ministry of Health has made the Caderneta de Saúde da Criança (CSC), a child health booklet, available to all children born in Brazil, since 2005. It is a strategic tool for comprehensive child health care, a valuable instrument for registering and monitoring growth. The correct and complete registration of this information is a basic requirement for the CSC to fulfill itsrole. We chose the scoping review in order to discuss primary studies that quantitatively analyze the filling in of data on growth in the CSC. The research was carried out in the databases MEDLINE, LILACS, SciELO, and in the Biblioteca Virtual em Saúde, using the descriptors in Portuguese: "Saúde da Criança" and "Registros de saúde pessoal"; in English: "Child Health" and "Health Records, Personal"; and, in addition, the keyword "Caderneta de Saúde da Criança" was also used. A total of 191 papers were identified, 15 of which were eligible for this review. The studies observed an unsatisfactory filling in of data on the growth of CSC. Completion of weight-for-age charts ranged between 8.9% and 96.3%, for example, revealing weaknesses in the use of this instrument and the need to improve records in monitoring the growth of children.

Arquitectura de información para la gestión de la historia clínica de psiquiatría / Information architecture for the management of psychiatry medical record

RESUMEN Introducción: la historia clínica de psiquiatría recoge el informe de salud del paciente y su entorno social. Sin embargo, en su formato de papel enfrenta diversas dificultades, como su deterioro o pérdida, la redacción en ocasiones, con una escritura pobre, ilegible e incompleta que dificulta la interpretación del mensaje, además de que solo puede contribuir de forma pasiva a la toma de decisiones. Objetivo: diseñar la arquitectura de información para la gestión de la historia clínica de psiquiatría, del Hospital Psiquiátrico Provincial "Dr. Isidro de Armas". Métodos: se realizó una investigación de desarrollo tecnológico sobre la gestión de la información de la historia clínica del Hospital Psiquiátrico, según la metodología ágil de desarrollo de software para programación extrema, y la aplicación de métodos teóricos y empíricos para el análisis, revisión y modelación de los procesos objetos de informatización. Resultados: como producto final, se desarrolló la arquitectura de información para la gestión de la historia clínica en psiquiatría, a partir de la cual se elaboró el prototipo de la aplicación informática, el cual facilitó el análisis con los especialistas en psiquiatría de las funcionalidades propuestas y de la organización, disposición y estructuración de la información de la historia clínica. Conclusión: el prototipo elaborado permitirá a los programadores implementar la aplicación informática que contribuirá, en el futuro, al desarrollo del proceso y la toma de decisiones como resultado de la gestión de la información que se genera. Con gran impacto social para las entidades psiquiátricas donde se instaure.

ABSTRACT Introduction: the psychiatric medical record collects the health report of the patient and his social environment. However; the paper format faces several difficulties, such as its deterioration or loss and, sometimes, with a poor, illegible and incomplete writing that hinders the interpretation of the message, in addition to the fact that it can only contribute passively to decision making. Taking into account this difficulty and the need for psychiatry specialists to be able to know immediately the medical procedures received by the patient, in each episode of his/her illness, it was decided to develop a computer tool for such purposes. Objective: to design the information architecture for the management of the psychiatric clinical history at Dr. Isidro de Armas Provincial Psychiatric Hospital. Methods: a technological development research was carried out on the information management of the clinical history of the Psychiatric Hospital, following the agile methodology of software development for extreme programming, and applying theoretical and empirical methods for the analysis, review and modeling of the processes to be computerized. Results: as a final product, the information architecture for the management of psychiatric medical records was developed, from which the prototype of a computer application was developed, which facilitated the analysis with psychiatric specialists of the proposed functions and of the organization, arrangement and structuring of the medical records information. Conclusions: the prototype developed will allow the programmers to implement the computer application that will contribute, in the future, to the development of the process and decision making as a result of the management of the information generated. Having great social impact for the Psychiatric entities where it is implemented, with benefits for both patients and healthcare professionals. The implementation of an Information Technology tool is a strategic decision that can simplify the work, as well as to contribute to the optimization of time, organization, management and security.

Arquitectura de información para la gestión de la historia clínica digital en oftalmopediatría / Information architecture for the management of computerized medical records for pediatric-ophthalmological specialty

RESUMEN Introducción: la Historia Clínica es un instrumento que contiene la información del paciente que debe ser procesable, almacenada y trasmitida de forma segura y accesible, por lo que resulta necesario el empleo de recursos y estrategias para facilitar el cuidado de la salud, entre las que puede figurar un software. Objetivo: desarrollar la arquitectura de información para la gestión de una historia clínica electrónica para uso en la consulta de Oftalmopediatría del Hospital Pediátrico Provincial Docente "Pepe Portilla" de Pinar del Río. Métodos: estudio cuali-cuantitativo, con métodos teóricos y empíricos para analizar la evolución y desarrollo de la historia clínica de Oftalmopediatría, caracterizar la situación actual, así como la introducción de las tecnologías de la información y las comunicaciones en esta disciplina en Cuba. Resultados: se creó un prototipo de software de gestión de historia clínica electrónica en Oftalmopediatría, con un gran impacto social para las entidades donde se implemente el sistema, que beneficia tanto al paciente como a los profesionales. Conclusión: la implementación de una herramienta informática es una decisión estratégica que puede simplificar el trabajo, optimizar tiempo, recursos, y mejorar en organización, gestión y seguridad.

ABSTRACT Introduction: the Medical History is a tool that contains the information of patients, which should able to be processed, stored and transmitted in a safe and accessible way, thus it is necessary to use resources and strategies to facilitate healthcare services, among which software designs can be included. Objective: to develop the information architecture for the management of an computerized medical record to be used in the Pediatric Ophthalmology Office at Pepe Portilla Provincial Pediatric Teaching Hospital in Pinar del Rio. Methods: a qualitative-quantitative study was conducted, applying theoretical and empirical methods to analyze the evolution and development of a pediatric-ophthalmological history, to characterize the current situation, as well as the introduction of information and communication technologies into this specialty in Cuba. Results: the design of a prototype of software for the management of a computerized medical record in the Pediatric Ophthalmology Office, with a great social impact for the healthcare institutions where the system is implemented, which benefit both the patient and the professionals. Conclusion: the implementation of a computerized tool is a strategic decision that can simplify work, optimize time and resources, improving organizational process, management and safety.

Construção de ferramenta computacional para auxiliar a coordenação do cuidado pelos serviços de atenção básica / Construcción de herramienta computacional para ayudar a la coordinación del cuidado por parte de los servicios de cuidado básico / Design of a computer tool to assist in care coordination by the primary care services

RESUMO Objetivo: construir um prontuário eletrônico no formato de aplicativo para os serviços de atenção básica. Método: estudo metodológico que apresenta o processo de construção de uma ferramenta tecnológica no formato de aplicativo. A construção do aplicativo deu-se em três etapas: a) construção de uma revisão integrativa sobre o tema; b) desenvolvimento das variáveis e estabelecimento do padrão de respostas utilizando os achados da revisão integrativa, a Resolução do Conselho Federal de Medicina nº 1.638 de 2002 e o Manual de uso do sistema com prontuário eletrônico do cidadão (PEC); e c) construção propriamente dita do prontuário eletrônico no formato de aplicativo. Para a construção do aplicativo, foi usado o programa NetBeans e a linguagem Java. Resultados: o prontuário eletrônico construído conta com princípios básicos: cadastro do país, estado, cidade, distrito sanitário, unidade básica de saúde, bairro, rua/avenida, residência uni ou multifamiliar e identificação do morador/família, além de possibilitar a notificação de doenças e vacinas dos usuários. Conclusões: o modelo de prontuário eletrônico aqui apresentado, no formato de aplicativo, pode ser modificado de acordo com a necessidade de cada comunidade, bem como facilitar e tornar mais efetivo o trabalho do profissional de saúde, à medida que pode gerar relatórios de atendimentos nos diferentes pontos de atenção, agilizando o atendimento e a prestação de um cuidado longitudinal e individualizado.

RESUMEN Objetivo: construir una historia clínica electrónica en formato de aplicación para los servicios de atención primaria. Método: estudio metodológico que presenta el proceso de construcción de una herramienta tecnológica en el formato de aplicación. La construcción de la aplicación se realizó en tres etapas: a) construcción de una revisión integradora sobre el tema; b) desarrollo de las variables y establecimiento del estándar de respuestas utilizando los hallazgos de la revisión integradora, la Resolución del Consejo Federal de Medicina No. 1.638 de 2002 y el Manual de uso del sistema con la historia clínica electrónica del ciudadano; y c) la construcción real de la historia clínica electrónica en el formato de aplicación. Para la construcción de la aplicación se utilizó el programa NetBeans y el lenguaje Java. Resultados: la historia clínica electrónica construida tiene principios básicos: registro del país, estado, ciudad, distrito de salud, unidad básica de salud, barrio, calle / avenida, residencia unifamiliar o multifamiliar e identificación del residente / familia, además de permitir la notificación de las enfermedades y vacunas de los usuarios. Conclusiones: el modelo de historia clínica electrónica que aquí se presenta, en forma de aplicación, puede ser modificado según las necesidades de cada comunidad, además de facilitar y hacer más efectivo el trabajo del profesional de la salud, ya que puede generar informes en los diferentes puntos de atención, agilizando el servicio y brindando atención longitudinal e individualizada.

ABSTRACT Objective: to design an electronic medical chart in the app format for the primary care services. Method: a methodological study that presented the process of designing a technological tool in the app format. The design of the app occurred in the three stages: a) elaboration of an integrative review on the theme; b) development of the variables and establishment of the response pattern using the findings of the integrative review, Resolution No. 1,638, of 2002, of the Federal Medical Council, and the Manual for using the system with the Citizen's electronic medical chart (Prontuário Eletrônico do Cidadão, PEC); and c) design of the electronic medical chart in the app format. The NetBeans program and Java language were used to design the app. Results: the electronic medical chart designed has the following basic principles: registration of the country, state, city, health district, primary health unit, neighborhood, street/avenue, uni- or multi-family residence and identification of the resident/family, in addition to enabling the notification of users' diseases and vaccines. Conclusions: the electronic medical chart model herein presented, in the app format, can be modified according to the needs of each community, as well as facilitate and make the health professional's work more effective, as it can generate appointment reports in different care points, speeding up assistance and the provision of longitudinal and individualized care.

Patients' Adoption of Electronic Personal Health Records in England: Secondary Data Analysis.

BACKGROUND: In England, almost all general practices (GPs) have implemented GP online services such as electronic personal health records (ePHRs) that allow people to schedule appointments, request repeat prescriptions, and access parts of their medical records. The overall adoption rate of GP online services has been low, reaching just 28% in October 2019. In a previous study, Abd-Alrazaq et al adopted a model to assess the factors that influence patients' use of GP online services in England. According to the previous literature, the predictive power of the Abd-Alrazaq model could be improved by proposing new associations between the existing variables in the model. OBJECTIVE: This study aims to improve the predictive power of the Abd-Alrazaq model by proposing new relationships between the existing variables in the model. METHODS: The Abd-Alrazaq model was amended by proposing new direct, mediating, moderating, and moderated mediating effects. The amended model was examined using data from a previous study, which were collected by a cross-sectional survey of a convenience sample of 4 GPs in West Yorkshire, England. Structural equation modeling was used to examine the theoretical model and hypotheses. RESULTS: The new model accounted for 53% of the variance in performance expectancy (PE), 76% of the variance in behavioral intention (BI), and 49% of the variance in use behavior (UB). In addition to the significant associations found in the previous study, this study found that social influence (SI) and facilitating conditions (FCs) are associated with PE directly and BI indirectly through PE. The association between BI and UB was stronger for younger women with higher levels of education, income, and internet access. The indirect effects of effort expectancy (EE), perceived privacy and security (PPS), and SI on BI were statistically stronger for women without internet access, patients with internet access, and patients without internet access, respectively. The indirect effect of PPS on BI was stronger for patients with college education or diploma than for those with secondary school education and lower, whereas the indirect effect of EE on BI was stronger for patients with secondary school education or lower than for those with college education or a diploma. CONCLUSIONS: The predictive power of the Abd-Alrazaq model improved by virtue of new significant associations that were not examined before in the context of ePHRs. Further studies are required to validate the new model in different contexts and to improve its predictive power by proposing new variables. The influential factors found in this study should be considered to improve patients' use of ePHRs.

Metrics for Outpatient Portal Use Based on Log File Analysis: Algorithm Development.

BACKGROUND: Web-based outpatient portals help patients engage in the management of their health by allowing them to access their medical information, schedule appointments, track their medications, and communicate with their physicians and care team members. Initial studies have shown that portal adoption positively affects health outcomes; however, early studies typically relied on survey data. Using data from health portal applications, we conducted systematic assessments of patients' use of an outpatient portal to examine how patients engage with the tool. OBJECTIVE: This study aimed to document the functionality of an outpatient portal in the context of outpatient care by mining portal usage data and to provide insights into how patients use this tool. METHODS: Using audit log files from the outpatient portal associated with the electronic health record system implemented at a large multihospital academic medical center, we investigated the behavioral traces of a study population of 2607 patients who used the portal between July 2015 and February 2019. Patient portal use was defined as having an active account and having accessed any portal function more than once during the study time frame. RESULTS: Through our analysis of audit log file data of the number and type of user interactions, we developed a taxonomy of functions and actions and computed analytic metrics, including frequency and comprehensiveness of use. We additionally documented the computational steps required to diagnose artifactual data and arrive at valid usage metrics. Of the 2607 patients in our sample, 2511 were active users of the patients portal where the median number of sessions was 94 (IQR 207). Function use was comprehensive at the patient level, while each session was instead limited to the use of one specific function. Only 17.45% (78,787/451,762) of the sessions were linked to activities involving more than one portal function. CONCLUSIONS: In discussing the full methodological choices made in our analysis, we hope to promote the replicability of our study at other institutions and contribute to the establishment of best practices that can facilitate the adoption of behavioral metrics that enable the measurement of patient engagement based on the outpatient portal use.

Qualidade dos registros da assistência pré-natal na caderneta da gestante / Calidad de los recordados de cuidado prenatal en el cuaderno de la mujer pregnant / Quality of the prenatal care records in the pregnant women's booklet

Objetivo avaliar a qualidade dos registros na caderneta da gestante averiguando a legibilidade e completude dos registros da assistência pré-natal de risco habitual. Método estudo avaliativo, descritivo e quantitativo, realizado em nove unidades de saúde da atenção básica em São Luís, Maranhão, Brasil, no período de maio de 2017 a setembro de 2018. Os registros foram avaliados quanto à legibilidade e completude. Resultados 92,4% das cadernetas foram consideradas com registros legíveis. A avaliação da completude evidenciou que 72,4% apresentaram completude ruim. Nenhuma caderneta foi classificada com registro bom ou excelente. A avaliação por seções demonstrou que a seção de Exames Complementares de Rotina apresentou os melhores resultados, enquanto a seção de Atividades Complementares apresentou os menores níveis de completude. Conclusão os registros nas cadernetas da gestante foram predominantemente ruins, denotando uma desvalorização desse instrumento e um provável descumprimento das recomendações do Ministério da Saúde para uma assistência de qualidade.

Objetivo evaluar la calidad de los registros en la cartilla de las mujeres embarazadas, evaluando la legibilidad y la integridad de los registros de control prenatal de riesgo habitual. Método estudio evaluativo, descriptivo y cuantitativo, realizado en nueve unidades de atención básica en salud en São Luís, Maranhão, Brasil, en el período de mayo de 2017 a septiembre de 2018. Los registros fueron evaluados en cuanto a la legibilidad y la integridad. Resultados el 92,4% de las cartillas fueron consideradas con registros legibles. La evaluación de la integridad mostró que el 72,4% tenía mala integridad. Ningún registro de la cartilla fue clasificado como bueno o excelente. La evaluación por secciones mostró que la sección de Exámenes Complementarios de Rutina obtuvo los mejores resultados, mientras que la sección de Actividades Complementarias obtuvo los niveles más bajos de la integridad. Conclusión los registros de la cartilla de mujeres embarazadas eran, en su mayoría, pobres, denotando una devaluación de este instrumento y un probable incumplimiento de las recomendaciones del Ministerio de Salud para una asistencia de calidad.

Objective to evaluate the quality of the records in the pregnant women's booklet, assessing the legibility and completeness of usual-risk pre-natal records. Method evaluative, descriptive and quantitative study, conducted in nine basic health care units in São Luís, Maranhão, Brazil, in the period from May 2017 to September 2018. The records were evaluated according to legibility and completeness. Results 92.4% of the booklets were considered with legible records. The assessment of the completeness showed that 72.4% had bad completeness. No record booklet was classified as good or excellent. The assessment by sections showed that the Routine Complementary Test section showed the best results, whereas the Complementary Activities section showed the lowest levels of completeness. Conclusion the records in the pregnant women's booklet were predominantly bad, denoting a devaluation of this instrument and a probable noncompliance with the recommendations of the Ministry of Health for a quality assistance.

Determinants and outcomes of patient access to medical records: Systematic review of systematic reviews.

BACKGROUND: Patient access to electronic health records (EHRs) is associated with several determinants and outcomes, which are interrelated. However, individual studies and the reviews summarizing them have only addressed particular aspects, such as policy, usability or health outcomes of adoption. Therefore, no comprehensive overview exists. Additionally, reviews used different theoretical frameworks, which makes results difficult to compare. OBJECTIVE: We aimed to systematically review recent systematic reviews on determinants and outcomes of patient access to EHRs to create a comprehensive overview and inform policy-makers and EHR implementers about the available literature, and to identify knowledge gaps in the literature reviews. METHODS: We searched MEDLINE, EMBASE and PsycINFO for systematic reviews on patient portals, personal health records, and patient access to records that addressed determinants and outcomes of adoption. We synthesized the results from these reviews into the Clinical Adoption Framework (CAF), by mapping quotes from the reviews to categories and dimensions of the CAF, starting with the most recent ones until saturation of the CAF had been reached. The risk of bias in the reviews was assessed using the AMSTAR2 checklist. RESULTS: We included nineteen reviews from 8871 records that were retrieved until February 19th, 2018. The reviews had a median of 4 (IQR: 4-4) critical flaws according to the AMSTAR2 checklist. The reviews contained a total of 1054 quotes that were mapped to the CAF. All reviews reported on the dimension 'People' that can affect adoption (e.g. personal characteristics such as age) and the dimension 'HIS use' (health information system use). Most reviews reported the dimensions 'Organisation', 'Implementation', HIS 'System quality', and outcomes of HIS use. However, gaps in knowledge might exist on macro-level determinants and outcomes, such as healthcare standards, funding, and incentives, because few reviews addressed these aspects. CONCLUSIONS: No review covered all aspects of the CAF and there was a large variety in aspects that were addressed, but all dimensions of the CAF were addressed by at least two reviews. Although reviews had critical flaws according to the AMSTAR2 checklist, almost half of the reviews did use methods to assess bias in primary studies. Implementers can use the synthesized results from this study as a reference for implementation and development when taking quality restrictions into account. Researchers should address the risk of bias in primary studies in future reviews and use a framework such as CAF to make results more comparable and reusable.

Factors Affecting Patients' Use of Electronic Personal Health Records in England: Cross-Sectional Study.

BACKGROUND: Electronic personal health records (ePHRs) are secure Web-based tools that enable individuals to access, manage, and share their medical records. England recently introduced a nationwide ePHR called Patient Online. As with ePHRs in other countries, adoption rates of Patient Online remain low. Understanding factors affecting patients' ePHR use is important to increase adoption rates and improve the implementation success of ePHRs. OBJECTIVE: This study aimed to examine factors associated with patients' use of ePHRs in England. METHODS: The unified theory of acceptance and use of technology was adapted to the use of ePHRs. To empirically examine the adapted model, a cross-sectional survey of a convenience sample was carried out in 4 general practices in West Yorkshire, England. Factors associated with the use of ePHRs were explored using structural equation modeling. RESULTS: Of 800 eligible patients invited to take part in the survey, 624 (78.0%) returned a valid questionnaire. Behavioral intention (BI) was significantly influenced by performance expectancy (PE; beta=.57, P<.001), effort expectancy (EE; beta=.16, P<.001), and perceived privacy and security (PPS; beta=.24, P<.001). The path from social influence to BI was not significant (beta=.03, P=.18). Facilitating conditions (FC) and BI significantly influenced use behavior (UB; beta=.25, P<.001 and beta=.53, P<.001, respectively). PE significantly mediated the effect of EE and PPS on BI (beta=.19, P<.001 and beta=.28, P=.001, respectively). Age significantly moderated 3 paths: PE→BI, EE→BI, and FC→UB. Sex significantly moderated only the relationship between PE and BI. A total of 2 paths were significantly moderated by education and internet access: EE→BI and FC→UB. Income moderated the relationship between FC and UB. The adapted model accounted for 51% of the variance in PE, 76% of the variance in BI, and 48% of the variance in UB. CONCLUSIONS: This study identified the main factors that affect patients' use of ePHRs in England, which should be taken into account for the successful implementation of these systems. For example, developers of ePHRs should involve patients in the process of designing the system to consider functions and features that fit patients' preferences and skills to ensure systems are useful and easy to use. The proposed model accounted for 48% of the variance in UB, indicating the existence of other, as yet unidentified, factors that influence the adoption of ePHRs. Future studies should confirm the effect of the factors included in this model and identify additional factors.

[Use of Electronic Medical Records for Research: New Ethical Challenges and Possible Solutions]. / Uso dos Registos Clínicos Eletrónicos para Investigação: Novos Desafios Éticos e Soluções Possíveis.

Some clinicians feel that Ethics Committees act as a blockade to observational clinical studies. In the case of retrospective studies some have tried to solve this problem by reducing this sensitive data to simple administrative data in the hands of the government. Others see the new European General Data Protection Regulation 2016/679 (European Union) as being more liberal than the Portuguese Law nº 21/2014, April 16th (Clinical Research Law). Both solutions presume participant consent from his / her silence, even if nobody truly tried to specifically inform him / her. Such views do collide with the guarantees of protection of patient's ethical rights. In this article we propose an ethical alternative to those positions.

Alguns investigadores entendem que as Comissões de Ética para a Saúde são um bloqueio aos estudos clínicos observacionais. No que toca aos estudos retrospetivos há quem proponha resolver este problema tratando os Dados Pessoais de Saúde como dados administrativos simples na posse do Estado e há quem interprete o novo Regulamento Geral de Proteção de Dados (União Europeia) 2016/679 de forma menos garantista que a Lei nº 21/2014, de 16 de abril (sobre a Investigação Clínica), resultando em ambos os casos na presunção que o silêncio do participante constitui consentimento, mesmo se ninguém tentar sequer informá-lo do novo usodos seus dados. Estas soluções colidem com garantias éticas de proteção dos direitos dos doentes. Propomos uma alternativa ética a estas propostas.

[Legal framework for electronic medical records in the Region of the Americas: definition of domains to legislate and situation analysisEnquadramento legal para os registros eletrônicos em saúde na Região das Américas: definição de domínios para regulamentação e análise da situação]. / Marco legal para registros médicos electrónicos en la Región de las Américas: definición de dominios a legislar y análisis de situación.

OBJECTIVES: Define a legal framework for electronic medical records (EMRs) and determine the degree to which the countries of the Region of the Americas are prepared in this regard. METHODS: The methodology consisted of two phases. In the first, a Delphi methodology was used to develop a questionnaire and define the framework and legal domains applicable to EMRs. In the second, the questionnaire was completed in each country. This included identifying national experts and the data collection process. RESULTS: Information was collected from a total of 21 countries regarding their situation with respect to legislation on EMRs in the following domains: 1) specific legislation on EMRs; 2) protection of patients' data and secondary use of the data; 3) legislation related to the actions of health professionals; 4) regulation on EMRs and the role of patients; and 5) health standards and EMR promotion programs. CONCLUSIONS: There has been progress in the Region with respect to new legislation covering the main areas related to EMRs (for example, protection of sensitive data and use of digital signatures). However, it is necessary to continue to address issues such as access to and updating of information in EMRs. This study contributes information on the essential components of legislation on EMRs, and reports on the situation in the Region of the Americas.

OBJETIVOS: Definir um enquadramento legal para os registros eletrônicos em saúde (RES) e identificar o grau de preparação dos países da Região das Américas neste sentido. MÉTODOS: A metodologia do estudo foi dividida em duas fases. Na primeira fase, foi usado o método Delphi para elaborar o questionário e definir o enquadramento e os domínios legais para RES. Na segunda fase, foi realizada a pesquisa por país, com a identificação de dados referentes nacionais e processo de coleta de dados. RESULTADOS: Ao todo, foram obtidos dados de 21 países sobre os aspectos legais e RES distribuídos nos seguintes domínios: 1) legislação específica para RES, 2) proteção dos dados dos pacientes e uso secundário da informação, 3) legislação relacionada à atuação dos profissionais da saúde, 4) regulamentação dos RES e papel dos pacientes e 5) padrões em saúde e programas de promoção dos RES. CONCLUSÕES: Houve progresso na Região quanto à promulgação de leis que abrangem os principais domínios dos RES (p. ex., proteção de dados sensíveis ou o uso de assinatura digital). Porém, alguns aspectos precisam ser reforçados, como o acesso e a atualização das informações nos registros. Este estudo contribui ao descrever os aspectos básicos da regulamentação e informar a situação dos RES na Região das Américas.

Consumer-Mediated Data Exchange for Research: Current State of US Law, Technology, and Trust.

A compendium of US laws and regulations offers increasingly strong support for the concept that researchers can acquire the electronic health record data that their studies need directly from the study participants using technologies and processes called consumer-mediated data exchange. This data acquisition method is particularly valuable for studies that need complete longitudinal electronic records for all their study participants who individually and collectively receive care from multiple providers in the United States. In such studies, it is logistically infeasible for the researcher to receive necessary data directly from each provider, including providers who may not have the capability, capacity, or interest in supporting research. This paper is a tutorial to inform the researcher who faces these data acquisition challenges about the opportunities offered by consumer-mediated data exchange. It outlines 2 approaches and reviews the current state of provider- and consumer-facing technologies that are necessary to support each approach. For one approach, the technology is developed and estimated to be widely available but could raise trust concerns among research organizations or their institutional review boards because of the current state of US law applicable to consumer-facing technologies. For the other approach, which does not elicit the same trust concerns, the necessary technology is emerging and a pilot is underway. After reading this paper, the researcher who has not been following these developments should have a good understanding of the legal, regulatory, technology, and trust issues surrounding consumer-mediated data exchange for research, with an awareness of what is potentially possible now, what is not possible now, and what could change in the future. The researcher interested in trying consumer-mediated data exchange will also be able to anticipate and respond to an anticipated barrier: the trust concerns that their own organizations could raise.

Patient Engagement as Measured by Inpatient Portal Use: Methodology for Log File Analysis.

BACKGROUND: Inpatient portals (IPPs) have the potential to increase patient engagement and satisfaction with their health care. An IPP provides a hospitalized patient with similar functions to those found in outpatient portals, including the ability to view vital signs, laboratory results, and medication information; schedule appointments; and communicate with their providers. However, IPPs may offer additional functions such as meal planning, real-time messaging with the inpatient care team, daily schedules, and access to educational materials relevant to their specific condition. In practice, IPPs have been developed as websites and tablet apps, with hospitals providing the required technology as a component of care during the patient's stay. OBJECTIVE: This study aimed to describe how inpatients are using IPPs at the first academic medical center to implement a system-wide IPP and document the challenges and choices associated with this analytic process. METHODS: We analyzed the audit log files of IPP users hospitalized between January 2014 and January 2016. Data regarding the date/time and duration of interactions with each of the MyChart Bedside modules (eg, view lab results or medications and patient schedule) and activities (eg, messaging the provider and viewing educational videos) were captured as part of the system audit logs. The development of a construct to describe the length of time associated with a single coherent use of the tool-which we call a session-provides a foundational unit of analysis. We defined frequency as the number of sessions a patient has during a given provision day. We defined comprehensiveness in terms of the percentage of functions that an individual uses during a given provision day. RESULTS: The analytic process presented data challenges such as length of stay and tablet-provisioning factors. This study presents data visualizations to illustrate a series of data-cleaning issues. In the presence of these robust approaches to data cleaning, we present the baseline usage patterns associated with our patient panel. In addition to frequency and comprehensiveness, we present considerations of median data to mitigate the effect of outliers. CONCLUSIONS: Although other studies have published usage data associated with IPPs, most have not explicated the challenges and choices associated with the analytic approach deployed within each study. Our intent in this study was to be somewhat exhaustive in this area, in part, because replicability requires common metrics. Our hope is that future researchers in this area will avail themselves of these perspectives to engage in critical assessment moving forward.