Enfermeras: Intranet y usabilidad / Nurses: Intranet and usability

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'Fit-for-purpose?' - challenges and opportunities for applications of blockchain technology in the future of healthcare.

Blockchain is a shared distributed digital ledger technology that can better facilitate data management, provenance and security, and has the potential to transform healthcare. Importantly, blockchain represents a data architecture, whose application goes far beyond Bitcoin - the cryptocurrency that relies on blockchain and has popularized the technology. In the health sector, blockchain is being aggressively explored by various stakeholders to optimize business processes, lower costs, improve patient outcomes, enhance compliance, and enable better use of healthcare-related data. However, critical in assessing whether blockchain can fulfill the hype of a technology characterized as 'revolutionary' and 'disruptive', is the need to ensure that blockchain design elements consider actual healthcare needs from the diverse perspectives of consumers, patients, providers, and regulators. In addition, answering the real needs of healthcare stakeholders, blockchain approaches must also be responsive to the unique challenges faced in healthcare compared to other sectors of the economy. In this sense, ensuring that a health blockchain is 'fit-for-purpose' is pivotal. This concept forms the basis for this article, where we share views from a multidisciplinary group of practitioners at the forefront of blockchain conceptualization, development, and deployment.

Crowd sourcing difficult problems in protein science.

Dedicated computing resources are expensive to develop, maintain, and administrate. Frequently, research groups require bursts of computing power, during which progress is still limited by available computing resources. One way to alleviate this bottleneck would be to use additional computing resources. Today, many computing devices remain idle most of the time. Passive volunteer computing exploits this unemployed reserve of computing power by allowing device-owners to donate computing time on their own devices. Another complementary way to alleviate bottlenecks in computing resources is to use more efficient algorithms. Engaging volunteer computing employs human intuition to help solve challenging problems for which efficient algorithms are difficult to develop or unavailable. Designing engaging volunteer computing projects is challenging but can result in high-quality solutions. Here, we highlight four examples.

Cursos masivos abiertos en línea y salud mental: una oportunidad de acercamiento a un problema de salud global / Massive open online courses and mental health: an opportunity to approach to a global health problem

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[About the improvement of communication system and information transmission in medical service control in airborne division].

Frequent changes in tactical, rear and medical situations cause the medical service officials of airborne division (ABD) to obtain and transmit the data characterizing the medical service forces and means for a lot of times. It decreases the effectiveness of the control process. Equipping of ABD medical service staff with programming-and-technical systems (PTS), development of algorithm of official interaction, creation of report forms and selection of materials necessary for PTS database input will contribute to the effectiveness of ABD medical service control.

Resultados preliminares de DERMATEL: estudio aleatorizado prospectivo comparando modalidades de teledermatología síncrona y asíncrona / Preliminary results of DERMATEL: prospective randomized study comparing synchronous and asynchronous modalities of teledermatology

Introducción. Los estudios de fiabilidad diagnóstica en teledermatología muestran considerable variabilidad en sus resultados. Sólo hay dos estudios que comparen las modalidades de teleconsulta síncrona y asíncrona en la misma muestra. Presentamos resultados del proyecto piloto DERMATEL, estudio de concordancia diagnóstica que pretende incrementar la evidencia acerca de estos aspectos. Material y métodos. Ciento cincuenta y nueve pacientes remitidos por médicos generales en primera consulta fueron aleatorizados (algoritmo 3:2:1) en tres ramas: teledermatología asíncrona (almacenamiento o TDA) o síncrona (tiempo real o TDTR) y consulta convencional (CC). Utilizamos imágenes digitales fijas de alta calidad en todos los casos. Los pacientes TDTR fueron evaluados además mediante videoconferencia. Finalmente todos los pacientes fueron atendidos en consulta de presencia considerada como estándar oro. Un segundo dermatólogo evaluó la concordancia diagnóstica y de manejo entre las teleconsultas y las consultas de presencia. Resultados. Ciento cuarenta y siete pacientes completaron el estudio, distribuidos como 74 TDA, 47 TDTR y 26 CC (grupo control). Del total de 121 pacientes evaluados por telemedicina (TDA + TDTR), la evaluación teledermatológica fue idéntica a la de presencia (no error) en 100 pacientes (82,6 %). Los errores fueron leves en 14 (11,6 %) y graves en 7 (5,8 %). La concordancia diagnóstica fue muy alta (kappa = 0,813). Los errores agrupados por patologías fueron: 6/54 tumoral (11 %), 10/30 inflamatoria (33,3 %), 1/20 infecciosa (5 %), 3/12 alopecia/acné (25 %) y 1/5 otros (20 %). Hubo 15/74 errores en el grupo TDA (20,3 %) y 6/47 en el TDTR (12,8 %), estas diferencias no fueron estadísticamente significativas (Chi cuadrado 1,12; p = 0,288). Conclusión. La fiabilidad de la teleconsulta dermatológica es muy elevada, especialmente para patología tumoral o infecciosa. La interacción sincrónica con audio consume más recursos, es difícil de coordinar y no es más eficaz en diagnóstico que la TDA

Introduction. There is considerable variability in the results of studies that evaluate diagnostic reliability in teledermatology. There are only two studies that compare the synchronous and asynchronous modalities of teleconsult in the same sample. We present the results of the pilot project DERMATEL, a study of diagnostic concordance that aims to increase the evidence of these aspects. Material and methods. One-hundred-fifty.nine patients referred by the general practitioner in the first consult were randomized (algorithm 3:2:1) in three arms: asyncronous teledermatology (store-and-forward or SAF), synchronous teldermatology (real-time or VTC), and conventional consult (CC). We used high-quality, fixed digital images in all cases. The patients on the VTC teledermatology arm were also evaluated by videoconference. Finally all patients attended a face-to-face consult, considered the gold standard of patient care. A second dermatologist evaluated the diagnostic and management concordance between the teleconsults and the face-to-face consults. Results. One-hundred.forty-seven patients completed the study as follows: 74 in the SAF teledermatology arm, 47 in the VTC teledermatology arm and 26 in the conventional consult (control group). The teledermatological (SAF and VTC) and face-to-face evaluations were identical in 100 of 121 patients (82.6 %). The errors were mild in 14 cases (11.6 %) and severe in 7 (5,8 %). The diagnostic concordance was very high (kappa = 0,813). The errors grouped by diseases were as follows: 6/54 (11 %) for tumors, 10/30 (33.3 %) for inflammatory conditions, 1/20 (5 %) for infectious diseases, 3/12 (25 %) for alopecia/acne and 1/5 (20 %) for others. There were 15 errors in the SAF teledermatology arm (20.3 %) and 6 in the VTC teledermatology arm (12.8 %); these differences were not statistically significant (**2 1.12; p = 0.288). Conclusion. The reliability of dermatological teleconsult is very high, especially for tumoral or infectious diseases. The synchronous interaction with audio requires more resources, is difficult to coordinate and its diagnostic efficacy is not superior to SAF teledermatology

E-neuroscience: challenges and triumphs in integrating distributed data from molecules to brains.

Imaging, from magnetic resonance imaging (MRI) to localization of specific macromolecules by microscopies, has been one of the driving forces behind neuroinformatics efforts of the past decade. Many web-accessible resources have been created, ranging from simple data collections to highly structured databases. Although many challenges remain in adapting neuroscience to the new electronic forum envisioned by neuroinformatics proponents, these efforts have succeeded in formalizing the requirements for effective data sharing and data integration across multiple sources. In this perspective, we discuss the importance of spatial systems and ontologies for proper modeling of neuroscience data and their use in a large-scale data integration effort, the Biomedical Informatics Research Network (BIRN).

Intranet usage and potential in acute care hospitals in the United States: survey-2000.

This paper provides the results of the Survey-2000 measuring Intranet and its potential in health care. The survey measured the levels of Internet and Intranet existence and usage in acute care hospitals. Business-to-business electronic commerce and electronic commerce for customers were measured. Since the Intranet was not studied in survey-1997, no comparisons could be made. Therefore the results were presented and discussed. The Intranet data were compared with the Internet data and statistically significant differences were presented and analyzed. This information will assist hospitals to plan Internet and Intranet technology. This is the third of three articles based upon the results of the Survey-2000. Readers are referred to prior articles by the author, which discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.(1) The first article based upon the survey results discusses technology transfer, system design approaches, user involvement, and decision-making purposes. (2) The second article based upon the survey results discusses distribution of Internet usage and rating of Internet usage applied to specific applications. Homepages, advertising, and electronic commerce are discussed from an Internet perspective.

Handheld computers in critical care.

BACKGROUND: Computing technology has the potential to improve health care management but is often underutilized. Handheld computers are versatile and relatively inexpensive, bringing the benefits of computers to the bedside. We evaluated the role of this technology for managing patient data and accessing medical reference information, in an academic intensive-care unit (ICU). METHODS: Palm III series handheld devices were given to the ICU team, each installed with medical reference information, schedules, and contact numbers. Users underwent a 1-hour training session introducing the hardware and software. Various patient data management applications were assessed during the study period. Qualitative assessment of the benefits, drawbacks, and suggestions was performed by an independent company, using focus groups. An objective comparison between a paper and electronic handheld textbook was achieved using clinical scenario tests. RESULTS: During the 6-month study period, the 20 physicians and 6 paramedical staff who used the handheld devices found them convenient and functional but suggested more comprehensive training and improved search facilities. Comparison of the handheld computer with the conventional paper text revealed equivalence. Access to computerized patient information improved communication, particularly with regard to long-stay patients, but changes to the software and the process were suggested. CONCLUSIONS: The introduction of this technology was well received despite differences in users' familiarity with the devices. Handheld computers have potential in the ICU, but systems need to be developed specifically for the critical-care environment.

Information superhighway or information traffic jam for healthcare consumers?

The phenomenal development and growth of the information superhighway over the past few years has brought with an ever-increasing number of sites associated with health care. At the same time, community access to the Internet and multimedia technology has allowed greater access to healthcare sites by consumers wishing to find healthcare information relevant to their needs. The Internet has greater potential for improving the healthcare knowledge of the community, especially in remote areas or in parts of the community that have limited access to community health infrastructure. However, most of the current development of healthcare sites has focused on the needs of healthcare professionals rather than consumers. Indeed, with the volume of information available over the Internet, it is easy to spend hours browsing through a maze of sites with information that often is fragmented, incomplete, or only accessible with a password. Once a relevant site is located, the information often is presented as vast amounts of text with possibly some graphics. It appears little consideration is given during the development of web sites to the actual presentation of the information. For the full potential of the information superhighway to be realized in relation to health care, more consideration should be given during the development stages of web sites to how the information is presented and how to make access more streamlined.

A standard data format for medical information in the IS & C system.

This paper describes the file format of the IS & C standard and the results of IS & C scientific exhibition at Yokohama. The English version of IS & C standard Version 1.0 was published in the spring of 1992 by the IS & C committee. On the basis of this document, the IS & C data format was explained. The enhanced description of color images, wave data and the laboratory data is still under discussion. The data format of the color images was established in March 1993. In April 1992, the IS & C scientific exhibition was held at the general assembly of the Japanese Radiological Society. At this exhibition, the demonstration of the compatibility among IS & C workstations was successful. The consensus on IS & C system was investigated. IS & C system was well understood by observers and the interchangeability of radiological images was recognized as very feasible.